Lactation Management in Patients With Cancer: An Evidence-Based Framework for Surgical Practice

BackgroundThe coexistence of lactation and cancer care, termed oncolactation, is becoming increasingly common as childbearing is delayed and more women are diagnosed with malignancy during the reproductive years. However, evidence-based guidance regarding breastfeeding during oncologic evaluation and treatment remains fragmented, particularly for surgeons involved in multidisciplinary cancer care.MethodsWe conducted a narrative review with a systematic literature search using PubMed/MEDLINE and professional society guidelines (American Society of Breast Surgeons (ASBrS), American College of Radiology (ACR), American College of Obstetricians and Gynecologists (ACOG), and the Drugs and Lactation Database (LactMed®). Publications addressing surgical management, diagnostic imaging, systemic therapy, radiation therapy, and reproductive counseling in lactating patients with cancer were critically synthesized to develop practical, evidence-based recommendations.ResultsMost diagnostic and surgical interventions-including mammography, breast MRI, computed tomography, image-guided biopsy, and general anesthesia-are compatible with continued breastfeeding when appropriate precautions are observed. Cytotoxic chemotherapy, endocrine therapy, and most targeted or immunotherapeutic agents remain contraindicated because of insufficient safety data or potential infant toxicity. Radiation therapy generally precludes breastfeeding from the treated breast, but permits continued feeding from the contralateral breast. Emerging evidence also supports individualized counseling regarding fertility preservation, future pregnancy, and survivorship.ConclusionsOncolactation should be incorporated into routine surgical oncology practice. Most surgical and diagnostic procedures can be performed without interrupting breastfeeding, whereas systemic therapies require individualized pharmacologic assessment. Integration of evidence-based lactation guidance into multidisciplinary cancer care promotes safe, patient-centered decision-making while maintaining oncologic safety and supporting breastfeeding whenever feasible.