On October 15, 2004, I was diagnosed with breast cancer. I was 43 years old, had no family history of the disease, and no lump or symptoms. I was also tandem nursing my two young children.
The cancer was discovered during my first routine mammogram. Mammograms (a procedure that uses low-dose x-rays to examine the breasts) are recommended annually for women over the age of 40. Although I was over 40, I had delayed this initial mammogram because I was pregnant, and delayed it again because I was breastfeeding, a potentially life-threatening mistake. When the radiologist examined my mammogram, he noted a small cluster of microcalcifications in my left breast, a half-dozen white flecks that looked like grains of salt sprinkled over the image. These microcalcifications were an indicator of Ductal Carcinoma in Situ (DCIS) – a non-invasive breast cancer where the malignant cells in the milk ducts have not yet invaded the surrounding tissue. The next day I had a core biopsy, where a section of breast tissue was removed to determine if the cells were indeed cancerous. Two days later the radiologist called with bad news: the tissue removed confirmed the presence of DCIS. My next step was to see a surgeon.
The first surgeon I saw began by discussing mastectomy, the surgical removal of the breast. Although DCIS is non-invasive, it is considered a risk factor for developing invasive breast cancer and is therefore usually treated aggressively. I sought a second opinion and consulted a breast surgeon at a different hospital. She recommended immediate weaning from both breasts prior to surgery, advising that it would be impossible for me to stop nursing only on the affected side. I knew this to be incorrect: women can (and do) breastfeed on only one side. A third opinion from the surgical oncologist who had supervised my original biopsy recommended a partial mastectomy (essentially a lumpectomy, where only the affected area and a small margin of healthy tissue is removed, except that I had no lump) without weaning, followed by radiation to make sure that all of the cancer cells were destroyed. Removal of lymph nodes and chemotherapy were not necessary as the cancer was not invasive and therefore there was virtually no possibility of its spread to any other part of my body.
In November I had a partial mastectomy of the left breast. As I had after the biopsy, and with my doctors’ blessing, I was able to nurse my 22-month-old son within 12 hours after surgery. Six weeks later I began Intensity Modulated Radiation Therapy (IMRT), an advanced mode of high-precision radiation therapy that uses computer-controlled x-ray accelerators to deliver precise radiation doses to specific areas. My treatments were scheduled five days a week for 6-1/2 weeks. Although the IMRT itself was painless, I suffered some common side effects: extreme fatigue and sunburned patches of skin. But with the approval of my radiation oncologist, and the help of friends and family, I continued caring for my children and breastfeeding until radiation burns to my nipple forced me to wean on the treated side. I have continued nursing on my right breast.
I completed radiation therapy around Valentine’s Day, 2005. Since I am now considered at higher risk of developing another breast cancer, I see my surgical oncologist for a breast exam every three months and have a mammogram every six months. I also see a medical oncologist, who will continue to monitor my health for the rest of my life. Because my cancer was ER+ (estrogen receptor positive), after we stop breastfeeding I will take tamoxifen, a medication that blocks the estrogen receptors on the breast cells and deprives the potentially malignant cells of the estrogen they need for growth. Tamoxifen, a pill which is usually taken for 5 years, decreases the incidence of subsequent breast cancer in both breasts, and can be used both before and after menopause.
Although I was aware of breast cancer before my diagnosis, I never thought it would happen to me. I was healthy, active, never smoked, rarely drank, and had breastfed for four years all things I knew reduced the risk of cancer. But breast cancer is mysterious: most women with the disease have no family history and no obvious cause. Yet increasing numbers of women are being diagnosed with breast cancer due to a combination of having children later in life (a known risk factor), reduced rates of breastfeeding, and improved screening techniques (such as digital mammography). Women can protect themselves by having regular breast exams by a healthcare professional and by having mammograms according to the recommended schedule – even while lactating. You can also decrease your chances of developing breast cancer by continuing to breastfeed: although the exact mechanism of protection is unclear, studies have shown that the longer a woman breastfeeds throughout her lifetime, the greater the protective effect.
I am fortunate in that my breast cancer was detected very early and that I have an excellent prognosis. I have continued to breastfeed and sought physicians who were sensitive to my desire to preserve the function, as well as the form, of my breasts. Breastfeeding through this turbulent time brought a sense of normalcy to my life and that of my children, and in doing so I have also served as an example to my healthcare team. They now know that the ability to breastfeed, something with enormous health and psychological benefits for both mother and child, can be preserved and continued for many women with early stage breast cancer.
copyright Carole Baas, Ph.D.
Carole is a medical researcher, writer, and lecturer, specializing in health and parenting issues. An active member of LLLI for five years, Carole is also a breastfeeding mother of two young children. Following her breast cancer diagnosis, she began researching the relationships between pregnancy, breastfeeding and breast cancer. Carole is currently spearheading efforts to write the first book on this subject, Battle for the Breast, a cooperative effort between internationally renowned researchers and clinicians in breast cancer, infertility, and lactation.
For more information on pregnancy, breastfeeding and breast cancer,
visit www.komen.org, www.youngsurvival.org, www.pregnantwithcancer.org and
www.lalecheleague.org.
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