Influence of pregnancy on the outcome of breast cancer: A case-control study

Abstract

The relationship between pregnancy and the outcome of breast cancer remains controversial. The purpose of this study was to determine the prognostic value of pregnancy at the time of diagnosis of primary infiltrating breast cancer. In a retrospective multi-center study we compared a group of 154 patients presenting pregnancy-associated (PA) breast cancer with a control group of 308 patients presenting non-pregnancy-associated (non-PA) breast cancer. Classic prognostic factors , treatment modalities, disease-free survival and overall survival were compared in the 2 groups. The relative importance of pregnancy was assessed by Cox multivariate analysis. There was a significantly higher proportion of inflammatory breast cancer, large tumors and negative receptor status in the PA group. Five-year recurrence-free survival, metastasis-free survival and overall survival were lower both in the whole PA group and in the PA subgroup excluding patients with inflammatory breast cancer than in the corresponding non-PA groups. According to clinical stage, histoprognostic grade and microscopic lymph-node involvement, probability of 5-year metastasis-free survival and overall survival was lower in the PA group. Outcome was significantly poorer after chemother-apy for patients in the PA subgroup than in the non-PA subgroup. Multivariate analysis demonstrated that pregnancy was an independent and significant prognostic factor. Pregnancy has an adverse effect on the outcome of breast cancer. Concurrent or recent pregnancy should be taken into account in the development of new systemic therapies. Our findings have important implications for further research into the basic mechanisms of cancer. Int. The relationship between pregnancy and breast cancer remains controversial. Recent series (De La Rochefordière et al., 1993; Bonnier et al., 1995b) and several registry-based studies (Adami et al., 1986) indicate that breast cancer has a poorer prognosis in younger women. Hormonal and immunologic changes associated with pregnancy could promote the growth and spread of breast cancer and modify response to treatment. However, published data concerning the effects of recent or concurrent pregnancy on the outcome of breast cancer present several limitations, such as a small patient population collected over long periods of time, failure to take age into account, comparison with unmatched controls, and unbalanced prognostic factors. Moreover, since breast cancer is uncommon during pregnancy, anecdotal case reports describing rapidly unfavorable outcomes have encouraged misinformation. The purpose of the present retrospective multi-institutional study was to analyze the prognostic value of pregnancy at the time of diagnosis of primary infiltrating breast cancer. We compared a group of 154 patients presenting pregnancy-associated (PA) breast cancer with a control group of 308 patients presenting non-pregnancy-associated (non-PA) breast cancer. The 2 groups were matched with regard to age and date of beginning of treatment. Classic prognostic fac...

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

“…3 Of the premenopausal breast cancers diagnosed, approximately 58% are both estrogen receptor (ER) and progesterone receptor (PR) positive, 6% are ER positive only, 17% are PR positive only, and 20% are both ER and PR negative. 4 The management and treatment of breast cancer in premenopausal women can affect menstruation, reproduction, and gynecologic health. Breast cancer treatment can have a marked affect on fertility in women who have delayed childbearing and have fewer remaining reproductive years.…”

Pregnancy-Associated Breast Cancer: A Literature Review

“…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].…”

“…Additionally, a retrospective and multi-institutional study from Bonnier and colleagues [27] found immunohistochemical assessment of hormone receptor status to be more reliable than a ligand-based assay. Ligand-based assays depend upon the availability of unbound hormone receptors, which may be less accurate during pregnancy secondary to interference by circulating steroid receptors.…”

“…A milk-rejection sign has been described rarely in case reports when a nursing infant refuses a lactating breast that harbors occult carcinoma [29,30]. The differential diagnosis of a pregnancy-associated breast mass is broad and includes: [2] 100% (4) 50% (15) Petrek et al/1991 [18] 82% (22) 47% (34) Ishida et al/1992 [9] 90% (71) 52% (101) Kuerer et al/1997 [23] 60% (14) 45% (12) Bonnier et al/1997 [27] 63% (50) 31% (64) Reed et al/2003 [17] 62% (31) 40% (69) n ¼ sample size. Abbreviations: diff, differentiated; IDC, invasive ductal carcinoma; IHC, immunohistochemical examination; ILC, invasive lobular carcinoma; LBA, ligand-based assay; med, medullary carcinoma; mod, moderately; N, number of subjects; N.E., not examined; NPCs, nonpregnant controls.…”

Clinicopathological Features and Prognosis of Pregnancy Associated Breast Cancer – A Matched Case Control Study

“…The prognosis of PABC is more often reported as being unfavorable [1,[7][8][9][10]. Whether this poor prognosis is related to pregnancy or mainly due to the young age of patientswhich in itself is known to be a poor prognostic factor [11] -is not clear.…”