Pregnancy associated breast cancer
Introduction
Breast carcinoma is one of the most commonly diagnosed cancers during the pregnancy. Pregnancy associated breast cancer (PABC) is defined as one that is diagnosed during pregnancy or up to 1 year postpartum. It has been estimated that up to 3% of breast cancers may be diagnosed in pregnant women.1 The incidence of breast cancer increases with age, and it has been hypothesized that the incidence of breast cancer diagnosed during pregnancy will increase as more women delay childbearing.2, 3
Nowadays, obstetricians are seeing increasing numbers of women who are pregnant with breast cancer. The diagnosis may be delayed and difficult owing to the physiological changes within the breast. Once diagnosis has been confirmed, options for treatment will be influenced by the need to give optimal treatment to the mother whilst minimising risks to the foetus.4
Scarce data available suggest that the pregnancy termination does not improve the outcome for pregnant women with breast cancer5, 6, 7, 8 and chemotherapy treatment can be safely administered to women within the second and third trimester of pregnancy.9, 4, 10 Therefore, we might offer to pregnant women with breast cancer the same goal as that for the non-pregnant breast carcinoma patient: local control of disease and prevention of systemic metastases.11
Breast carcinoma is optimally treated when diagnosed early. However, pregnancy associated breast cancer, usually presents as an advanced stage. In spite of multiple opportunities for clinical breast examinations arising from the increased frequency of physician visits, examination of the breast during pregnancy is hampered by hypertrophy of the gland. Moreover, densities and nodularities in the breast of pregnant women are often overlooked or ascribed to benign proliferative changes.11
The aim of this study was to evaluate retrospectively our single-institution experience focusing on clinicopathologic and immunohistochemical features, therapeutic management and foetal outcome of 22 patients affected by breast cancer during pregnancy.
Section snippets
Patients and methods
This retrospective descriptive analysis includes 22 patients with pregnancy associated breast cancer, treated at our hospital between 1996 and 2006.
The patients' medical records were reviewed to check family history for breast cancer or ovarian cancer, previous parity, maternal age and foetal gestation age at diagnosis, clinical presentation, radiographic results, clinical stage, and follow-up. Immunohistochemical evaluation of proliferative fraction (ki67), receptor hormonal status (ER & PR),
Clinical results
Seventeen patients were diagnosed during pregnancy and five were diagnosed during lactation. In the breast cancer during pregnancy group, six were diagnosed in the first trimester, four during the second and seven during the third. All the six patients who had a concurrent diagnosis of breast cancer and pregnancy (first trimester) decided to treat breast cancer after a careful discussion of all the available options.
Patients' age ranged from 26 to 40 years (Mean age 34 years). Foetal gestation
Discussion
The incidence of breast carcinoma occurring in association with pregnancy ranges from 0.2 to 4%. The concomitant diagnosis of pregnancy and breast cancer is a difficult time for women as complexities regarding the health of mother and foetus must be made. Traditionally, pregnancy associated breast cancer is defined as the breast cancer diagnosed during pregnancy or up to 1 year postpartum. In our opinion, patients with breast cancer during pregnancy do not represent the same situation than
Conflict of interest
The authors have no conflict of interest.
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Effects of cancer treatment during pregnancy on fetal and child development
2017, The Lancet Child and Adolescent HealthCitation Excerpt :Prematurity, particularly late preterm birth (onset of labour 34 weeks to 36 weeks and 6 days), is the most commonly reported neonatal outcome: a mean gestational age at birth of 35·8 weeks (SD 2·8) was reported in 157 chemotherapy-exposed neonates born to mothers enrolled in the Pregnancy and Cancer Registry between 1995 and 2008.38 Similar findings were described in most published studies and case series on infants born to pregnant mothers with cancer.17,18,37,44–46 Prematurity is the main determinant of early neonatal morbidities and later neurodevelopmental impairment: the more immature the infant, the higher the risk of postnatal complications and impaired long-term outcome.
Malignancies in pregnancy
2016, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Indications for chemotherapy should be the same as those for nonpregnant women, taking into consideration the gestational age at diagnosis as chemotherapy should generally not be initiated in the first trimester. The largest experience with chemotherapeutic agents in pregnancy has been with anthracycline antibiotics, alkylating agents, and taxanes, and available data support their safety [64–69]. Iftaxane chemotherapy is used; weekly administration of paclitaxel after the first trimester is preferred [59].
Taxanes for Breast Cancer during Pregnancy: A Systematic Review
2013, Clinical Breast CancerCitation Excerpt :The mean (SD) weight of babies at delivery was 2380 ± 473 g (median, 2410 g; range, 1417-3200 g). In the majority (76.7%) of cases, a completely healthy neonate (23 of 30 neonates) was born10-22,24; whereas, in the remaining cases, a neonate who was dystrophic and premature17; a newborn with mild hydrocephalus19; one with signs of bacterial sepsis12; a neonate with hyperbilirubinemia24; a newborn with apnea of prematurity, respiratory distress syndrome, and gastroesophageal reflux24; a newborn with meconium-stained fluid24; and a neonate with neutropenia and pyloric stenosis24 were reported. Twenty-seven (90%) of 30 children were completely healthy, with a median follow-up of 16 months10-22,24; in the remaining cases, one child with recurrent otitis media,24 one child with immunoglobulin A deficiency and mild constipation,24 and another child with delayed speech were reported.
Cancer treatment in pregnancy
2023, Current Topics in Perinatology and Neonatology