Patient actively breastfeeding. Most antineoplastic agents transfer into breast milk at c...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-LACTATION-ACTIVE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-NCCN-BCELL-2025` `SRC-NCCN-BREAST-2025`

Red Flag Origin

Definition	Patient actively breastfeeding. Most antineoplastic agents transfer into breast milk at clinically relevant concentrations. Triggers lactation suspension (with cabergoline if indicated) before treatment start, or postponement of treatment if oncologically safe.
Clinical direction	hold
Category	reproductive-status

Trigger Logic

{
  "any_of": [
    {
      "finding": "lactation_active",
      "value": true
    },
    {
      "finding": "breastfeeding",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

LactMed (NIH database) categorizes drugs by lactation safety. Almost all chemotherapy: hold breastfeeding for treatment + 1-2 weeks after last dose (variable by half-life — methotrexate 1 week, anthracyclines 10 days, taxanes 7 days). Tamoxifen, aromatase inhibitors, ICI — hold breastfeeding throughout treatment. Anti-CD20 (rituximab, obinutuzumab) — small molecular size, low milk transfer, but precaution warranted for at least 6 months given long half-life and infant B-cell development. Cabergoline 1 mg single dose for lactation suppression if patient consents. Direction `hold` — flags lactation cessation rather than alternative oncologic indication.

Used By

No reverse references found in the YAML corpus.