Breast Cancer and Breastfeeding

Publication Date: June 9, 2020

Recommendations

Screening Breastfeeding Women for Breast Cancer

Breastfeeding women do not need to abstain from routine breast cancer screening due to lactational status, but may decide to defer screening if they plan to wean in a few months.
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The decision to screen breastfeeding women should be individualized, and related to personal lifetime risk of breast cancer.
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All radiologic modalities used for breast cancer screening are safe during lactation.
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The lactating breast has a unique radiographic appearance.
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Breastfeeding or expressing breast milk before a screening study is recommended to reduce density and improve examination sensitivity.
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Supplemental imaging may be beneficial during lactation.
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Breastfeeding Management in Women with a History of Breast Cancer

As breast cancer survivors have multiple risk factors for reduced milk production, breastfeeding dyads require close monitoring to ensure adequate infant growth.
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No adequate milk production should be expected from the affected side after a total mastectomy, irrespective of technique.
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Reduced milk production from the affected breast is likely after breast conservation therapy (partial mastectomy and radiation).
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Diminished milk production from both breasts may occur after chemotherapy.
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Ongoing research is examining the oncologic safety of interrupting adjuvant endocrine therapy for childbearing with and without breastfeeding.
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Breastfeeding Management in Pregnant Women Diagnosed with Breast Cancer

Pregnancy-associated breast cancer (PABC) treatments likely will impact breastfeeding.
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Breastfeeding medicine experts represent valuable members of the multidisciplinary team caring for PABC patients.
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Women who require oncologic breast surgery during pregnancy may be reliant on a single breast for breastfeeding, either anatomically or functionally; contralateral surgical procedures should be deferred until breastfeeding is complete.
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Postpartum oncologic breast surgery does not require preoperative weaning.
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Tracers used for sentinel lymph node biopsy may require a breastfeeding interruption of up to 24 hours; during this time, milk should be expressed and discarded to maintain milk production.
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Reduced breast milk production should be expected in women who require chemotherapy during pregnancy.
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Women with PABC who require postpartum chemotherapy may be able to maintain milk production, but expressed milk is not safe for infant consumption.
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Breastfeeding is not recommended during adjuvant anti-HER2 or endocrine therapy.
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Breastfeeding Management in Postpartum Women Diagnosed with Breast Cancer

Breast cancer diagnosed up to 5 years postpartum is generally more aggressive than other presentations of this malignancy.
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Breastfeeding medicine experts should participate in multidisciplinary discussions about breastfeeding women diagnosed with postpartum breast cancer.
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Most radiologic staging studies are compatible with breastfeeding; nuclear medicine studies may require a brief period of limited contact, but expressed milk can be safely fed to the infant during this time.
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Chemotherapy, targeted anti-HER2 therapy, and endocrine therapy likely require discontinuation of breastfeeding.
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Cabergoline and other medications can be used for lactation cessation.
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Women who elect to wean should be informed of options for obtaining donor milk.
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Recommendation Grading

Disclaimer

Overview

Title

Breast Cancer and Breastfeeding

Authoring Organization

Publication Month/Year

June 9, 2020

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse midwife, nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Assessment and screening, Management

Diseases/Conditions (MeSH)

D001942 - Breast Feeding, D001943 - Breast Neoplasms

Keywords

breast cancer, Breastfeeding, mastectomy

Source Citation

Johnson HM, Mitchell KB; Academy of Breastfeeding Medicine. ABM Clinical Protocol #34: Breast Cancer and Breastfeeding. Breastfeed Med. 2020 Jul;15(7):429-434. doi: 10.1089/bfm.2020.29157.hmj. Epub 2020 Jun 9. PMID: 32516007.

Methodology

Number of Source Documents
36
Literature Search Start Date
January 1, 2000
Literature Search End Date
December 31, 2019