Radiotherapy use while Breastfeeding

Radiotherapy Levels and Effects while Breastfeeding

Summary of Use during Lactation

High-dose breast radiation for the therapy of breast cancer can decrease or eliminate subsequent milk production in the treated breast, but not the untreated breast. Medical professionals sometimes advise mother's who have received breast cancer surgery and radiation not to breastfeed; however, it appears that these concerns are unfounded. Lower radiation doses to the breast in the treatment of Hodgkin lymphoma appear to have only a minor effect on subsequent lactation success. Women who were treated as children for leukemia with cranial radiation often have low serum prolactin levels and difficulty in nursing their infants. For information on diagnostic x-rays, see the LactMed entry for X-rays.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Possible Effects on Lactation

A woman who had been treated with high-dose external radiation and an iridium-192 implant for breast cancer became pregnant 1 year later and delivered a healthy infant. Her baby nursed equally well from both breasts. The treated breast produced milk that was slightly thicker with a quantity of about half the amount from the untreated breast.[1]

A review of medical records revealed 8 women who became pregnant after breast-conserving surgery, chemotherapy and radiotherapy for breast cancer. Of 8 women who attempted breastfeeding, 4 were successful. Breastmilk production was usually less or absent from the irradiated breast than from the contralateral breast.[2]

A survey of radiation oncologists identified 53 women who had been treated for breast cancer with surgical excision of the breast tumor and radiotherapy. In subsequent pregnancies, 18 of the women (34%) were able to lactate, although milk production was sometimes less in the affected breast. Thirteen (25%) were able to successfully breastfeed from the treated breast. The mean dose of radiation to the breast was 47 grays among those who lactated. The mean dose in women who could not lactate was 50.6 grays. Most of the women received radiation from cobalt or a high-energy liner accelerator.[3]

In a retrospective study of 21 women with breast cancer treated with a median cumulative radiation dose of 50 grays to the affected breast, milk production in the irradiated breast was substantially reduced or eliminated in subsequent pregnancies. Milk production in the non-irradiated breast was usually not affected.[4]

A retrospective case-control study of 83 women who received radiation for Hodgkin lymphoma compared subsequent breastfeeding success to that of 70 sisters of patients who received radiation. The median dose of whole chest radiation was 41 grays (range 27 to 46 grays). There was a trend toward less success in breastfeeding in irradiated patients that was not statistically significant. The greater breastfeeding success relative to breast cancer patients in other studies was attributed to the lower radiation to the breast and less breast surgery in the Hodgkin lymphoma patients.[5]

Twenty women were identified from the European Institute of Oncology database who had breast cancer from 1988 to 2006 who agreed to take a survey of breastfeeding behavior. Fourteen of 15 women who underwent breast conserving surgery followed by irradiation reported hypoplasia of the irradiated breast during pregnancy. Of the 15 women, eight did not attempt to breastfeed. Of the 7 who attempted breastfeeding, one woman successfully breastfed 2 infants (2 pregnancies) for more than 6 months, one other successfully breastfed for 11 months. The duration of nursing in the other 5 women is unclear in the paper. Only two women attempted to breastfeed from both breasts, and both could breastfeed from both breasts for only 2 weeks because of reduced milk production. Of the women who did not attempt breastfeeding, medical counseling against breastfeeding was a major reason because of "uncertainty regarding maternal safety", and "a priori unfeasibility" expressed either by the obstetrician or the oncologist.[6]

A study of 44 women who were treated with cranial radiotherapy of 18 to 30 Gy as children for leukemia was conducted 8 to 20 years following radiotherapy. Forty were growth hormone deficient and 4 were growth hormone insufficient. Seven of the women became pregnant at 18 to 22 years after therapy while taking growth hormone replacement therapy. Growth hormone therapy was discontinued in the second trimester and restarted 6 months postpartum. Six of the 7 women were unable to lactate. Stimulation with thyroropin-releasing hormone showed a lower prolactin response among women who had undergone radiotherapy than in matched controls.[7]

References

1. David FC. Lactation following primary radiation therapy for carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1985;11:1425. PMID: 2989233

2. Higgins S, Haffty BG. Pregnancy and lactation after breast-conserving therapy for early stage breast cancer. Cancer. 1994;73:2175-80. PMID: 8156522

3. Tralins AH. Lactation after conservative breast surgery combined with radiation therapy. Am J Clin Oncol. 1995;18:40-3. PMID: 7847257

4. Moran MS, Colasanto JM, Haffty BG. Effects of breast-conserving therapy on lactation after pregnancy. Cancer J. 2005;11:399-403. PMID: 16259870

5. McCullough L, Ng A, Najita J et al. Breastfeeding in survivors of Hodgkin lymphoma treated with chest radiotherapy. Cancer. 2010;116:4866-71. PMID: 20629028

6. Azim HA, Bellettini G, Liptrott SJ et al. Breastfeeding in breast cancer survivors: pattern, behaviour and effect on breast cancer outcome. Breast. 2010;19:527-31. PMID: 21078487

7. Follin C, Link K, Wiebe T et al. Prolactin insufficiency but normal thyroid hormone levels after cranial radiotherapy in long-term survivors of childhood leukaemia. Clin Endocrinol (Oxf). 2012. PMID: 23167807

Radiotherapy Identification

Substance Name

Radiotherapy

Drug Class

• Radiation Therapy

Administrative Information

LactMed Record Number

817

Information from the National Library of Medicine's LactMed Database.

Last Revision Date

2013-01-24

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