By now everyone knows: against breast cancer you have to anticipate and run faster. Early diagnosis allows timely interventions, more effective treatments and - without going around it too much - to save one's life. The breast is the symbol of femininity par excellence, as well as a source of well-being and very precious food at least for the first months of our babies. All this must give us the right motivation to do prevention, without fear or modesty, especially after the age of 30. And especially if we are thinking about a pregnancy. Yes, because being in good health before conception is already a pass for 9 quieter months. Why, as the professor explains in this interview Vincenzo Adamo, Professor of Medical Oncology at the University of Messina and Scientific Director of the Oncology Project AO "Papardo" of Messina, you can get sick even during pregnancy. So, as an evergreen slogan goes, prevention is better than cure.
Prof. Vincenzo Adamo
Professor Adam, what is the incidence of breast cancer in pregnancy?
“The onset of breast cancer in pregnancy is not common. It occurs in 1-3 percent of all breast cancers, but it is not negligible because we discover 1-7 per 10.000 pregnant women and it is not a fact to be taken lightly ”.
How is prevention going in our country?
“There are 3 cancer screenings offered free of charge in Del Paese: against breast, cervical and colorectal cancer. They are performed in all regions, but with differences in the percentage of adhesion: 30-35 percent in the south (maximum 40), 55 percent in the center, 65-70 percent in the north, with peaks of 75. Screenings are intended for the population between the ages of 50 and 70, so the young remain out. We advise them to approach the prevention of breast cancer, doing an ultrasound and, from the age of 40, even mammography. Today there is great interest in expanding the screening to all those aged 45 to 75. There should be some news within this year ”.
Nowadays, for various reasons, pregnancies are almost always planned. Is it okay to book a breast examination before attempting to have a baby?
"Absolutely yes! Just as the woman undergoes blood tests and other tests, she certainly needs an ultrasound and, if you are over 40, a mammogram. In this way the pregnancy can begin with greater serenity. If there is a minimum risk (for example, cases of cancer in the family) it is practically an obligation ".
During pregnancy, should normal breast checks be postponed or should they be carried out anyway?
“In general, if there are no risk situations, such as familiarity with some cancers or complex breast dysplasia, we tend to postpone. Even if you are expecting a baby, nothing prevents you from having an ultrasound, perhaps because you don't want to wait until you have given birth. This is the safest test ".
Who to contact with the baby bump for the prevention of breast cancer? Gynecologist or breast specialist?
“This is a fundamental step. It is always convenient to go to a breast center, which has the best skills from both a medical and radiological point of view. In the city, for example, there are 16 Breast Units. The Breast Units follow the woman throughout her journey, from prevention to possible therapies, up to palliative care. In many Breast Units, prevention weeks are organized throughout the year for everyone, without age limits for screening. In addition to the Breast Units, there are also private facilities that deal with breast care, but you have to look for them carefully and turn to safe centers for technology and clinical expertise. In some European countries, the gynecologist also plays a role in breast cancer prevention. In Spain, for example, he is part of the Breast Unit team. He can be of great help because he sees women often, especially in pregnancy. He is therefore complementary to the activity of the breast specialist ".
Are there any red flags in pregnancy?
“The main warning signs are 2: a sudden hardening in some parts of the breast or a redness. But be careful: it's not necessarily a tumor. This can be inflammation, engorgement, or normal changes that occur during gestation. Sometimes it is difficult to be able to delimit a lump. The woman more often notices a diffuse hardening ".
Can a pregnant woman undergo mammography and ultrasound? And while breastfeeding?
“Mammography and MRI are prohibited in pregnancy. When breastfeeding, if there is an absolute necessity, then they are done, albeit with a short suspension of breastfeeding. Whether pregnant or breastfeeding, the only truly safe instrumental investigation is ultrasound. It must be done by experts belonging to a Breast Unit because they do from 3.000 to 5.000 ultrasound scans per year. If necessary, needle biopsy and needle aspiration can also be performed ".
Breast changes during pregnancy and lactation. Is this a problem for breast monitoring? And for self-examination?
“The breasts change a lot. The changes are related to breastfeeding preparation. This involves difficulties, especially in self-examination. Even the clinician may have some problems and then we resort to ultrasound. I reiterate the importance of this examination. Today there are highly refined probes with a resolution that, at times, exceeds that of mammography ".
While breastfeeding, it may happen to feel a lump in the breast, perhaps caused by an engorgement of milk. Can you tell the difference with other types of formations, for example a tumor?
“The consistency of the lump is different from that of the engorgement. Those that we consider dangerous are hard or hard-elastic. An experienced hand is able to recognize them. In pregnancy, everything is more complicated because the mammary gland changes consistency. We therefore resort to instrumental tests ".
Is breast cancer discovered during pregnancy 'bad'?
“First of all, it must be said that the prognosis of breast cancer discovered during pregnancy is no worse than one of the same stage in a non-pregnant patient. Also, unlike what is often said, it is not 'faster'. There may be a hormonal push of a proliferative type, but the problem is that it is often discovered late, which worsens the prognosis ”.
Is it necessary to terminate the pregnancy?
“Pregnancy must be terminated only if its continuation involves a considerable delay in oncological therapy. For example, if a woman becomes ill in the first trimester and has a very aggressive tumor, she must carefully consider what to do because continuing the pregnancy could be a danger to her life. It is a process that must be discussed in depth, even with psychological counseling. Another issue is whether the diagnosis reaches the third trimester: you can wait a few weeks, deliver the baby and then intervene ".
What are the surgical and drug options?
“The treatment of breast cancer in pregnancy is a very complex problem that depends on the stage of the disease, its characteristics, such as aggression, and the gestational period. Communication with the woman is very important. The second and third trimesters are the best times for breast surgery, while in the first trimester there are higher risks to the fetus. Radiotherapy and hormone therapy are not indicated during pregnancy. As regards medical-oncological treatments, the danger of fetal malformations is greater in the first trimester, while a therapeutic path can be undertaken in the second and third trimesters, carefully evaluating the relationship between risks and benefits ".