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Breast-feeding: A healthy choice

patient Emily Miller Land

by Elizabeth Jane Walker

Researchers discover that breast-feeding may ease some late effects of childhood cancer treatment.

When Emily Miller Land delivered a son in March of 2008, she had already identified breast-feeding as a healthy option. But Emily did not appreciate just how important that activity might be to cancer survivors like herself.

“I knew it would help me lose weight a little bit faster and that it was supposed to be good for my bones,” says Emily, who received treatment for the bone cancer osteosarcoma  at St. Jude Children’s Research Hospital.

Justin’s premature arrival reinforced Emily’s determination to provide him with the best possible nourishment.

“Breast-feeding was something I had planned to do anyway,” she says, “but I had this compelling urge to do everything I could to help Justin get out of the hospital.” She immediately began pumping breast milk for her 3½-pound infant. Today, Justin is a delightful toddler who speaks two languages and amazes his parents with his accomplishments.

Emily is grateful that she was able to provide her son with a nutritional option that helped him thrive. But she recently learned that the activity may have offered extra benefits to her own health. According to new St. Jude research, breast-feeding may help ameliorate many of the problems encountered by pediatric cancer survivors.

A happy coincidence

Thanks to advances in cancer biology and treatment, the survival rates for childhood cancer have increased exponentially in the past few decades. But few survivors have emerged unscathed. Almost all of them have an increased risk of significant health problems ranging from obesity to early-onset osteoporosis. Survivors also experience high rates of heart disease, diabetes and second malignancies.

Wouldn’t it be great if one simple activity could help alleviate those risks?

St. Jude researchers found that breast-feeding may do just that.

“We know that breast-feeding protects babies,” says Susan Ogg, RN, a research nurse in St. Jude Epidemiology and Cancer Control. “But it also protects moms in wonderful ways.”

Not only does lactation boost metabolism—helping a new mother burn up to 500 extra calories per day—but it also has a positive effect on her calcium reabsorption after the baby is born. Breast-feeding has been shown to reduce maternal stress and postpartum depression, as well as decrease a woman’s risk of developing diabetes and high cholesterol.

Of particular interest to childhood cancer survivors is the fact that breast-feeding reduces their risk of breast, uterine and ovarian malignancies.

“It just so happens that breast-feeding benefits many of the same systems that are adversely affected by cancer treatment,” says James Klosky, PhD, of St. Jude Psychology. “We’re not saying that it’s the cure-all for the late effects encountered by childhood cancer survivors, but it appears reasonable that the benefits of breast-feeding in the healthy population should generalize to the childhood cancer population.”

Challenges for survivors

Klosky and Ogg study the issues surrounding lactation and survivorship. Among their findings, published recently in the Journal of Cancer Survivorship, is the realization that many childhood cancer survivors are physically unable to breast-feed.

Former St. Jude patient Victoria Boren is one of those survivors. After undergoing treatment for acute lymphoblastic leukemia (ALL) at St. Jude, Victoria encountered late effects ranging from chronic fatigue syndrome and fibromyalgia to cardiomyopathy, an enlarged heart. Because the medicine Victoria required to treat her heart condition might pass through her breast milk to her infant, doctors discouraged her from nursing her son, Parker.

“I had been planning on breast-feeding because it makes the mom and baby healthier,” she explained. “I knew it would boost Parker’s immune system, would help us to bond and would help prevent postpartum depression. I was disappointed that I couldn’t do it. I definitely hope to breast-feed if we have another baby.”

Other childhood cancer survivors sometimes discover that the surgery or radiation used to cure their disease may have damaged their pituitary glands or caused other issues that affect lactation. In an Australian study of women who received high-dose cranial irradiation for the treatment of childhood ALL, only 17 percent were able to breastfeed their children. In another study, 66 percent of Hodgkin lymphoma survivors reported successful lactation.

Baby, oh baby!

Ogg emphasizes the need to educate community physicians about the advantages of breast-feeding as well as about the lactation challenges experienced by some cancer survivors. Most of the benefits to infants are well known: Breast-fed babies have a lower risk of sudden infant death syndrome, infections and conditions ranging from asthma and obesity to diabetes. But many parents are unaware that infants who are breast-fed for more than six months have a significantly lower risk of ALL, Hodgkin lymphoma and non-Hodgkin lymphoma, as compared to babies who were not breast-fed.

“Moms who have survived childhood cancer do not want their children to go through what they endured,” Ogg says. “Anything they can do to protect their children is psychologically beneficial to the survivors. It makes them feel like they’re empowered to help their children avoid some of the same disease processes that they had to suffer.”

Klosky and Ogg are already pursuing further research on the topic. They are interested in exploring whether women who had specific types of treatment are at significantly increased risk for lactation problems. In addition, the team wants to examine the specific physiological changes that occur in mothers who have breast-feeding challenges. A retrospective study within the St. Jude After Completion of Therapy Clinic  will allow women to report their experiences. Plans are also in the works to educate primary care providers about the risks faced by adult survivors of childhood cancer.

Klosky says that this research has implications for cancer survivors around the globe. “If you’re a mother, breast-feeding is something that has benefits, but no known risks,” he says. “It’s something that you may be able to do—regardless of whether you live in India or China or Argentina. There’s really no down side to it, and the benefits are numerous. So why not try it?”

Promise magazine, Summer 2011

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