Breast cancer diagnosed during pregnancy and lactation: biological features and treatment options

Gentilini, Oreste; Masullo, Michele; Rotmensz, Nicole; Peccatori, Fedro Alessandro; Mazzarol, Giovanni; Smeets, Ann; Simsek, Serife; Dosso, Sara De; Veronesi, Paolo; Intra, Mattia; Zurrida, Stefano; Viale, Giuseppe; Goldhirsch, Aron; Veronesi, Umberto

doi:10.1016/j.ejso.2004.11.012

Cited by 63 publications

(36 citation statements)

References 17 publications

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“…Additionally, there is a higher frequency of lymphovascular invasion, high nuclear grade, and hormone independence. These histopathologic and immunohistochemical features are similar to those of nonpregnant young women with breast cancer, and they are felt to be determined by the age of diagnosis rather than pregnancy [4,25,26].…”

Section: Prognosismentioning

confidence: 74%

Pregnancy-Associated Breast Cancer: A Literature Review

Barnes

Newman

2007

Surgical Clinics of North America

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Breast cancer, along with cervical cancer, is one of the most commonly diagnosed cancers of pregnancy. Most would define gestational breast cancer as breast cancer that is diagnosed during pregnancy, lactation, and up to 12 months post-partum. The diagnostic and therapeutic implications in this clinical setting are special. These women typically present with a more advanced-stage disease that carries an associated poorer prognosis. Physicians thus are challenged to balance aggressive maternal care with appropriate modifications that will ensure fetal protection. . Of women diagnosed with breast cancer younger than 40 years, only approximately 10% will be pregnant [2,3]. These data certainly suggest a low incidence of pregnancy-associated breast cancer. In fact, historically, the incidence is estimated at 1 in 3000 pregnancies [4][5][6]. Despite the overall low incidence, however, gestational breast cancer is one of the most common pregnancy-associated malignancies, second only to cervical cancer [4,6]. Notably, many have offered that this incidence will only increase as more women delay childbearing until later in life [4,7]. This concern is based on the fact that pregnancy-associated breast cancer is age-related, and women

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Section: Prognosismentioning

confidence: 74%

Pregnancy-Associated Breast Cancer: A Literature Review

Barnes

Newman

2007

Surgical Clinics of North America

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“…The panel of the Consensus Conference on the role of SLNB in breast carcinoma advised against SLNB in pregnant women until more data are available [31]. So far, sentinel biopsy should not be used as standard in pregnant women [34].…”

Section: Local Therapymentioning

confidence: 99%

Review: breast cancer and pregnancy

Bauerfeind

Lenhard

Kahlert

et al. 2005

Eur Clinics Obstet Gynaecol

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With an incidence of 0.3-1 per 10,000 pregnancies, breast cancer is the second most common malignant disease (after cervical cancer) associated with pregnancy. Because evidence-based data are lacking, current recommendations derive from nonrandomized experiences. We reviewed the current literature on breast cancer during pregnancy and pregnancy-associated breast cancer. The diagnosis of breast cancer during pregnancy is often made at an advanced stage with limited prognosis. With a few limitations, surgery and chemotherapy can be performed during pregnancy, whereas radiotherapy should be postponed until after delivery. Reports of endocrine treatment during pregnancy are rare and disappointing, but it should be applied after delivery in estrogen/progesterone-receptorpositive cases. Breast cancer during pregnancy remains a multidisciplinary challenge in both therapeutic and ethical aspects. Because experience and guidelines are lacking, individual decisions after intensive discussions with the pregnant patient are necessary.

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“…In a recent review, the axillary lymph node dissection is advocated as opposed to sentinel lymph node biopsy [7]. However, according to others, we believe that it can be performed safely [8,9], since -even with normal intra-tumoural dosage -the dose to the foetus is proven to be negligible [9]. We used a dose Correspondence to: E. J. Th.…”

Section: Discussionmentioning

confidence: 99%

Breast cancer and pregnancy: diagnosis and treatment options

Velde

Sonke

Rutgers

2009

Breast Cancer Online

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A 36-year-old woman had noticed a lump in her right breast, just after she had discovered she had been pregnant for about 6 weeks. At referral to our clinic, on physical examination a palpable mass was found in the upper quadrant of her right breast, sized 2 cm in diameter.Diagnostic mammography and ultrasound were performed elsewhere and showed an uncertain density on mammography and an uncertain hypoechoic structure on ultrasound cranial to the righter mammilla, sized 15 mm in diameter. Utrasound of the axilla showed no suspected lymph nodes. A core biopsy proved an adenocarcinoma.After discussing the different options, the patient preferred a skin-sparing mastectomy with nipple banking and sentinel node biopsy. The sentinel node was retrieved by 85 MBq technetium-99m nanocolloid intra-tumoural injection, without using blue dye.At histopathology the tumour was T1 (15 mm) in size, B&R grade II; the sentinel node was tumournegative after multiple slicing and IHC staining with Cam 5.2; oestrogen receptor was 100% positive and progestin receptor was 100% positive; HER2-neu was negative. The margins were free. The Mammaprint s showed a low-risk signature, that is no distant metastases within at least 5 years.Since the patient was in her first trimester of pregnancy, and the child was very much desired, finally, the patient opted for endocrine therapy. She will receive tamoxifen and ovarian suppression by LHRH agonist after her child delivery. She decided not to have adjuvant chemotherapy, particularly considering the high hormone responsiveness of the tumour and the Mammaprint low risk. In addition, due to her young age, she was referred to the genetic counselling department. DiscussionBreast cancer is the second most common cancer in pregnant women. The prognosis of breast cancer is independent of the pregnancy, and termination of the pregnancy is not indicated [1]. Surgery is not contraindicated during the first trimester, but could be associated with low birth weight or premature labour [2].Skin-sparing mastectomy was chosen over breast-conserving surgery in this patient to prevent radiotherapy during her pregnancy, as well as considering the higher local relapse rates after breast-conserving treatment in young women [3,4]. In younger women, 10-years risk of recurrence of 20% can be reduced to 10% by radiotherapy boost [5]. However, older radiation courses showed to be dangerous to the foetus [6], and although no data exist on effects of modern radiotherapy, it is not advised in the first trimester until after delivery (Dutch guidelines: http://www.oncoline.nl).The sentinel node biopsy was performed using a lower dose of nanocolloid than usual. In a recent review, the axillary lymph node dissection is advocated as opposed to sentinel lymph node biopsy [7]. However, according to others, we believe that it can be performed safely [8,9], since -even with normal intra-tumoural dosage -the dose to the foetus is proven to be negligible [9]. We used a dose Correspondence to: E. J. Th. Rutgers, The

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Breast cancer diagnosed during pregnancy and lactation: biological features and treatment options

Cited by 63 publications

References 17 publications

Pregnancy-Associated Breast Cancer: A Literature Review

Pregnancy-Associated Breast Cancer: A Literature Review

Review: breast cancer and pregnancy

Breast cancer and pregnancy: diagnosis and treatment options

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