Breast Cancer in Pregnancy

Abstract

Breast cancer in pregnancy will increase as more women postpone childbearing until later in life. Objective: To review the literature on diagnosis, staging, treatment, and prognosis. Design and Methods: Articles were obtained from MEDLINE (1966-present) using the keywords breast, cancer, carcinoma, and pregnancy. Additional articles were sought using the references of those obtained. A total of 171 articles were found, 125 in English. More than 100 were reviewed, including 7 prospective and 40 retrospective studies, 6 case reports, and at least 47 review articles on various aspects of pregnancy and cancer. Data extraction was performed by 1 reviewer. Results: Diagnostic delays are shorter than in the past but remain common. Mammography has a high falsenegative rate during pregnancy. Biopsy or needle aspi

Pregnancy-Associated Breast Cancer: A Literature Review

“…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 who have their first term pregnancy after the age of 30 years have a two to three times higher risk of developing breast carcinoma than women who have their first pregnancy before the age of 20 years [8].…”

“…Notably, both Anderson and colleagues [16] and Ishida and colleagues [9] document no difference in the prognosis of early cancers (when matched for age and stage), but a poorer prognosis is demonstrated for patients with more advanced disease. Numerous studies have documented that these women present with larger tumors and have a higher incidence of lymph node metastases (56% to 89% when compared with 38% to 54% in nonpregnant young women) that appears to translate into a more advanced stage [7][8][9][17][18][19][20][21]. Most women present with stage II or III disease (65% to 90% compared with 45% to 66% of nonpregnant controls) [8,9,17].…”

“…Most women present with stage II or III disease (65% to 90% compared with 45% to 66% of nonpregnant controls) [8,9,17]. Table 2 references the 5-and 10-year survival for node-negative and node-positive disease for pregnancy-associated breast cancer as 60% to 100% and 31% to 52% respectively [7,22,23]. A delay in diagnosis, on the part of physician and patient alike, is thought to contribute to the advanced disease at presentation.…”

“…Several theories persist. The first is that the high circulating levels of estrogen and progesterone in pregnancy may occupy all of the hormone receptor binding sites; the second relates to receptor down-regulation during pregnancy [7,9,27,28].…”

“…Although 80% of these masses are benign, further evaluation is warranted if findings persist more than 2 to 4 weeks [7,32]. Evaluation begins with a thorough clinical examination, and a baseline breast examination is recommended at the first prenatal visit [4].…”