Pregnancy-associated breast cancer - diagnosis, treatment and outcomes for women and their offspring
DOI:
https://doi.org/10.12775/JEHS.2020.10.08.029Keywords
pregnancy-associated breast cancer, breast cancer, prognosis, pregnancy, breast cancer treatmentAbstract
Introduction: Pregnancy-associated breast cancer (PABC) is the most common malignancy in pregnant women with an incidence of 1 in 3-10 thousand pregnancies. It is mostly defined as breast cancer diagnosed during pregnancy or within 1 year postpartum. The number of PABCs is going to raise due to the trend of delaying childbearing.
Purpose: This review summarizes data on the occurrence and characteristics of PABC. The analysis comprises diagnosis and proper treatment of BC during pregnancy. Prognosis of women and their offspring are emphasized.
Material and methods: The review is based on publications mainly from 2010 to 2019 and 5 articles from 1994-2008 collected on the PubMed.
Results: The sensitivity of breast ultrasonography (USG) in pregnancy is 70-100% and it is considered as safe for the fetus. Staging evaluation in pregnant women consists of chest x-ray, liver USG and non-contrast bone MRI. 71-88% of PABCs are invasive ductal carcinomas. Treatment consists of breast surgery regardless of time and optionally, chemotherapy from the 2nd trimester. Radiotherapy, tamoxifen and trastuzumab are contraindicated in PABC. Therapeutic abortion does not improve oncological outcome. Overall prognosis is similar for both pregnant and non-pregnant patients with similar type and stage of BC. The rate of congenital malformations is 1,3% for both children of PABC patients treated with chemotherapy and born from women without chemotherapeutic treatment. The most frequent obstetrical complication of PABC treatment is preterm delivery.
Conclusions: Pregnancy does not impact oncologic outcome, if the treatment is appropriate. PABC patients have survival rates consistent with the stage of disease. Proper treatment of PABC does not increase the risk of congenital malformations and is relatively safe for the fetus.
References
Pugh AM, Giannini CM, Pinney SM, Hanseman DJ, Shaughnessy EA, Lewis JD. Characteristics and diagnosis of pregnancy and lactation associated breast cancer: Analysis of a self-reported regional registry. Am J Surg. 2018;216(4):809-812. doi: 10.1016/j.amjsurg.2018.07.060.
Lambe M, Hsieh CC, Trichopoulos D, Ekbom A, Pavia M, Adami HO. Transient increase in the risk of breast cancer after giving birth. N Engl J Med. 1994;331:5-9.
Ruiz R, Herrero C, Strasser-Weippl K, Touya D, St Louis J, Bukowski A et al. Epidemiology and pathophysiology of pregnancy-associated breast cancer: A review. Breast. 2017;35:136-141. doi: 10.1016/j.breast.2017.07.008.
Martinez MT, Bermejo B, Hernando C, Gambardella V, Cejalvo JM, Lluch A. Breast cancer in pregnant patients: A review of the literature. Eur. J. Obstet. Gynecol. Reprod. Biol. 2018;230:222-227. doi.org/10.1016/j.ejogrb.2018.04.029.
Becker S. Breast cancer in pregnancy: A brief clinical review. Best Pract Res Clin Obstet Gynaecol. 2016;33:79-85. doi: 10.1016/j.bpobgyn.2015.10.013.
Córdoba O, Llurba E, Saura C, Rubio I, Ferrer Q, Cortés J et al. Multidisciplinary approach to breast cancer diagnosed during pregnancy: maternal and neonatal outcomes. Breast. 2013;22(4):515-9. doi: 10.1016/j.breast.2012.10.005.
Cordeiro C, Gemignani M. Breast Cancer in Pregnancy: Avoiding Fetal Harm When Maternal Treatment Is Necessary. Breast J. 2017;23(2):200–205. doi:10.1111/tbj.12780.
Langer A, Mohallem M, Stevens D, Rouzier R, Lerebours F, Cherel P. A single-institution study of 117 pregnancy-associated breast cancers (PABC): Presentation, imaging, clinicopathological data and outcome. Diagn Interv Imaging. 2014;95(4):435–41. doi: 10.1016/j.diii.2013.12.021.
Kanal E, Barkovich AJ, Bell C, et al. ACR guidance document for safe MR practices: 2007. A J Roentgenol. 2007;188:1447-1474. doi: 10.2214/AJR.06.1616.
Amant F, Loibl S, Neven P, Van Calsteren K. Breast cancer in pregnancy. Lancet Oncol. 2012;379:570-579. doi: 10.1016/S1470-2045(11)70363.-1.
Gropper AB, Zabicki Calvillo K, Dominici L, Troyan S, Rhei E, Economy KE et al. Sentinel Lymph Node Biopsy in Pregnant Women With Breast Cancer. Ann Surg Oncol. 2014;21(8):2506-2511. doi: 10.1245/s10434-014-3718-2.
Genin AS, Lesieur B, Gligorov J, Antoine M, Selleret L, Rouzier R. Pregnancy-associated Breast Cancers: Do They Differ From Other Breast Cancers in Young Women? Breast. 2012;21(4):550-555. doi: 10.1016/j.breast.2012.05.002.
Genin AS, Rycke Y, Stevens D, Donnadieu A, Langer A, Rouzier R et al. Association With Pregnancy Increases the Risk of Local Recurrence but Does Not Impact Overall Survival in Breast Cancer: A Case-Control Study of 87 Cases. Breast. 2016;30:222-227. doi: 10.1016/j.breast.2015.09.006.
Zagouri F, Sergentanis TN, Chrysikos D, Papadimitriou CA, Dimopoulos MA, Bartsch R. Trastuzumab administration during pregnancy: a systematic review and meta-analysis. Breast Cancer Res Treat. 2013;137(2):349–357. doi:10.1111/tbj.12780.
Grimm D, Woelber L, Trillsch F, Keller-v Amsberg G, Mahner S. Clinical management of epithelial ovarian cancer during pregnancy. Eur J Cancer. 2014;50(5):963–971. doi: 10.1016/j.ejca.2013.12.020.
Fajdic J, Gotovac N, Hrgovic Z, Fassbender WJ. Diagnosis and therapy of gestational breast cancer: a review. Adv Med Sci. 2008;53(2):167–171. doi: 10.1111/tbj.12780
Lohsiriwat V, Peccatori FA, Martella S, Azim HA Jr, Sarno MA, Galimberti V et al. Immediate breast reconstruction with expander in pregnant breast cancer patients. Breast. 2013;22(5):657– 660. doi: 10.1016/j.breast.2013.06.005.
Loibl S, Schmidt A, Gentilini O, Kaufman B, Kuhl C, Denkert C et al. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA Oncol. 2015;1(8):1145-1153. doi: 10.1001/jamaoncol.2015.2431
Toesca A, Gentilini O, Peccatori F, Azim HA, Amant F. Locoregional treatment of breast cancer during pregnancy. Gynecol Surg. 2014;11:279–284. doi: 10.1007/s10397-014-0860-6.
Azim Jr. HA, Del Mastro L, Scarfone G, Peccatori FA. Treatment of breast cancer during pregnancy: regimen selection, pregnancy monitoring and more. Breast. 2011;20:1–6. doi.org/10.1016/j.breast.2010.10.008
Amant F, Van Calsteren K, Halaska MJ, Gziri MM, Hui W, Lagae L, et al. Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study. Lancet Oncol. 2012;13(3):256–264. doi: 10.1016/S1470-2045(11)70363-1.
Hahn KM, Johnson PH, Gordon N. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer. 2006;107(6):1219–1226. doi: 10.1002/cncr.22081
Framarino-dei-Malatesta M, Piccioni MG, Brunelli R, Iannini I, Cascialli G, Sammartino P. Breast cancer during pregnancy: a retrospective study on obstetrical problems and survival. Eur J Obstet Gynecol Reprod Biol. 2014;173:48-52. Doi.org/10.1016/j.ejogrb.2013.11.017
Guidroz JA, Scott-Conner CE, Weigel RJ. Management of pregnant women with breast cancer. J Surg Oncol 2011;103:337-340. doi: 10.1002/jso.21673
Amant F, Brepoels L, Halaska MJ, Gziri MM, Calsteren KV. Gynaecologic cancer complicating pregnancy: an overview. Best Pract Res Clin Obstet Gynaecol. 2010;24(1):61–79. doi: 10.1016/j.bpobgyn.2009.08.001
Aviles A, Neri N. Hematologic malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2001;2(3)173–177. doi: 10.3816/CLM.2001.n.023
Maor GS, Czuzoj-Schulman N, Spence AR, Abenhaim HA. Neonatal outcomes of pregnancy-associated breast cancer: Population-based study on 11 million births. Breast J. 2019;25(1):86-90. doi: 10.1111/tbj.13156
Peccatori FA, Azim HA. Managing pregnancy-associated breast cancer: Is more really better? Breast. 2016;30:215-216. doi: 10.1016/j.breast.2016.06.006
Litton JK, Warneke CL, Hahn KM, Palla SL, Kuerer HM, Perkins GH et al. Case control study of women treated with chemotherapy for breast cancer during pregnancy as compared with nonpregnant patients with breast cancer. Oncologist. 2013;18(4):369–376. doi: 10.1634/theoncologist.2012-0340
Azim HA, Santoro L, Russell-Edu W, Pentheroudakis G, Pavlidis N, Peccatori A. Prognosis of pregnancy-associated breast cancer: A meta-analysis of 30 studies. Cancer Treat Rev. 2012;38(7):834-842. doi: 10.1016/j.ctrv.2012.06.004
Van den Rul N, Han SN, Van Calsteren K, Neven P, Amant F. Postpartum breast cancer behaves differently. Facts Views Vis Obgyn. 2011;3(3):183–188.
Eng Lee G, Mayer EL, Partridge A. Prognosis of pregnancy-associated breast cancer. Breast Cancer Res Treat. 2017;163:417–421. doi: 10.1007/s10549-017-4224-6
Downloads
Published
How to Cite
Issue
Section
License
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 481
Number of citations: 0
