Nurse practitioner Davia Moss with her husband, Patrick Adcock, MD, and their children, from left, Asher, Eliana and Cason. (photo by Susan Kahn)

在她儿子出生前四天，她被诊断出患有乳腺癌

BY AMBER SMITH

家庭执业护士达维亚·莫斯在脱下运动胸罩时发现乳房上有一个肿块. She was 34 and pregnant with her third child.

她的产科医生向莫斯保证，可能没什么，只是让她做了个活检，以防万一.

“When I felt the lump, I thought that it was probably pregnancy related, 要么是导管堵塞，要么是正常的囊性变. I was very surprised,” Moss says. “即使两年过去了，我仍然有点惊讶.”

Cancer in pregnancy

Cancer during pregnancy is uncommon. 当它发生时，诊断和治疗可能是一个挑战，她说 Jayne Charlamb, MD, 他是一名推荐最近最火的赌博软件的内科医生，专门从事乳房护理和治疗乳腺癌高危妇女.

莫斯在一位乳房外科医生建议她不要给新生儿喂奶后，向查兰姆寻求指导，她之前听过查兰姆关于母乳喂养的讲座. 哺乳是指婴儿依附在母亲的乳房上进行母乳喂养的方式.

“Breastfeeding has been a huge passion of mine,” says Moss, who breastfed her ﬁrst two children – Eliana Adcock, now 7, and Cason Adcock, now 5 – until they were 2. 她说，直到她意识到这可能意味着不能给第三个孩子哺乳，她才明白自己的诊断.

查兰姆认为，任何患有乳腺癌的新妈妈都应该能够考虑母乳喂养的风险和益处. “我不认为这是每个妈妈，甚至大多数妈妈都想做的事情. It’s a lot of work,” she says. “It takes a dedicated mom. It takes a very ﬂexible baby. Davia was sort of set up to succeed. She was an experienced breastfeeding mom. She’d done this before. It was something that was highly important to her. 幸运的是，这个宝宝是我见过的最灵活的宝宝. That was very helpful.”

Breastfeeding success

在接受化疗的几周里，莫斯不得不定期抽吸和丢弃她的牛奶, 但在她体内的药物消失后，她每隔几周就能给儿子喂奶几天. She clung to those moments. 她从社交媒体上找到的一群女性那里获得了支持, or were facing, cancer during pregnancy. Asher Adcock is now a healthy 2-year-old.

Jayne Charlamb, MD

查兰姆建议任何在怀孕期间被诊断患有癌症的女性先深呼吸. 然后，比较适用于她情况的治疗方案.

“We try to time things during pregnancy. There are times when it’s safer to do surgery, during the second or third trimester, rather than early on, but we always need to weigh the risk and beneﬁts,” she says. 副作用也要考虑到，即使胎盘, the organ that forms in the uterus as the baby grows, does a good job of protecting the baby.

对女性乳腺癌的评估和治疗几乎是一样的, 不管她们是怀孕还是哺乳期, Charlamb says. “当你有一个女人来找你抱怨乳房, 谁碰巧在哺乳期或者碰巧怀孕了, you evaluate her in almost exactly the same way, 如果她没有哺乳期或怀孕，你会有同样的紧迫感. 做乳房x光检查、超声波检查和活组织检查都是完全安全的.”

查兰姆说莫斯的产科医生做得很好. 她立刻派莫斯去取医学图像，第二天又做了活检. As the results came in, quickly a team of specialists was assembled, including from radiology, pathology, oncology, pediatrics, genetics and others. 她的乳腺癌已经扩散到她的淋巴系统，而它是由雌激素喂养的.

Exploring genetics

莫斯在北州从事青少年医学工作，她在确诊四天后生下了孩子. 十天后，她和她的丈夫，医学博士帕特里克·阿德科克(Patrick Adcock)前往听取第二种意见. They returned to Syracuse, and Moss had a port placed beneath her skin, which allows easy access for administering IV drugs.

Chemotherapy began before Asher was a month old. 她每隔一周接受八次化疗，持续了四个月.

After learning she carried the BRCA2 gene, 哪些因素会显著增加她患乳腺癌和卵巢癌的风险, 2020年4月，莫斯切除了一侧乳房以降低患病风险. 她留下了另一只，这样她就可以继续照顾亚设直到他一岁. 从那时起，她开始服用他莫昔芬，这是一种用于治疗她的乳腺癌的药物.

她在2020年11月切除了第二个乳房和输卵管. 莫斯解释说:“越来越多的证据表明，这可能会降低我患卵巢癌的风险. 当她40岁时，她会考虑是否也切除卵巢.

关于怀孕期间乳腺癌的6件事

这种情况很罕见，大约每3000次怀孕中就有1次出现.
从长远来看，怀孕会降低女性一生中患乳腺癌的风险. However, during pregnancy, and shortly after, 女性患乳腺癌的风险会暂时增加, says Jayne Charlamb, MD, 谁擅长母乳护理和母乳喂养医学.
Breasts change, naturally, during pregnancy. They grow bigger, may be tender or become firm, or may leak colostrum, the first breast milk produced after childbirth. 如果变化只影响一个乳房，这是一个值得向你的产科医生提及的危险信号.
孕期和哺乳期乳腺癌的诊断常常被推迟，因为通常的症状没有被认为是异常的，或者因为卫生保健提供者错误地认为孕期不可能进行评估. 对任何对你来说不寻常的乳房变化进行彻底的评估总是很重要的.
对于正在接受乳腺癌治疗的新妈妈来说，母乳喂养是可能的——尽管可能具有挑战性.
婴儿没有从母亲那里感染癌症的风险.