- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
In Greece, as in most Western countries, breast cancer is the most common form of cancer affecting women and accounts for more than ¼ of all cancers.
Cancer is a disease in which cells grow abnormally and create more cells in an uncontrolled way. It begins in the tissues that make up the breast, with cancer cells forming a mass called a tumor. (Note: Not all tumors are cancerous). They can also invade surrounding tissues and spread to lymph nodes and other parts of the body.
The most common types of breast cancer are:
Through routine screening, breast cancer can often be detected at an early stage, even before it has spread.
Statistics from the U.S. and Europe show that approximately 1 in 10 women will develop breast cancer at some point in their lives. In our country, it is estimated that about 5,000 new cases occur each year, with the disease being the most common form of cancer among Greek women. However, new treatments have already contributed to increased survival rates and continuously improving quality of life for patients. Impressive data shows that the 5-year survival rate for women with breast cancer has reached 85%, compared to about 50% in the past — largely due to early detection.
In the early stages, breast cancer does not cause signs or symptoms. However, as it grows, it begins to create changes in the appearance of the breast or abnormalities that can be detected during palpation.
Keep in mind that most breast changes are not cancer.
For example, a breast lump could be a cyst, which is filled with fluid and is not cancerous.
Early breast cancer usually does not cause pain. This is why mammography saves lives. Thanks to screening, breast cancer is often detected before a woman experiences any symptoms. It identifies cancer at an early stage, allowing for timely treatment before it spreads. However, a woman should be familiar with the normal appearance and feel of her breasts so she can report any unusual changes to her doctor. If you notice a change in your breast or experience pain, contact your doctor and schedule a consultation.
Many women of reproductive age who have successfully overcome breast cancer reasonably wonder whether they can become pregnant. According to current evidence, after five years have passed since the disease and completion of preventive hormone therapy, pregnancy does not negatively affect their condition.
It is also important to note that for women facing fertility issues, in vitro fertilization (IVF) does not increase the risk of breast cancer. In any case, for women with a history of breast cancer there is also the option of surrogacy, which is now widely used, so that they can complete their family.
Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy or within the first year after delivery. It is rare. Large series estimate it at about 1 in 3,000 pregnancies, yet it is one of the most common cancers seen in pregnancy, along with cervical cancer, melanoma and lymphomas. As more and more women have children after 35, its frequency is expected to rise.
The main problem is delay. In pregnancy the breasts grow and become firmer, more tender and more “lumpy”. A lump is easily attributed to hormonal changes, both by the woman herself and by the doctor. As a result, diagnosis is often delayed by a few months and made at a more advanced stage than in non-pregnant women of the same age.
A clinical breast exam at the first pregnancy visit is valuable for exactly this reason: it records the baseline picture, so that a new change later stands out right away.
Pregnancy is not a reason to postpone testing. Tests are chosen so that fetal exposure is zero or negligible.
If the tumor is large or there are affected lymph nodes, doctors check whether the disease has spread. A chest X-ray with shielding, liver ultrasound and MRI without contrast for the bones are preferred. Abdominal CT, bone scans and PET are avoided as far as possible and done after delivery, unless the result would immediately change treatment.
At the same time, the obstetrician confirms gestational age and checks fetal anatomy with obstetric ultrasound, because the entire treatment timeline depends on it.
Treatment is planned by a team that includes a breast surgeon, an oncologist, an obstetrician experienced in high-risk pregnancies and a neonatologist. The goal is twofold: proper treatment of the cancer without compromise and a safe completion of the pregnancy.
It can be done in any trimester. General anesthesia is safe with appropriate monitoring of mother and fetus. Both mastectomy and lumpectomy are options. The sentinel lymph node can be checked with a low-dose radioisotope, while blue dye is usually avoided because of the risk of an allergic reaction.
It is not given in the first trimester, because that is when the fetal organs form. From the second trimester, usually after 14 weeks, specific regimens (mainly with anthracyclines and, where needed, taxanes) are given with reasonable safety. The last dose is scheduled about three weeks before delivery, so that the white blood cells of the mother and the newborn have recovered.
Ending the pregnancy does not improve the mother's prognosis. It may be discussed in very specific cases, for example when treatment that is incompatible with pregnancy is urgently needed in the first trimester. The decision always belongs to the couple, after full counseling.
A pregnancy with active breast cancer is by definition a high-risk pregnancy. Appointments become more frequent, and the obstetrician coordinates with the oncology team before each treatment cycle.
The goal is for delivery to take place as close to term as possible, ideally after 37 weeks. Follow-up studies of children exposed to chemotherapy in the womb have shown that their development is comparable to that of their peers, while the problems recorded were linked mainly to prematurity. That is why early delivery “so treatment can start sooner” is avoided unless there is a serious reason.
The type of delivery is decided on obstetric criteria. Breast cancer on its own is not an indication for a cesarean section. After the birth the placenta is sent for histological examination, as recommended in every pregnancy with an active malignancy.
For women diagnosed before having children, the fertility discussion should take place before chemotherapy. Chemotherapy drugs can reduce ovarian reserve, and the risk increases with age.
Women with a BRCA1 or BRCA2 mutation have a 50% chance of passing it on to each child. Those who wish can discuss IVF with preimplantation genetic testing, so that only embryos without the mutation are transferred.
For years, women with hormone-sensitive cancer feared that a pregnancy would “wake up” the disease. The international POSITIVE study examined women who temporarily paused hormone therapy, after taking it for 18 to 30 months, in order to try to conceive. During the follow-up period no increased risk of recurrence was recorded compared with women who did not pause. The decision remains individualized and is always made together with your oncologist.
Breastfeeding is not allowed while you are receiving chemotherapy, hormone therapy or targeted therapies, because the drugs pass into breast milk. Once treatment has been completed, the picture changes, and breastfeeding is then usually possible from the breast that was not operated on. A breast that received radiation therapy usually produces very little milk.
If treatment must continue right after the birth, lactation is suppressed with medication and cold compresses. This is not a failure. It is part of the plan.
For the mother, the prognosis depends mainly on the stage and biological type of the tumor. Compared with young women at the same stage who are not pregnant, outcomes are similar, as long as treatment is not delayed.
Breast ultrasound is completely safe. Mammography is done when needed, with the abdomen shielded.
Certain regimens are given safely after the first trimester. The plan is decided by the oncology team together with the obstetrician.
Waiting about two years after the end of treatment is usually recommended, depending on the type of tumor.
No, most are benign. However, any lump that persists for more than two weeks should be checked.
It is extremely rare. Metastases to the placenta or the fetus have been described mainly in melanoma and blood cancers, while in breast cancer they are very rare. As a precaution, the placenta is examined histologically and the newborn is checked by a pediatrician after the birth.
No. Studies have not shown better survival for the mother when the pregnancy is ended. The decision is discussed only in special cases, mainly when treatment that is incompatible with pregnancy is required in the first trimester.
Not necessarily. The type of delivery is decided on obstetric criteria. What matters is the right timing in relation to chemotherapy, so that mother and newborn have normal white blood cell counts at the time of birth.
Rarely, but it happens. Inflammatory breast cancer can look like mastitis. If the redness and swelling do not improve after 7 to 10 days of antibiotics, or there is no fever, an ultrasound and possibly a biopsy are needed.
It is usually recommended for women diagnosed with breast cancer at a young age, for triple-negative tumors and when there is a family history of breast or ovarian cancer. The result affects both the surgical choice and family planning.
