A review in RadioGraphics, published on 1 October, sets out how to screen and investigate the breast in pregnant and breastfeeding patients, drawing on the ACR Appropriateness Criteria and other professional guidance.
Mammography is safe in pregnancy and lactation, but hormonal changes increase breast density and reduce sensitivity. Ultrasound uses no ionising radiation and is the primary test for a symptomatic patient, though its value for routine screening in this group is uncertain because evidence is limited. Breast MRI is avoided in pregnancy because of gadolinium, but can be used during lactation for high-risk screening or staging a new cancer, despite marked background enhancement.
Pregnancy-associated breast cancer is becoming more common as childbearing is delayed, and it is often diagnosed late because lumps are attributed to physiological change. The review's central message is to investigate a persistent breast symptom in a pregnant or lactating woman promptly rather than waiting for delivery or weaning.
- Investigate a persistent breast lump in a pregnant or lactating woman now, starting with ultrasound.
- Add mammography when ultrasound is suspicious or a cancer is found; it is safe in pregnancy and lactation.
- Avoid gadolinium-enhanced breast MRI during pregnancy.
- Continue high-risk MRI screening during lactation; ask the patient to feed or express just before the scan to reduce density.
- Identify women with hereditary risk who need screening to continue through pregnancy.
Why it matters
Delay, not the choice of modality, is what most often harms women with pregnancy-associated breast cancer.
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