Pregnancy-associated breast cancer - diagnosis, treatment and outcomes for women and their offspring

Martyna Maria Zielińska, Natalia Zarankiewicz, Aleksandra Kuchnicka, Katarzyna Kosz, Bogumiła Ciseł

DOI: http://dx.doi.org/10.12775/JEHS.2020.10.08.029

Abstract


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.  


Keywords


pregnancy-associated breast cancer; breast cancer; prognosis; pregnancy; breast cancer treatment

Full Text:

PDF

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


Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM




Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014

https://pbn.nauka.gov.pl/sedno-webapp/search?search&searchCategory=WORK&filter.inJournal=36616

POL-index 2011 - 2014

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-32a319c5-a850-4f44-ba70-1418a6087655

BASE 2011 - 2014

https://www.base-search.net/Search/Results?lookfor=Journal+of+Health+Sciences+%28Radom%29&type=all&oaboost=1&ling=1&name=&thes=&refid=dcrespl&newsearch=1

http://elibrary.ru/contents.asp?titleid=37467

http://journal.rsw.edu.pl/index.php/JHS/issue/archive

Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska, EuroPub database, NLM Catalog Result - NCBI, BASE, Russian Sciences Index, Arianta.

https://zdb-katalog.de/title.xhtml?idn=1080187162

https://europub.co.uk/journals/22625

US NLM = 101679844

101679844 - NLM Catalog Result - NCBI

https://www.ncbi.nlm.nih.gov/nlmcatalog/101679844

Find a library that holds this journal: http://worldcat.org/issn/23918306

 

PBN Poland

https://pbn.nauka.gov.pl/sedno-webapp/journals/49068

POL-index

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-c39c8169-88d2-45db-9e7f-d948ce9981c4

BASE

https://www.base-search.net/Search/Results?join=AND&bool0[]=AND&lookfor0[]=2391-8306&type0[]=all&page=11&l=pl&oaboost=1&refid=dcpagepl

Redaction, Publisher and Editorial Office

Publisher and Editorial Office
Department of Physical Culture,
Faculty of Earth Sciences and Spatial Management,
Nicolaus Copernicus University in Toruń, Poland
Address: Str. Lwowska 1, 87-100 Toruń, Poland

  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at https://dbh.nsd.uib.no/publiseringskanaler/erihplus/periodical/info?id=485984

Indexed in Index Copernicus Journals Master List.

http://journals.indexcopernicus.com/Journal+of+Education+Health+and+Sport,p24782242,3.html

ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

RG Journal Impact: 0.18 *

*This value is calculated using ResearchGate data and is based on average citation counts from work published in this journal. The data used in the calculation may not be exhaustive.

RG Journal impact history

2020Available summer 2021
2018 / 20190.18
20170.07
20160.03

RG Journal impact over time

RG Journal impact
0.180.160.140.120.100.080.060.040.02201620172018
  

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (https://pbn.nauka.gov.pl/journals/36616)

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ) http://elibrary.ru/contents.asp?titleid=37467

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski

(http://www1.bg.us.edu.pl/bazy/czasopisma/czasop_full.asp?id=3595)

Partnerzy platformy czasopism