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

Abstract

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.

Breast Cancer in Young Women: Status Quo and Advanced Disease Management by a Predictive, Preventive, and Personalized Approach

“…Despite that postmenopausal women represent the majority of BC patients, an age-profiling of BC is currently shifting as a response to the growth of the cohort of young premenopausal BC patients [1,2]. The heterogeneous nature of the genotype and phenotype of premenopausal BC [3], often asymptomatic course of the disease [5], insufficient screening programs for younger women [8], complications in PABC diagnostics [12,13], along with more aggressive subtypes of BC in young women [4,57] contribute to an increase in early-onset BC. Therefore, an urgency in the novel alternations of diagnostic, prediction, prognosis, and therapy approaches is a necessary basis of new strategies of clinical management focused on young premenopausal females [45].…”

“…An awarded article in the category “Medicine and Public Health” [10] entitled “Pregnancy-associated breast cancer: The risky status and new concepts of predictive medicine”, focused on the pregnancy-related malignancy of the mammary gland, presented innovative concepts for the paradigm shift to the predictive preventive and personalized approach [11]. However, impeded and delayed diagnosis of pregnancy-associated BC (PABC), as the most prevalent type of malignancy during pregnancy, combined with aggressive cancer type, leads to the dramatic decline in overall survival in the PABC group [12,13]. Currently, any population screening program, standardized diagnostic approach, generally accepted factors associated with risk assessment or measures of prevention targeting particularly PABC, have not been established [14].…”

Teaching cross-cultural design thinking for healthcare

“…Refs. [ 5 , 6 ]). Moreover, the increasing number of long-term breast cancer survivors has highlighted the extensive impact of breast cancer and its treatment on women’s quality of life [ 7 ].…”

A Longitudinal Study of a Multicomponent Exercise Intervention with Remote Guidance among Breast Cancer Patients

“…However, the occurrence of breast cancer is still increasing, and postoperative patients experience long-term side effects including recurrence, fatigue, lymphoedema, and a decline in physical function, which all seriously affect their physical and mental health [4,5]. Therefore, it is imperative to adopt appropriate treatment to better facilitate disease management in this population [6].…”