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, but cranial irradiation for Hodgkin's lymphoma can reduce subsequent breastmilk production. 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.

Effects on Lactation and Breastmilk

A systematic review compiled data from 102 patients treated with breast irradiation and subsequent lactation. The authors found a large variation in milk output of the irradiated breast, which may be due to the type and intensity or the radiation, concomitant surgery. Two studies found changes in breastmilk in the irradiated breast compared to the untreated breast, including elevated sodium, and reduced potassium, phosphate and triglycerides, Most patients could breastfeed successfully using the untreated breast. Cranial irradiation for Hodgkin's lymphoma or during childhood for leukemia can also reduce subsequent breastmilk production.[1]

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.[2]

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.[3]

References

1. Leal SC, Stuart SR, Carvalho Hde A. Breast irradiation and lactation: a review. Expert Rev Anticancer Ther. 2013;13:159-64. PMID: 23406557

2. 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

3. 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). 2013;79:71-8. PMID: 23167807

Radiotherapy Identification

Substance Name

Radiotherapy

Drug Class

Radiation Therapy

Administrative Information

LactMed Record Number

817

Last Revision Date

20130907

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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