Early Breast Cancers During Pregnancy Treated With Breast-Conserving Surgery in the First Trimester of Gestation: A Feasibility Study

Abstract

Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.

The molecular landscape of breast mucoepidermoid carcinoma

“…In these patients, if high‐risk features are detected (e.g., large tumor size, high histologic grade, high Ki67 index, lymph‐vascular invasion) surgery with sentinel lymph node are still recommended 61–63 . On the other hand, MECs without any of the aforementioned characteristics, breast‐conserving surgery with clear margins would suffice to avoid overtreatment 64–66 . In both scenarios, it is wise to adopt tailored follow‐up procedures 67–69 .…”

“… 61 , 62 , 63 On the other hand, MECs without any of the aforementioned characteristics, breast‐conserving surgery with clear margins would suffice to avoid overtreatment. 64 , 65 , 66 In both scenarios, it is wise to adopt tailored follow‐up procedures. 67 , 68 , 69 Similarly, the de‐escalation of adjuvant medical treatment, including chemotherapy, immunotherapy, targeted therapies, and radiotherapy requires a multidisciplinary approach.…”

Pathological examination of breast cancer samples before and after neoadjuvant therapy: recommendations from the Italian Group for the Study of Breast Pathology - Italian Society of Pathology (GIPaM-SIAPeC)

“…Pathologists must be fully aware of the recommended procedures for an accurate assessment of tumor response to NAT, including the evaluation of all the relevant parameters that correlate with long-term prognosis and inform the subsequent adjuvant interventions. Another important aspect that warrants particular attention is the role of BCS in these patients 4 , 53 , 54 . Indeed, this approach leads not only better overall prognosis, but also to improvement of the esthetic result, reduction of psychological burden, lower incidence of post-surgical complications, reduction in time of execution of the intervention (and anesthesia), cost-effectiveness for the National Health System, and ultimately improving the health-related quality of life of breast cancer survivors 7 , 8 , 55-59 .…”

Immune plasticity in pregnancy-associated breast cancer tumorigenesis

“…The occurrence of cancer during pregnancy is a rare event; however, pregnancy-associated breast cancer (PrBC) represents one of the most common malignancies occurring during pregnancy showing increasing incidence rates in recent years (Shao et al ., 2020; Lambertini et al ., 2021). This condition accounts for around 4% of breast cancers in women of childbearing age and generally exhibits an aggressive clinical course requiring complex and delicate clinical management (Chelmow et al ., 2020; Poggio et al ., 2020; Blundo et al ., 2021). Existing data in the literature suggest that when patients with PrBC receive standard treatments, they experience comparable clinical outcomes with other young non-pregnant patients (Anderson et al ., 2022); however, caution is being paid on the biological mechanisms inhibited by the therapeutical regimens in order to preserve maternal and fetal health avoiding adverse outcomes (Margioula-Siarkou et al ., 2023).…”