Ultrasound is the first test for a palpable breast lump in a pregnant or lactating woman: it uses no ionising radiation and handles the dense, glandular breast of pregnancy well. Mammography is not contraindicated and can be added when ultrasound is suspicious or malignancy is likely, with a very low fetal dose.
Gadolinium-enhanced breast MRI is avoided in pregnancy. During lactation it can be used for high-risk screening or staging, accepting marked background enhancement.
A persistent lump in pregnancy needs prompt imaging and, where indicated, biopsy; pregnancy is not a reason to wait until after delivery.
- Start with ultrasound for a breast lump in pregnancy or lactation.
- Add mammography when ultrasound is suspicious; it is not contraindicated.
- Avoid gadolinium-enhanced breast MRI during pregnancy.
- Do not defer biopsy of a suspicious lump until after delivery.
Why it matters
Pregnancy-associated breast cancer is often diagnosed late because symptoms are attributed to normal breast changes.
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