My wife is 30-years-old. Her doctor found a lump in her breast; they are in the process of having it tested. What we (her and I) want to know is, depending on if it is cancer, since she has not had children yet, how will this affect having children and what can we expect to happen? What effect will the treatments have on her, when she does have children, or should she never try to have children after treatment?

First, it's good that your wife's breast lump has been identified and is undergoing further evaluation. Fortunately, most breast lumps in young women are benign and can have a number of different causes. To learn more about breast lumps, you and your wife can read the Related Q&As listed below.

Women of childbearing age who are diagnosed with breast cancer are understandably concerned about their fertility and ability to give birth while/after they undergo treatment. They are also concerned about how the disease and the treatments will affect the health of their offspring. Happily, babies born to survivors of breast cancer are as healthy as those born to women who have not had cancer. (Women whose biological mothers had breast cancer before the age of 50, however, have a higher risk of breast cancer later on in life.) And being pregnant and having a child does not adversely affect the health of women who have had breast cancer.

However, high levels of radiation and chemotherapy for cancer treatment can negatively affect a developing fetus if administered shortly before or during pregnancy. If a pregnant woman's breast cancer is detected early, the lump and any other abnormal tissue is usually surgically removed. If the cancer is further along, chemotherapy is postponed until after the first trimester to reduce the chances of affecting the fetus.

If a woman has already been diagnosed with and treated for breast cancer, medical providers usually recommend waiting a couple of years before attempting to conceive. That way, health care providers can determine whether or not the cancer is recurrent. If the cancer is recurrent, a woman and her partner may wait a while longer before getting pregnant. Also, depending upon the health of the woman and/or age of the couple, they could explore the possibility of adopting a child or children.

Age is one of the most important factors when discussing cancer and pregnancy. About fifty percent of older women (those approaching menopause) who receive high levels of chemotherapy stop producing fertile egg cells. If a short course of chemotherapy is administered, younger women are less likely to experience a negative effect on their fertility. If a woman is to undergo treatment that likely will affect her fertility, she has the option to have her eggs harvested and frozen for future use before treatment begins. Women who do not undergo chemotherapy treatment need not see any negative effects on their ability to conceive.

Breastfeeding is a common concern for women who have or have had breast cancer. Some women's cancer may have required them to have a partial or total mastectomy (breast removal procedure). Women who have not had mastectomies certainly can breastfeed their babies. Some women who have had radiation therapy on one (or both) breasts may find insufficient milk production in the treated breast(s). Often, in that case, the untreated breast produces enough milk for breastfeeding. La Leche League is a non-profit organization made up of women who assist other women in breastfeeding, offering practical information and support. Women currently undergoing radiation or chemotherapy are not to breastfeed until a few months after treatments have stopped. Health care providers need to test breast milk to be sure that no harmful chemicals can be transmitted to the nursing child.

It is important for the two of you to talk with each other about concerns you both have about your wife's health, your sexuality, your feelings, and her ability to conceive and carry a child. By bringing your concerns to the table first with each other, and then with your oncologist, gynecologist, primary care physician, etc., you will get the information you need to help you make the best decisions for yourselves and your future family.

Alice

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