Translated from the original Italian version by Dr. Fedro Alessandro Peccatori – Milan, Italy
Such a beautiful story, that of Valentina and her baby twins, Alessandro and Lorenzo!
A love story which shows that determination and the nearly magical beauty of breastfeeding ultimately win and that mothers are almost always right.
A story that, on the other hand, confirms that breastfeeding after breast cancer remains a taboo subject.
Some of the doctors Valentina met were too focused on the disease to be able to really listen. The art of listening is as important as the art of speaking and requires time, open-mindedness, and a non-judgmental attitude. It is important to know that there are no medical contraindications for a mother who wants to breastfeed after breast cancer. In a research study we published a few years ago, mothers who breastfed their babies had an even better prognosis than mothers who decided not to breastfeed for various reasons.
It is likely that the affected and treated breast will produce less milk than the other breast. It is therefore important to explain clearly during the consultation that even milk produced from a single breast can still be sufficient and that the properties of mother’s milk cannot be reproduced by any formula.
Furthermore, breastfeeding isn’t just about feeding, but also about creating a unique relationship with your child, affecting his future physical and mental development, as well as offering the mother several benefits, even in the case of a previous diagnosis of breast cancer.
However, there is a need for competent and consistent responses from healthcare professionals.
Mothers should not be forced to slalom between sensitive and insensitive healthcare providers. They shouldn’t be told, “Six months of mother’s milk is enough, if you don’t want to spoil your baby”. Paternalistic medicine should no longer exist, especially when addressing important issues such as reproductive health and breastfeeding. Also, there is a need for support, as Valentina’s story teaches us that breastfeeding after breast cancer may not be easy and that the role of associations and organizations – such as La Leche League – is fundamental.
From a purely oncological point of view, it is important to reiterate that undergoing hormonal therapy for five years reduces the risk of relapse, but that it is also possible, after clinical evaluation, to suspend it temporarily to try having a baby and then resume it after pregnancy and breastfeeding.
In January 2020 an international clinical study (POSITIVE study) evaluating this approach was concluded and, in a few years, we will be able to answer the many questions that young women with breast cancer keep asking.
We already have the answer to one question: you can breastfeed even after surgery and treatments for breast cancer and there is no reason to deprive women and their children of this opportunity.
Fedro Alessandro Peccatori is a medical oncologist and gynecologist.
His clinical activity mainly focuses on women suffering from gynecological and mammary neoplasms, with particular attention to their reproductive health problems.
He has been one of the pioneers of oncofertility in Italy and has a particular interest in the biology and treatment of neoplasms diagnosed during pregnancy and breastfeeding.
He directs the Fertility and Procreation Unit in Oncology at the European Institute of Oncology IRCCS and is the Scientific Director of the European School of Oncology, in Milan and Bellinzona.
He is the author of 220 publications and teaches at the University of Milan. He is also co-editor of “Tumori Journal” and “Journal of Human Lactation”.
He is happily married since 1990 to Giulia Bellettini, pediatrician and International Board Certified Lactation Consultant (IBCLC) and together they raised five children, all nursed. He loves his work, the sea, long walks, and Giulia.
The International Breast Cancer Study Group (IBCSG), POSITIVE study (Full version), 18 January 2018, https://www.youtube.com/watch?v=m2sDaj1PLaY (accessed 10 August 2020).
Linkeviciute A, et al. Breastfeeding After Breast Cancer: Feasibility, Safety, and Ethical Perspectives. Journal of Human Lactation February 2020; 36(1):40-43. doi: 10.1177/0890334419887723. Epub 15 November 2019. PMID: 31730386.
Sun Z, et al. Estimation of historical control rate for a single arm de-escalation study – Application to the POSITIVE trial. POSITIVE Steering Committee. Clinical Breast Cancer 2 June 2020; 53:1-7. doi: 10.1016/j.breast.2020.05.012. Online ahead of print. PMID: 32535486 Free PMC article.
Paluch-Shimon S, et al. ESO-ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women (BCY4). Annals of Oncology 19 March 2020; S0923-7534(20)36363-8. doi: 10.1016/j.annonc.2020.03.284. Online ahead of print. PMID: 32199930.
Lambertini M, et al. Long-term Safety of Pregnancy Following Breast Cancer According to Estrogen Receptor Status. Journal of the National Cancer Institute April 2018; 1; 110(4):426-429. doi: 10.1093/jnci/djx206. PMID: 29087485 Free PMC article.
Pistilli B, et al. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treatment Reviews May 2013; 39(3):207-11. doi: 10.1016/j.ctrv.2012.10.002. Epub 28 November 2012. PMID: 23199900 Review.
Azim HA Jr, Peccatori FA, de Azambuja E, Piccart MJ. Motherhood after breast cancer: searching for la dolce vita. Expert Review of Anticancer Therapy February 2011; 11(2):287-98. doi: 10.1586/era.10.208. PMID: 21342046 Review.
Azim HA Jr, et al. Breastfeeding in breast cancer survivors: pattern, behaviour and effect on breast cancer outcome. The Breast December 2010; 19(6):527-31. doi: 10.1016/j.breast.2010.05.018. PMID: 21078487 Free article.
Azim HA Jr, Bellettini G, Gelber S, Peccatori FA. Breast-feeding after breast cancer: if you wish, madam. Breast Cancer Research and Treatment March 2009; 114(1):7-12. doi: 10.1007/s10549-008-9983-7. Epub 29 March 2008. PMID: 18373190 Review.