Cath Williams asks for input about a case her colleague has, of a mother who
will be undergoing treatment for lymphoma and wants to know if it's worth it
to pump right through it for her now ten week old baby.
The treatment to achieve bone marrow ablation followed by autologous stem
cell transplant is about as noxious as they come.  
There is the possibility that the increased blood supply to the breast
during lactation could lead to worse damage to milk glands than if the
breast was involuted and not lactating.  However, if she is lactating at all
right now, she will be unlikely to have time to stop completely and let her
breasts involute.  This means her breast tissue will be exposed to greater
amounts of the very toxic drugs she will be receiving, and this could
present a separate breast cancer risk 
in itself.  

The other consideration is that chemotherapy hits hardest in cells that are
most metabolically active, and people undergoing it generally have a
transient period in which all rapidly dividing cells die off in huge
numbers.  This manifests itself in the skin and the epithelium of the
airways and the digestive tract, and any other epithelium or endothelium,
with painful sores everywhere.  When their bone marrow stops producing
cells, which is the goal of this therapy, they get their own stem cells back
but it takes about a week before they start to divide.  During that time the
person is dangerously vulnerable to infection from any site where there is a
break in the skin and an opportunity for bacterial growth.  They may require
transfusions of platelets to prevent spontaneous hemorrhage from any body
parts with even small injuries.  Simply bruising from a pump that doesn't
fit right or using too much force with hand expression, could lead to
dangerous blood loss.  

If it is felt that the risk of future illness as a long term consequence of
chemo drugs on the breast is outweighed by the benefit of continuing to
maintain some kind of supply, there are still practical problems.  During
the period in which the person is in protective isolation, they feel worse
than they have ever felt in their life and they would be completely
dependent on having someone else who could do every single bit of the actual
work of expressing while they just lie there between rounds of vomiting and
having diarrhea.

This treatment for lymphoma is the most effective there is and is considered
curative.  Most of the time it works.  If it doesn't, there is nothing else
available and the disease runs its fatal course.  Depending on how the
person's disease is classified the prognosis may be more or less guardedly
optimistic.  Any decisions about breastfeeding must be taken in full
awareness of the gravity of the diagnosis, and of the fact that the woman
will not become pregnant again even if she does recover.  It's not at all a
clear cut call, and the person doesn't have the luxury of weeks of
contemplation and reflection before acting.  

I hope you, Cath, will convey my sympathy, and that we get to hear how it
goes with the mother. 

Rachel Myr
Kristiansand, Norway

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