Being Pregnant and Diagnosed with Breast Cancer

Abstract

Breast cancer during pregnancy (BCP) is an important subgroup within the young and very young breast cancer patients. It accounts for about 1% of all breast cancers. Due to an increased awareness, the attitude towards breast cancer during pregnancy has changed and, today, women with BCP are more likely to receive standard chemotherapy and have a term delivery instead of being advised to interrupt the pregnancy or undergo an early preterm delivery. This increased knowledge is based on small cohort studies and international collaborations such as the registry by the German Breast Group for BCP and the initiative of the European Society of Gynaecological Oncology (ESGO). Guidelines and recommendations such as the German guidelines by the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie, www.ago-online.org) and the National Comprehensive Cancer Network (NCCN) guidelines include recommendations for BCP. In general, surgery and chemotherapy (beyond the 13th week of gestation) can be safely performed during pregnancy. Chemotherapy should follow the treatment recommendations for breast cancer in young women. Trastuzumab, endocrine treatment, and radiotherapy are not indicated during pregnancy. Preterm delivery should be avoided as far as possible because it bears a higher risk of infant morbidity and mortality. The treatment of BCP should be planned within a multidisciplinary team including perinatologists, obstetricians and neonatologists.

Frequency of Pregnancy Related Cancer

“…2 It is generally reported that it accounts for about one third of all pregnancy-related cancers. We confirm this finding.…”

Misconceptions surrounding pregnancy-associated breast cancer

“…Compared with other types of breast cancers, a prognosis of this subtype is poorer due to fewer therapeutic options being available 11. Generally, younger women diagnosed with breast cancer tend to have this more aggressive form of cancer compared with older women, with over 90% of under the 40s being diagnosed with an invasive ductal carcinoma, mostly undifferentiated and most without receptor expression 12…”

“…These include postponing chemotherapy until the second and third trimester, avoiding radiotherapy and hormonal therapy until post partum and ensuring chemotherapy is stopped a month before delivery. Furthermore, the literature recommends that delivery of the baby should be as close to term as possible, with worse fetal prognoses recorded in early preterm deliveries 12. These proposals aim to optimise the outcomes of both the mother and the fetus.…”

Trastuzumab in der Behandlung schwangerer Mammakarzinompatientinnen – ein Literaturüberblick

“…Bildgebende Verfahren zum Staging des Mammakarzinoms während der Schwangerschaft sind dann indiziert, wenn sie nachfolgende therapeutische Strategien beeinflussen. Wird das Risiko für Metastasen als gering eingeschätzt, besteht grundsätzlich auch die Möglichkeit, Staginguntersuchungen erst nach der Entbindung durchzuführen und somit den Fetus keinen unnötigen Strahlenrisiken auszusetzen [4,22].…”