ASO Author Reflections: Is Breastfeeding Still Possible after Breast Cancer Treatment?

Past

Young women with breast cancer tend to be diagnosed with advanced stages of invasive cancer and have poorer survival rates than older women.^1,2 An important behavior that warrants attention among breast cancer survivors of reproductive age is breastfeeding. In addition to benefits to the infant, breastfeeding can improve the survival rates and overall quality of life of breast cancer survivors of reproductive age. Although more evidence is needed, breast cancer survivors are advised to wait for one to two years after treatment to attempt conception and breastfeeding.³ Given that the quality and volume of milk in the treated breast might be significantly affected after breast cancer treatment, breastfeeding from the unaffected breast may be the best option for many breast cancer survivors. Our study examines two research questions: How prevalent is breastfeeding among breast cancer survivors following breast cancer treatment, and what are the factors associated with breastfeeding among breast cancer survivors?⁴

Present

In this systematic review (n = 13 articles), breastfeeding initiation and duration varied across studies. Between 7.7% and 90.9% of breast cancer survivors who had successful deliveries attempted breastfeeding. Breastfeeding duration varied between a few weeks to more than two years. Factors that participants reported in helping them to breastfeed were use of the contralateral breast, support from multiple sources, lactation counseling, remaining motivated to breastfeed despite challenges, setting an example for other survivors, early skin-to-skin contact, frequent feedings, pumping after breastfeeding, and use of galactagogues.⁴ Reasons that were cited by participants to not breastfeed their infants included personal choice, medical counseling against breastfeeding, insufficient milk production, voluntary milk cessation through hormones, and refusal of infant to breastfeed from the treated breast.⁴ Those who attempted breastfeeding from the treated breast faced numerous challenges such as difficulties in latching, reduced milk production, breast pain, not being comfortable breastfeeding, and fear of recurrence of breast cancer in the lactating breast. Contralateral breastfeeding, i.e., from the unaffected breast, was also challenging for several reasons. Participants perceived contralateral breastfeeding to be a major commitment and physically difficult, and reported dissatisfaction with milk supply.⁴

Future

Breastfeeding among breast cancer survivors of reproductive age appears suboptimal with significant room for improvement. There is a need for interventions that promote safe and feasible breastfeeding among breast cancer survivors who wish to breastfeed their infants. Because most breast cancer survivors rely on the untreated breast for successful milk production, particular attention should be given to this issue during prenatal counseling and postpartum care through frequent appointments with a multidisciplinary team. It is important to provide physicians specialized in breastfeeding medicine, oncologists, pediatricians, nurse practitioners, lactation consultants and other healthcare professionals the necessary skills and knowledge so that they can support the breastfeeding needs of breast cancer survivors and address their fears and challenges adequately. Organizations that work with breast cancer patients to raise awareness of reproductive and breastfeeding issues might benefit from including couples, family members and friends to provide a network of support to these women.