Breastfeeding can lower a woman’s risk of breast cancer, but it does not make her immune to the disease, Dr Beatrice Wiafe Addai, President of Breast Care International, has said.
Speaking during a West African Journalists for Environment, Science, Health & Agriculture (WAJESHA) webinar for journalists across West Africa on the theme, Breast Cancer & Breastfeeding in West Africa: Understanding the Data, Trends, Risks & Best Practices, Dr Wiafe Addai warned that breast changes during pregnancy and breastfeeding should not be dismissed without medical assessment.
“A breastfeeding woman can still develop breast cancer,” she told participants, stressing that a persistent lump or suspicious change needs prompt investigation.
The warning comes amid concern about late diagnosis in West Africa, where cost, distance, misinformation and limited access to diagnostic services continue to affect breast-cancer outcomes.
Breast cancer is the leading cancer affecting women in Ghana. IARC/WHO GLOBOCAN 2022 estimates, presented by Dr Wiafe Addai, put the number of new cases in Ghana at 5,026 in 2022, with an estimated 2,491 deaths.
Across Western Africa, the presentation estimates 41.6 new breast cancer cases and 22.3 deaths for every 100,000 women.
Lower risk, not no risk
Dr Wiafe Addai said breastfeeding remains one of the most important interventions for maternal and child health and is associated with a modest reduction in breast-cancer risk.
Evidence reviewed by the International Agency for Research on Cancer indicates that the risk may fall by about 2% for every additional five months of breastfeeding over a woman’s lifetime. Another estimate cited in the presentation puts the reduction at about 4% for every 12 months of cumulative breastfeeding.
The possible protective effect is linked to changes in hormone exposure and breast tissue during pregnancy and lactation. But, she said, the effect must be explained carefully. Breastfeeding lowers risk; it does not eliminate it.
A woman who is pregnant, breastfeeding or recently gave birth can still develop breast cancer. Changes associated with pregnancy and lactation – including breast density, engorgement, nodularity, mastitis and milk-filled cysts – can also make it more difficult to identify a suspicious lump.
Dr Wiafe Addai said women should not automatically assume that a persistent breast change is caused by milk production, a blocked duct or mastitis.
Warning signs can include a breast lump, an abnormal nipple discharge, dimpling of the skin, nipple flattening or retraction, an ulcer, a change in breast size or shape, or a lump in the armpit.
Do not delay assessment
A breastfeeding woman should not be told to wait until breastfeeding ends before a suspicious symptom is investigated, Dr Wiafe Addai said.
Ultrasound is often the first imaging test for a palpable breast mass during pregnancy or lactation. Mammography can also be used where clinically indicated, she said, noting that breastfeeding alone should not prevent necessary diagnostic imaging.
If required, a biopsy can help establish a diagnosis. The belief that a biopsy spreads cancer is one of several myths that can delay care.
Dr Wiafe Addai listed other common misconceptions: that breast cancer is caused by witchcraft or evil spirits; that it is a curse or fate; that it cannot be treated; and that women die as a result of mastectomy.
She urged journalists to report on such beliefs without ridiculing patients or their families, while providing accurate information about the need for timely care.
Late presentation is one of the most serious obstacles to better breast-cancer outcomes, according to the presentation.
Women may delay seeking help because they lack information, fear stigma, cannot afford tests or treatment, live far from specialist services, or receive inadequate counselling and support.
Dr Wiafe Addai called on journalists to look beyond awareness campaigns and examine the pathway from the first symptom to treatment.
That includes asking whether women can afford diagnostic services, how far they have to travel, whether pathology is available, how long results take, and whether surgery, chemotherapy, radiotherapy and essential medicines can be accessed.
For breastfeeding mothers, it also means asking whether they are assessed promptly and whether infant-feeding counselling is available alongside cancer care.
Treatment, protecting mothers and children
If breast cancer is diagnosed, treatment and breastfeeding decisions must be made individually, Dr Wiafe Addai said.
The type and stage of cancer, surgery, chemotherapy, radiotherapy, hormonal treatment and targeted therapy can all affect what is possible. Some medicines can pass into breast milk and may require breastfeeding to be interrupted or stopped.
For survivors, breastfeeding may still be possible in some circumstances. Surgery and radiotherapy can affect milk production in the treated breast, while the other breast may produce enough milk for some women.
She said women need individual counselling from oncology and maternity teams rather than assumptions about what they can or cannot do.
Dr Wiafe Addai said protecting women’s breast health should go hand in hand with supporting breastfeeding.
WHO and Unicef recommend starting breastfeeding within an hour of birth, exclusively breastfeeding for the first six months, introducing appropriate complementary foods from six months and continuing breastfeeding up to two years or beyond.
Breastfeeding supports infant nutrition and health, while also offering mothers a modest reduction in breast-cancer risk.
But, she said, women must be supported to seek breast-cancer care without fear, stigma or financial hardship.
She called for stronger breast-health services at primary level, improved diagnostic and pathology capacity, better referral systems, wider access to surgery and cancer treatment, and efforts to reduce the financial burden on patients.
Breastfeed if possible, she said. Know your breasts. Do not ignore a persistent change. Seek assessment early.
