Posted with permission of mother

This particular mother happens to be one of my closest friends, not one of my
clients.

She is 40 yrs old, breastfeeding 18 month old child several times a day. Her
daughter was concieved through IVF.  Mom with strong family history of breast
cancer.  Mom with lump removed 5-6 years ago which turned out to be a benign
calcification. Mom planning another pregnancy through IVF within next year or
so. Mother is very invested in her health, pro-active with her health care, and
no interest in weaning child at this point. Child very attached to
breastfeeding still.

Her last mammogram was about three years ago, normal. (She's been mostly
pregnant or breastfeeding past 2 1/2 years)

For her breast care, she still uses the specialist that treated her for the
lump...an oncologolist specializing in breast cancer.  She contacted the MD to
arrange another mammogram, thinking she should do this before another
pregnancy.  Specialist told her. You have to wean first.

So, my friend calls me to ask (as she has learned to always do about medical
breastfeeding advice.) I sent her links explaining how breastfeeding and
mammograms are compatible, she should nurse or pump immediately before the
mammogram and be read by a radiologist experienced in reading lactating breasts.

My friend decides this is the course of action for her...
So she calls the specialists....who tells her, that breastfeeding at 18
months old is for "her" not the baby, and its time to wean and no, she will NOT
order a mammogram for her while lactating, and furthermore "all" radiologists are
experienced in looking at a lacatating breasts, and that the hospital that
she is planning to have this at has a "policy' of no mammograms on lactating
breasts. (A large well known Boston teaching hospital that has a state of the art
reputation for maternal health issues!) (Also, I have to wonder how "all" the
radiologists can be experienced at reading lactating breasts, if the hospital
won't do mammograms on lactating women!)

So my friend asks her about the risks of delaying the mammogram for awhile,
in the event she should become pregnant sooner rather then later, it could be a
few more years before she can have one with these conditions.
 The MD pressures her that she "should" have it.  My friend mentions the
reduced risk of breast cancer for lactating women, and the MD claims that "this is
only true for younger women, in older women breastfeeding slightly increases
the risk, although I would never tell a woman not to breastfed because of
that".  (which I have never heard).

My friend got very upset at the md, and feels she is trying to deny her
healthcare by refusing to do the mammogram even though she is breastfeeding.  Her
current plan is to call the lactation consultant, who she has talked to before,
at the large Boston Hospital and ask about this policy, and what they are
recommending for routine mammograms for lactating women.  I also suggested she
ask her OBGYN or her primary care provider about it, perhaps one of those MDs
would order a mammogram, even if she has to go to a different facility.

Does she have other alternatives? Ultrasounds?  She's considering nursing
through winter and weaning daughter around age 2, then getting the mammogram.  My
friend feels very strongly she should have a mammogram in the near future,
and I can't say I blame her. I just feel as if she should be able to chose one
with a lactating breast, and it sounds like to me that the MD is projecting her
own feelings about breastfeeding onto my friend. I also wonder that since the
specialist is an oncologist, she's more accustomed to crisis type healthcare,
and less accustomed to routine health care matters, thus affecting how she
interacts with her patients when giving advice.

I also wonder what others have heard about breastfeeding increasing breast
cancer risk in woman over age of forty. I couldn't find anything in archive
search.

Thank you.
June Eastman, BS, M.Ed., IBCLC,

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