Breast Cancer Diagnosed During Pregnancy

Abstract

Breast cancer during pregnancy (BCP), although rare, is becoming more common and treatment should be as similar as possible to that for nonpregnant young patients with breast cancer. A group of specialists convened to review current guidelines and provide guidance on how recent advances in breast cancer diagnosis and treatment can be adapted for pregnant patients. The majority of patients with BCP will be considered for treatment during the pregnancy. Premature delivery should be avoided whenever possible. Most treatments, including sentinel lymph node biopsy, systemic therapy with taxanes, platinum agents, or dose-dense treatment can be safely given during pregnancy, after careful risk/benefit assessment for mother and child. Chemotherapy is contraindicated during the first trimester because of a higher risk of fetal malformations but is feasible in the second and third trimesters. Other treatments such as radiation therapy or anti-human epidermal growth receptor 2 treatment are in general not indicated during pregnancy but might be considered in some instances. Patient data should be collected in a systematic way whenever possible.

The PREgnancy and FERtility (PREFER) study: an Italian multicenter prospective cohort study on fertility preservation and pregnancy issues in young breast cancer patients

“…PABC is a complex medical situation requiring the involvement of a multidisciplinary team with all different specialties since the early phases [9, 22]. A correct application of the available guidelines for the diagnosis, staging, and treatment of PABC is crucial to manage correctly this critical clinical situation [9, 22].…”

“…A correct application of the available guidelines for the diagnosis, staging, and treatment of PABC is crucial to manage correctly this critical clinical situation [9, 22]. Despite the important advances made in the last years, current guidelines rely on limited evidence and several questions remain unanswered in this field.…”

“…For the management of PABC, physicians are encouraged to follow the national AIOM guidelines on the topic developed from the international guidelines [9, 22]. While the management of women diagnosed within 1 year after delivery should not differ from that of premenopausal patients diagnosed outside pregancy (with the only exception that breastfeeding is contraindicated while receiving anticancer treatments), specific recommendations should be followed for women diagnosed with breast cancer during pregnancy.…”

“…Population-based studies report an overall incidence of PABC ranging between 2.4 to 7.3 per 100,000 pregnancies [17–20]. Although being a relatively rare condition, the issue of PABC might become more common in the coming years due to evidence suggesting that the incidence of breast cancer in young women and the occurrence of PABC are increasing [21, 22]. Moreover, in western countries, there is a current trend of postponing pregnancy to later in life: a recent Italian study in a cohort of more than 2000 women showed that mean maternal age was 33 years with approximately 40% of pregnancies occurring after the age of 35 years [23].…”

“…In the last decade, important advances in the field of managing PABC have been made thanks to the effort of several groups that looked mainly into the safety of administering chemotherapy during pregnancy [25–27]. These important contributions in the field allowed the development of specific guidelines to help physicians in dealing with PABC [9, 22]. However, due to its relative rarity, several aspect of the clinical management of these patients are based on limited evidence and further research efforts are warranted.…”