Pregnancy associated breast cancer

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Abstract

Background

Breast carcinoma during pregnancy put the health of the mother in conflict with that of the foetus. The aim is to give optimal treatment to the mother to maximise the chances of survival, whilst minimising the risk of harm of the foetus.

We report the epidemiology, pathology, clinical picture, therapeutic management and foetal outcome of pregnant women with breast cancer treated in our institution.

Patients and methods

Twenty-two pregnant breast cancer patients were treated in our hospital from January 1996 to October 2006. Parents were surveyed by mail or telephone regarding outcomes of children exposed to chemotherapy in uterus.

Results

The treatment of breast cancer pregnancy should conform as closely as possible to standardised protocols for patients without concomitant pregnancy. Most of the patients underwent surgery during pregnancy In four cases diagnosed during the first trimester chemotherapy was initiated during the 10th week when organogenesis period was finished. None of the children exposed to chemotherapy during this trimester presented congenital malformations. All 11 cases diagnosed during second and third trimester were treated with Doxorrubicin, Fluoracil and Cyclophosphamide and four cases were treated with taxanes. No congenital malformations were detected.

Conclusion

Breast cancer can be treated with FAC chemotherapy during the second and third trimesters without significant complications for the children exposed to chemotherapy in uterus. We report four cases treated with taxanes after the first trimester and no congenital anomalies were observed.

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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