Breast cancer in pregnancy
Breast cancer is often not detected early enough in women who are pregnant or breastfeeding. This has several causes: Through pregnancy and breastfeeding, the breast changes; Congestion can lead again and again to small nodules during lactation, which dissolve again by itself. On the other hand, the center of attention in pregnancy, and even more so in breastfeeding, is more on the baby, which demands all the strength and mindfulness. Both can cause a change in the breast is overlooked until a successful treatment is at risk.
Breast cancer in pregnancy or lactation is a rare disease: Roughly one in 5000 pregnant women is affected, in Germany only a little more than 100 women per year. For them, however, the diagnosis means an existential incision. First of all, as well as outside of pregnancy, the sooner the breast cancer is detected, the smaller the surgery and the better the outlook. Irradiation of the operated breast should be performed after pregnancy if possible in accordance with current guidelines to destroy possible tumor remnants. During this time should not be breastfed. A systemic therapy and / or surgery and can also be done during pregnancy.
Chemotherapy does not mean that a pregnancy must be stopped: after the first trimester, chemotherapy can be done with caution, without any long-term consequences for the child, as a scientific study in Belgium has shown. If the pregnancy is already well advanced and the child is mature enough to survive, the doctors and their parents will consider whether it makes sense to prematurely terminate the pregnancy before the chemotherapy is started.
Although breast cancer medications only pass into the breast milk in trace amounts, Prof. Dr. med. Alexander Strauss, Deputy Director of the University Gynecological Clinic Kiel, on the simultaneous breastfeeding during a systemic therapy in childbirth. However, breastfeeding is safe when breast cancer treatment is completed. Therefore, depending on the individual case, the young mother may well try to pump and discard the milk during the breast cancer treatment and then to take up breastfeeding. This will be exhausting in many cases if the child does not know or have forgotten how to drink at the breast. But it is possible, and there are no medical concerns, despite surgery, radiation and medical treatment, when breast cancer therapy is completed four weeks earlier.
Prof. Alexander Strauss speaks of a "dilemma": "If a mother becomes ill with breast cancer, she has to pay attention to herself, even if the baby actually needs her entire care. Here, her partner and her whole environment are in demand, so that the woman gets the necessary freedom to take care of her illness and her recovery without the baby suffering. Even in the medical field planning can not be planned according to the plan, but the doctors must always keep an eye on the baby. The worst solution, however, is to postpone the treatment until later. That can put the mother in great danger. "
Because the later the breast cancer disease is discovered and treated, the worse are the chances that the breast cancer can be defeated. Conversely, there is a chance that a woman will completely defeat her breast cancer if, despite her pregnancy or despite her baby, she gets involved in a prompt and well-planned treatment.
Diagnosis Breast Cancer: Reconstruction - but safe!
"The diagnosis of breast cancer, despite quality-assured care in breast cancer centers, has not been frightening," notes Dr. med. Uwe von Fritschen, Head of the Association of Breast Surgery in the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC). "Last but not least, the loss of one or even both breasts puts enormous strain on affected patients. In order to ensure the high standard of treatment in this area too, DGPRÄC has decided to develop a quality-assured, nationwide concept", reports the Plastic and Aesthetic Surgeon.
"In about 30 percent of the 52,000 women with breast cancer annually, the breast is amputated. The care guideline for breast cancer as well as the widely used certification in Germany via 'ONKOzert' stipulate that every woman should be informed about all possibilities of recovery at the beginning of treatment," reports von Fritschen. Only in the breast centers certified by the EUSOMA ("European Society of Breast Diseases") the participation of a plastic and aesthetic surgeon in consultation and intervention is a prerequisite. "With the quality assurance of breast reconstruction, we want to make our contribution to optimizing the restoration in the area of reconstruction by plastic and aesthetic surgeons," explains von Fritschen. Via the portal www.mammarekonstruktion.de it is currently possible to call who is participating in the data collection. Here doctors and patients already find contact persons with a special focus on reconstructive breast surgery.
Centers that bear the quality seal of the DGPRÄC must also meet significant requirements: The Center must, among other things, maintain all reconstructive procedures, whether with its own tissue, expander or implant. A specialist in plastic and aesthetic surgery must be particularly committed to the interdisciplinary care of breast cancer patients and integrate, among other things in the weekly tumor conference. Fritschen explains: "The special feature is that we expect regular high operational experience for breast reconstruction, as well as for the certification of breast cancer surgeons. At least 100 procedures are performed annually on the chest, of which at least 20 microsurgical, free flap plasties - ie reconstructions with own tissue. In addition, these data and the complication rates must be transparently presented to patients on the Internet. If these prerequisites are fulfilled, an inspection will be carried out if required, in which the data and organizational requirements are checked. Finally, the seal of quality "Reconstructive Breast Center" will be awarded and announced on site. "For those interested, the OR numbers of the department would also be visible on the portal. The department itself has the ability to audit their own results and compare them with others. "In the medium term, this will finally make it possible to analyze breast reconstruction with own tissue on a broad database and to develop it further," says the Plastic and Aesthetic Surgeon. "For the patients, we expect a further improvement in the quality of our work."