Breast Cancer in Childbearing Years: Breastfeeding After Cancer Treatment

Breast cancer is one of the leading causes of death by cancer in women younger than 35 years. Ironically, older women with the disease have better survival rates than younger patients, who tend to present later in the disease continuum with more advanced, thus more invasive, cancer. This risk could be influenced by a family history of breast cancer or a lifestyle behavior such as breastfeeding for a short period of time. Trishnee Bhurosy, PhD, and colleagues, of the Division of Population Science, Rutgers Cancer Institute of New Jersey in New Brunswick, conducted an online literature search to explore the feasibility of breastfeeding for young breast cancer survivors after cancer treatment.¹

Many breast cancer survivors of reproductive potential know the benefits of breastfeeding their babies, and some attempt to breastfeed their babies. However, they are often unsuccessful at continuing for the recommended length of time. Recommendations suggest breastfeeding exclusively for at least 6 months, but these women would only nurse for 2 or 3 months. Barriers to successful breastfeeding include insufficient milk production, the baby refusing to breastfeed from the affected breast, lack of access to lactation consultants, or nonadherence to the advice of these consultants. Some breast cancer survivors feared recurrence of their breast cancer and believed it could be harmful to their babies as well as themselves. Therefore, many women stopped breastfeeding at a very early stage.

Dr Bhurosy understood the significance of identifying, understanding, and promoting good health behaviors such as breastfeeding. The practice not only provides essential nutrients for an infant’s growth and normal development but also confers numerous benefits for the mother. It can improve survival rates and overall quality of life for survivors. A meta-analysis identified in her team’s research found that the risk of breast cancer is reduced by 4.3% for every 12 months of breastfeeding.

The more Dr Bhurosy delved into the subject, the more she became convinced that one important health behavior oncology clinicians can promote to young survivors is to breastfeed — even after they had been treated for cancer. Breastfeeding after cancer treatment is not something that many people think about. “All that we know is that these young survivors come off cancer treatment and they are discouraged,” she explained. “Aside from our learning that they are hesitant to try to conceive again, we do not have much information about what they actually do.”

Barriers to Breastfeeding

Some hesitancy exists on the part of both the practitioner as well as the patient regarding whether breastfeeding should be promoted and at what stage. Current recommendations are to wait at least 1 to 2 years after breast cancer treatment before attempting to conceive because treatments could interfere with conception and breastfeeding. Although specialists in breastfeeding medicine might know, not many in the oncology field can give optimal guidance and support to patients seeking advice. In addition, 5 to 10 years of endocrine therapy may substantially reduce a breast cancer survivor’s chances of conceiving.

Choices regarding surgical approach may also influence the survivor’s options. If the survivor chooses unilateral surgery to preserve her ability to breastfeed her baby, does she need to interrupt postsurgical endocrine treatment? This is when a woman of reproductive potential wants to successfully conceive a baby, but breast cancer treatment often takes a long time. The patient might have a difficult decision to make: Should she interrupt her treatment to attempt to conceive?

Even though only one breast is affected with breast cancer, women now often choose to remove tissue from both breasts. They are concerned about the cancer recurring, and if it does, recurrence may also involve the healthy breast.

Breastfeeding Aids

One factor that really helped survivors to breastfeed was having one healthy breast. In many cases, women simply used only that breast to breastfeed.

The survivors who breastfed also found breast pumps useful. Some lactation consultants or treatment centers provided survivors with electronic breast pumps, and sent the survivor a prompt when it was time to pump.

Some women found galactagogues helped to encourage milk production.² Galactagogues are synthetic, botanical, or herbal products or foods used to increase milk production. Some common synthetic ones are domperidone, oxytocin, metoclopramide, and chlorpromazine.

Note, the US Food and Drug Administration (FDA) cautions against using some of these. For example, domperidone is associated with possible adverse effects such as cardiac complications, and is therefore not recommended for this use in the United States; although, it is allowed in other countries.

Common examples of herbal galactagogues include fenugreek, fennel, anise, goat’s rue, and milk thistle. Use of these products can be risky because health practitioners must know the correct dose, the upper dose range, and length of time for administration.²