Management of breast cancer during pregnancy

Padmagirison, Radhika; Gajjar, Ketan; Spencer, Chris

doi:10.1576/toag.12.3.186.27601

Cited by 15 publications

(40 citation statements)

References 57 publications

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“…1 It accounted for 3.3% to 10% of women diagnosed with pre-menopausal breast cancer. 2,5 Meta-analysis has shown that risk of death is more than 40% in women with PABC compared with those with non-PABC (pooled hazard ratio=1.44; 95% confidence interval, 1.27-1.63), but other epidemiological studies have shown no direct relationship between pregnancy and mortality. 8 Moreover, the prognosis of patients with breast cancer during pregnancy is similar to that of non-…”

Section: Epidemiologymentioning

confidence: 99%

“…2,5,9 They also have a lower incidence of positive hormone receptor status. 3 Placental metastasis is rare but indicates poor maternal prognosis.…”

Section: Histopathologymentioning

confidence: 99%

“…2,15 Nipple discharge and 'milk rejection' sign, ie refusal by the infant to nurse from a diseased breast, can be signs of underlying occult carcinoma, but are not frequent. 13,14 Ultrasonography (USG) is the first imaging modality following clinical examination to assess a discrete lump.…”

Section: Diagnosismentioning

confidence: 99%

“…13 There are also no safety data regarding the use of gadolinium in pregnancy, 15 and fetal abnormalities have been noted in rats exposed to gadolinium. 2 To complete triple assessment, core needle or excision biopsy is the gold standard for tissue diagnosis. Histological grade, receptor status, and human epidermal growth factor receptor 2 (HER2) information should be obtained, just as for nonpregnant patients.…”

Section: Diagnosismentioning

confidence: 99%

“…1 It is the most common malignancy associated with pregnancy and the incidence is expected to rise in high-income countries. [2][3][4] Historically, this disease entity was thought to have a worse prognosis when compared with patients diagnosed with cancer in the non-pregnant state and termination of pregnancy was common. Here, we reviewed recent publications and summarised the most recent information.…”

Section: Introductionmentioning

confidence: 99%

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Current management of pregnancy-associated breast cancer

Cheung

Leung

et al. 2017

Hong Kong Med J

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A B S T R A C TPregnancy-associated breast cancer is the most common malignancy during pregnancy with an expected rise in incidence. The belief in the need for termination of pregnancy and that chemotherapy is contra-indicated during pregnancy is challenged by recent evidence. Patients can consider breastconserving surgery and sentinel lymph node biopsy with acceptably low fetal risk from radiation exposure. A range of chemotherapeutics is possible in the second trimester in terms of drug class and frequency. Hormonal therapy and monoclonal antibody therapy are contra-indicated during pregnancy and lactation. Fetal outcome after inutero exposure to chemotherapy appears similar to that in a non-pregnant population. Future pregnancy, in most situations, does not appear to be contra-indicated but a multidisciplinary and patient-centred approach is recommended. Fertility preservation techniques are also being developed Current management of pregnancy-associated breast cancer

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Section: Epidemiologymentioning

confidence: 99%

“…2,5,9 They also have a lower incidence of positive hormone receptor status. 3 Placental metastasis is rare but indicates poor maternal prognosis.…”

Section: Histopathologymentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Current management of pregnancy-associated breast cancer

Cheung

Leung

et al. 2017

Hong Kong Med J

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Current approaches in the clinical management of pregnancy-associated breast cancer—pros and cons

et al. 2018

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Malignancies are one of the leading causes of mortality in women during their reproductive life. Treatment of gynecological malignant tumors during pregnancy is possible but not simple, since it creates a conflict between care of the mother and the fetus. BC is the most prevalent malignancy diagnosed in pregnancy, ranking up to 21% of all pregnancy-related malignancies. Due to its stets increasing prevalence, aggressive cancer subtype, and severe ethical and psychological aspects linked to the disease, experts raise an alarm for an acute necessity to improve the overall management of the PABC-the issue which has strongly motivated our current paper. Comprehensive research data and clinical experience accumulated in recent years have advanced our understanding of the disease complexity. PABC treatment must be individualized with an emphasis on optimal care of the mother, while observing standard treatment protocols with regard to safety of the fetus. Treatment protocols should be elaborated based on the individualized patient profile, bearing in mind the acute danger to the mother, maximizing the therapy efficacy and minimizing harmful effects to the fetus. Complex consulting on treatment options, their impacts on pregnancy and potential teratogenic effects requires tight "doctor-patient" collaboration. Complications that may arise due to the treatment of breast cancer in pregnancy require a multiprofessional expertise including oncologists, neonatologists, perinatologists, obstetricians, teratologists, and toxicologists, and an extensive psychological support throughout the pregnancy and after giving birth. Thereby, specifically psychological aspects of PABC diagnosis and follow-up are frequently neglected, being not yet adequately explored in the entire disease management approach. Herewith, we update the status quo regarding the currently available diagnostic modalities, complex treatment algorithms, and novel clinical approaches which altogether argue for an urgent necessity of a paradigm shift moving away from reactive to predictive, preventive, and personalized medical approach in the overall management of PABC meeting the needs of young populations, persons at high risk, affected patients, and families as the society at large.

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