Although learning to breastfeed can be a challenge for new mothers, the healthcare consensus is that breast milk is the best source of nutrition for babies and breastfeeding should be encouraged.
But what if you have just received a diagnosis of breast cancer or have been through breast cancer treatment? Will you still be able to breastfeed? And will it be healthy to do so for you and your baby?
The answers can be complicated. But, overall, what applies to other mothers also applies to mothers who have faced breast cancer.
Make Sure You Have the Right Help
Breastfeeding is not easy, even in the best of circumstances, and a diagnosis of breast cancer multiplies the difficulties. In addition to sharing your plans to breastfeed with your cancer treatment team, you will want to consult your obstetrician and your child's pediatrician. Moreover, because the challenges can be psychological and emotional as well as physical, you might find it helpful to speak with a mental health professional who can help you work through issues involving body image or the loss of control you may feel.
Also consider enlisting the help of a certified lactation consultant. These trained clinical professionals can provide assistance with special situations, such as expressing milk and storing it for later use or maintaining milk supply during an interruption in your breastfeeding routine. If your cancer treatment center is affiliated with a hospital that has a birth center, the staff may be able to recommend a lactation consultant. The International Lactation Consultant Association website may be able to provide additional information about locating a lactation consultant near you.
Breastfeeding During Treatment
Because cancer is difficult to detect in a lactating breast, it is unusual -- though not impossible -- for women to be diagnosed during the time they are breastfeeding. Should this happen, it does not automatically mean the end of breastfeeding. For example, diagnostic procedures (such as a needle biopsy) do not generally pose an obstacle to continued breastfeeding.
After diagnosis, however, breastfeeding should be interrupted while a treatment plan is worked out. Again, this is not to say the child has to be weaned. Feeding your baby with previously pumped milk or commercial formula can bridge the gap until your doctor says you can start again.
If your treatment involves surgery, find out whether the surgeon has operated on a lactating breast before. It can be complicated terrain. While you do not want to harm the milk ducts unnecessarily, removing the cancer may involve some damage.
If your treatment plan includes chemotherapy, you will need to discontinue breastfeeding during the course of treatment and for some time thereafter. Chemotherapy agents are passed on through breast milk and may be toxic to your child.
Radiation therapy may also require an interruption in breastfeeding, depending on the type of radiation used and the duration of treatment. Your doctor will be able to explain the effects of your treatment and whether you can breastfeed using both breasts or only the unaffected breast while treatment is underway.
When you are not breastfeeding, you may adopt a "pump and dump" routine. This involves pumping the breasts each day so the milk supply continues but discarding the milk because its safety is in doubt.
Breastfeeding After Treatment
When your treatment has ended, you and your baby may be able to pick right up where you left off -- or you may need a bit of patience and perseverance to get back on track. Remember that the effects of your treatment may still linger in your body and your breast milk; ask your doctor when it is safe to try breastfeeding again.
After surgery, breastfeeding may be a challenge. Surgery may have damaged some of your milk ducts, reducing the amount of milk you are able to provide. If you were breastfeeding (or planning to) before your surgery, your surgeon may have sought to avoid duct damage where possible. But even if damage has occurred, diligent nursing may bring your supply back up within a few weeks, or the unaffected breast may increase its production sufficiently to make up the difference.
After radiation therapy, your milk supply may be diminished or eliminated in the treated breast. Radiation may also decrease the elasticity of the nipple, making it harder for your infant to "latch on" properly. If you find that the treated breast is not working, your other breast should be able to make up the missing volume of milk on its own within a couple of weeks of resuming regular nursing.
After chemotherapy, residual chemicals may still be present in your milk supply. Ask your doctor when it is safe to breastfeed again. The good news is that once you have been cleared by your doctor, chemotherapy is unlikely to have any long-term affect on your ability to breastfeed.
If you are prescribed ongoing Nolvadex (Tamoxifen) therapy, you will not be able to breastfeed until after you have stopped this course of treatment. Tamoxifen inhibits the production of milk, and its presence in any remaining breast milk could be harmful to the child.
Will It Make the Cancer Come Back?
A common question among breastfeeding cancer survivors is whether the hormones of pregnancy and lactation could trigger a recurrence of the disease. There is no evidence for this; in fact, some research indicates that breastfeeding may actually lower a woman's risk of breast cancer (though the studies have not addressed recurrence in women who have already been diagnosed).
Will It Increase the Baby's Risk of Cancer?
There is no evidence that breast milk from a cancer survivor poses any risk to her infant, so long as any residual effects of treatment have cleared her system. Given the strong benefits of breastfeeding, breast cancer survivors should feel as encouraged to do so as any other mom.
What if I Cannot Do It At All?
If, despite your best efforts and your doctor's OK, you find that breastfeeding just is not working, you can still make sure you both get the benefit of that special bond.
- Ask about donated breast milk. Some women pump and donate their milk so that the babies of women who are having trouble lactating still receive mother's milk. Ask your pediatrician or your hospital's lactation specialists if a program like is this near you.
- Treat feeding time as you always have. Just because it is coming from a bottle does not mean the time spent feeding your baby is any less special. Make eye contact with your baby, and get as much skin-to-skin contact as you can.
- Find a support group. Whether it is a breast cancer survivor group or a local moms' club, you may find comfort in talking with women who have faced the same challenges.
Sources:David, F. "Lactation Following Primary Radiation Therapy for Carcinoma of the Breast." Int J Radiat Oncol Biol Phys. 11. 7. Jul. 1985. 1425.
FDA staff. "Babies Are Born to Breastfeed." FDA.gov. Nov. 2007. Food and Drug Administration. 12 May 2008.
Higgins, S. and B. Haffty. "Pregnancy and Lactation After Breast-Conserving Therapy for Early Stage Breast Cancer." Cancer. 73. 8. 15 Apr. 1994. 2175-2180. (subscription)
SOGC Staff. "Breast Cancer, Breastfeeding and Pregnancy." SOGC.org. Feb. 2002. Society of Obstetricians and Gynaecologists of Canada. 12 May 2008.