Abstract
The protocol, “ABM Clinical Protocol #34: Breast Cancer and Breastfeeding,” by Johnson, Mitchell, and the Academy of Breastfeeding Medicine, 1 is a welcome recognition of an evolving social and medical development wherein an increasing number of young women are pursuing biological motherhood after having had breast cancer. In the past, pregnancy and breastfeeding often were discouraged or not possible, but advances in breast cancer treatment and fertility preservation have afforded more women the opportunity of biological motherhood.
The ABM protocol provides evidence-based information on breastfeeding options related to type and timing of breast cancer treatment. Yet, the protocol lacks attention to women's psychosocial needs including fears of cancer recurrence with interruption of hormonal therapy, difficulty with detecting breast cancer during lactation, 2 discomfort, and stress from reliance on only one breast; body image issues including sense of asymmetry, 3 social pressure to feed their infants a certain way, insensitivity of family, friends, and health care providers, and loss of control over their infant feeding choice. 4 Although some women may be motivated to breastfeed after breast cancer, 3 not all women can, which may exacerbate negative emotions after cancer. Even among women who establish lactation, unilateral and/or partial breastfeeding is the most realistic approach.
Our team recently published a qualitative study exploring the experience of infant feeding among women with a history of breast cancer. 4 We found that beyond the ability or inability to breastfeed, women's infant feeding experiences were varied. Some women felt empowered, some stressed, and others “normal.” Those physically unable to breastfeed (i.e., after bilateral mastectomy) were saddened by their lack of choice, the betrayal by their bodies, and by overt and subtle societal disapproval. Among women who were able to breastfeed, not all chose to breastfeed, whereas those who did often faced a range of physical, social, and psychological challenges.
As health care providers working with women who have had the life-altering experience of giving birth after breast cancer, we must empathetically listen to and acknowledge mother's lived experiences; furnish them, their families, and their health care providers with evidence-based information; assure them that they are not alone; and demonstrate respect and support for their infant feeding decisions.