Monday, October 24, 2011

Breast Cancer and Breastfeeding

Last night I gave a talk at an Oakland church that was putting on a breast cancer awareness and community education night. I was asked to speak about how breastfeeding reduces breast cancer as well as the options for a mom who is going through diagnosis of cancer and treatment. My audience was primarily black women. It was really fun. I especially loved that after I made a point, the pastor and audience would say, "Amen!" We need more of that. And if McKay hadn't been texting me, "Isaac cries every time he sees a picture of you on the computer," I would have stayed for all the speakers. I also think, that for the audience, it would have been better to include more stories. But hindsight is 20/20. Here is part of it:

It might not be immediately clear why breastfeeding would be brought up in discussions about breast cancer. However, the American Institute for Cancer Research has included breastfeeding in their Ten Recommendations for Cancer Prevention List. We know that breastfeeding sets a child up for a healthy life and that breastfed children are less likely to contract childhood diseases such as diabetes, heart disease, multiple sclerosis, and cancer including childhood leukemia and it also reduces the child's chances of getting breast cancer. Breastfeeding is not just for the child, though. Breastfeeding reduces a woman's chances of getting breast cancer.

In the Nurses' Health study between 1997 and 2005, over 60,000 women were studied. They reported that women who had a mother, sister or other close relative with breast cancer had a 59 percent lower risk of developing the disease if they had ever breastfed. Women experience a greater decrease in their chances of breast cancer if they nursing lasts 1 and a half to 2 years or more. In fact, nursing one child for one year will do more for decreasing your chances of breast cancer than nursing 2 children for 6 months each.

Does it make a difference as to what kind of breast cancer? There are two types of breast cancer: there is a kind that depends on estrogen or progesterone for growth and that one is reduced through breastfeeding because the breastfeeding hormone of prolactin keeps progesterone and estrogen levels down like birth control does. There is also a kind that is more aggressive and is not dependent on hormones and it disproportionally affects African American women. Amazingly, in a study of 47,000 African American women that was done between 1996 and 2009, published this past August in the journal Cancer Epidemology, it was found that while an African American woman increases her chances of that cancer when she has more than one child, breastfeeding 2 or more children causes that risk to decline considerably. It is believed that breastfeeding affect the immune response in such a way that this aggressive form of breast cancer is less likely to take hold.

In all, breastfeeding your baby will reduce both yours and your baby's risk of breast cancer.

Now, we know that early diagnosis greatly increases your chances of beating breast cancer. Tests such as X-rays, mammograms, MRIs, and CT scans are safe for breastfeeding. The radiation from those tests does not collect in the milk. There is no need to stop breastfeeding or to pump and dump for these procedures, though you'll probably be more comfortable if you have recently nurse and your breasts are more empty. A well-experienced radiologist should be able to tell the difference between cancer and normal functioning milk ducts, so if you are told to wean before a mammogram, then you might need to find a new radiologist. The agents used in imaging procedures are not absorbed in the breast milk, so they are breastfeeding safe.

However, there are some diagnostic procedures that use radioactive isotopes and particulate radiation. Those aren't breastfeeding safe, so you can pump and dump until the milk is clear of the radiation. That can be tested in the hospital and can take from hours up to a month to clear, depending on the agent used. Working closely with someone who knows a lot about these drugs and lactation will be priceless. If you know that such a procedure is coming up, you can store up milk to feed your baby while you wait out the radiation.

Procedures like biopsy can affect the nerves related to breastmilk production and release. Before a biopsy, it would be wise to tell the surgeon that you are breastfeeding and ask that they keep as much of the tissue intact as they can. If you imagine the breast is a bicycle wheel, cuts that are in the direction of the spokes are more likely to keep nerves and ducts intact as opposed to cuts that go through those nerves and ducts. Depending on the situation, it may not be possible to do that.

If cancer is found, or if you've recently had it removed and you're lactating, you might have some questions. First, your baby can't get cancer from nursing on an infected breast. It is possible for a breast's ability to make milk or the baby could refuse the breast because of the changes in it. Breastfeeding might also be painful. But it also might not be. You are the one going through all of this, so follow what feels right: if you feel like weaning is necessary, there are ways to wean that will minimize the impact on your child and your breasts. If breastfeeding isn't bothering you, then you can keep on nursing for as long as you want.

Unfortunately, breastfeeding during chemotheraphy is not safe. The chemo drugs are very literally poisons and will transfer to your milk. You can pump and dump through treatments, but you can also choose to wean as chemotherapy is extremely draining. Know that you are doing a great job and making hard choices about keeping you and your baby well and healthy. You know your situation better than anyone else and you'll make the best choice for you.

So that's a lot of technical information. The take-away from this is: breastfeeding prevents breast cancer in both your baby and you. Most procedures used for diagnosing cancer like mammograms, MRIs, CT scans, and ultrasounds are 100% compatible with breastfeeding and you don't have to wean. If you do have cancer, chemotherapy is toxic and so it's not safe to breastfeed your baby, but you can pump and dump to keep up a supply and breastfeed when the treatment is done, if you want to. Having a good breastfeeding support person is vital. This can take the form of a good doctor or midwife, an International Board Certified Lactation Consultant, or an LLL leader.

Information without reference links is taken from the Womanly Art of Breastfeeding, 8th edition.

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