A RadioGraphics review brings together current American College of Radiology Appropriateness Criteria and other professional guidance on breast screening and diagnosis in pregnant and breastfeeding women. More women now need breast imaging at these times, because childbearing is later and hereditary or familial risk is identified earlier, with risk assessment often from age 25.
Mammography is safe in pregnancy and lactation, but hormonal changes increase breast density and can hide a cancer. Ultrasound involves no ionising radiation and is the main tool for a woman with symptoms, though its value for routine screening in these groups is unproven. MRI is contraindicated in pregnancy but can be used during lactation to screen high-risk women or stage a new cancer, despite marked background enhancement.
Pregnancy-associated breast cancer is becoming more common, and delays in diagnosis are a recurring problem because changes are attributed to pregnancy. The review stresses prompt evaluation of any symptom and clear explanation of each test's limits to the woman and her referring clinician.
In practice, a palpable lump in a pregnant or lactating woman deserves ultrasound without waiting for delivery or weaning, and high-risk women should have a plan for continued screening rather than a pause.
- Image a new breast lump in pregnancy or lactation promptly with ultrasound; do not defer until after delivery.
- Mammography is safe in pregnancy with appropriate technique; add it when ultrasound is suspicious.
- Do not use breast MRI during pregnancy.
- During lactation, MRI can be used for high-risk screening or staging; advise feeding or pumping beforehand to reduce density.
- Make a screening plan for high-risk women that continues through pregnancy and breastfeeding.
Why it matters
Pregnancy-associated breast cancer is often diagnosed late because changes are put down to pregnancy, and imaging choices are where that delay can be shortened.
Don't overread it
This is a narrative review; evidence on screening performance in pregnant and lactating women remains limited.
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