Last update Oct. 12, 2022
Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.
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Breastfeeding, especially exclusive and/or long-term breastfeeding, reduces the risk of breast, ovarian, endometrial, and colorectal cancer in women. (Amitay 2022, Bothou 2022, Stordal 2022, Qiu 2022, Hoyt 2020, Walters 2019, Westerfield 2018, Ma 2018, Anstey 2017, Unar 2017, Zhou 2015, Zhan 2015, CGHF-Lancet 2002)
Breastfeeding decreases the risk of childhood leukemia, neuroblastoma, and cancer of the urinary system in infants. (Gong 2022, Su 2021, Amitay 2015)
During maternal cancer treatment, breastfeeding must be interrupted due to potentially serious side effects for the infant. Diagnostic procedures and treatment (antimetabolites, hormone inhibitors, radioisotopes) for proliferative breast diseases are contraindicated while breastfeeding, at the moment of administration and for a variable period of time after completion (Consult the file for each specific treatment). Tracers used for sentinel lymph node biopsy (lymphoscintigraphy) may require a breastfeeding interruption of up to 24 hours; during this time, milk should be expressed and discarded to maintain milk production. (Johnson 2020)
Abrupt weaning can be psychologically traumatic for both the mother and the infant (Pistilli 2013). If the mother wishes, the production of milk can be maintained by regularly expressing milk from the breast, being able to return to breastfeeding in between cycles, in the periods in which no significant traces of the drug remain in the milk (Damoiseaux 2022, Anderson 2016), or at the end of the treatment. (Pistilli 2013)
Pharmacokinetics show that after 3 elimination half-lives (T½) 87.5% of the drug is eliminated from the body; after 4 T½ it is 94%, after 5 T½, 96.9%, after 6 T½, 98.4% and after 7 T½ it is 99%. From 7 T½ the plasmatic concentrations of drug in the body are negligible. In general, a period of at least five half-lives can be considered a safe waiting period before breastfeeding again (Anderson 2016). When it is possible to do so, milk detections of each patient to determine the total elimination of the drug would be the best indicator to resume breastfeeding between two cycles of chemotherapy.
After cancer treatment, breastfeeding is possible (Johnson 2019). Some chemotherapeutic agents with an antibiotic effect can alter the composition of the microbiota (bacterial set or bacterial flora) of the milk and the concentration of some of its components (Urbaniak 2014). This possibly occurs temporarily with subsequent recovery, although no harmful effects are assumed or have been reported in breastfed infants.
Women undergoing chemotherapy during pregnancy have lower rates of breastfeeding due to difficulties in breastfeeding or have reduced breast milk production (Johnson 2020, Stopenski 2017), needing more support to achieve it.
Given the strong evidence that exists regarding the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of any maternal treatment, including chemotherapy, individually advising each mother who wishes to continue with breastfeeding. (Koren 2013)
In BREAST CANCER, when there is no residual tumor, breastfeeding can be achieved, either on the healthy or treated breast (Bhurosy 2021, Johnson 2020, Peccatori 2020, Linkeviciute 2020, Cardoso 2012, Gorman2009), whenever the patient has undergone conservative treatment. However, whether surgery or radiation is used, the latter instance may lead to less milk production (Johnson 2020), but always remaining the possibility of successful breastfeeding with one breast only.
About 50% of women whose breast was irradiated may produce milk on that breast but only one in four women may breastfeed on it. Mechanical or manual removal of milk and/or formula supplementation may be required. Breast irradiation induces to less milk production, although nutritionally adequate, the infant may refuse it because of more sodium content than on the non-radiated breast.
After radical and total mastectomy, there is not possibility to breastfeed in the future because of lacking to conservation of breast tissue, nipple or both. Only after partial subcutaneous mastectomy with preservation of part of breast tissue, breastfeeding may be feasible. Breastfeeding after breast cancer poses no danger to the mother nor the child, either if it is from the healthy breast or not. (Cardoso 2012, de Bree 2010, Azim 2010 y 2009, Hickey 2009, Bercovich 2009)
The mother will require appropriate information and assistance along with professional and family support. Breastfeeding is often more difficult when it must be done on one breast only, with a lot of emotional and physical stress together with frustration if exclusive breastfeeding is not achieved. You can read the personal testimony of a mother in E.D.- LactApp.
Prestigious Medical and Oncology Societies offer support to mothers who want to breastfeed after such an ordeal (Johnson 2020, Cardoso 2012, Camune 2007). Nursing mothers diagnosed with breast cancer who wish to breastfeed during breastfeeding or once cured or in the next lactation period are a vulnerable population that requires clinical support from oncologic multidisciplinary teams and lactation experts.(Bhurosy 2021, Linkeviciute 2020, Johnson 2019)
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