Because of the potential increased risk of breast cancer in this population, consider continued screening during lactation dependent upon the level of underlying risk and the expected duration of lactation. Breast Imaging of Pregnant and Lactating Women There are no studies specifically evaluating DBT in this patient population. The increased breast density seen in younger women and in the hormonally altered breasts of lactating women is more likely to mask small lesions. Therefore, this population may benefit from the ability of 3-D mammography to decrease the masking effect of dense breast tissue. US Breast There are no studies specifically evaluating hand-held or automated whole-breast US screening in women who are breastfeeding. Given the increased mammographic density during lactation, screening US could be considered as a supplemental screening option in lactating women at intermediate and high risk for breast cancer. It is, however, important to keep in mind that screening US may increase the false-positive rate and prompt additional biopsies with small additional risk of milk fistula in lactating women [39,40]. MRI Breast The physiologic increased vascularity of lactation causes a marked increase in background parenchymal enhancement on breast DCE-MRI. Although this may limit the sensitivity for detecting small enhancing masses and nonmass enhancement, studies have shown that breast DCE-MRI can differentiate enhancing breast cancer from background parenchymal enhancement based on kinetics and morphology [19,34,35,38,41]. A study of 53 patients with known PABC demonstrated moderate or marked background parenchymal enhancement in 58% of patients. Despite increased background parenchymal enhancement, there was 98% sensitivity for detection of known PABC; however, it is unknown how many women were lactating at the time of the MRI [19]. There are scant data on MRI screening in lactating women.
Breast Imaging of Pregnant and Lactating Women. Because of the potential increased risk of breast cancer in this population, consider continued screening during lactation dependent upon the level of underlying risk and the expected duration of lactation. Breast Imaging of Pregnant and Lactating Women There are no studies specifically evaluating DBT in this patient population. The increased breast density seen in younger women and in the hormonally altered breasts of lactating women is more likely to mask small lesions. Therefore, this population may benefit from the ability of 3-D mammography to decrease the masking effect of dense breast tissue. US Breast There are no studies specifically evaluating hand-held or automated whole-breast US screening in women who are breastfeeding. Given the increased mammographic density during lactation, screening US could be considered as a supplemental screening option in lactating women at intermediate and high risk for breast cancer. It is, however, important to keep in mind that screening US may increase the false-positive rate and prompt additional biopsies with small additional risk of milk fistula in lactating women [39,40]. MRI Breast The physiologic increased vascularity of lactation causes a marked increase in background parenchymal enhancement on breast DCE-MRI. Although this may limit the sensitivity for detecting small enhancing masses and nonmass enhancement, studies have shown that breast DCE-MRI can differentiate enhancing breast cancer from background parenchymal enhancement based on kinetics and morphology [19,34,35,38,41]. A study of 53 patients with known PABC demonstrated moderate or marked background parenchymal enhancement in 58% of patients. Despite increased background parenchymal enhancement, there was 98% sensitivity for detection of known PABC; however, it is unknown how many women were lactating at the time of the MRI [19]. There are scant data on MRI screening in lactating women.