Pregnancy associated breast cancer and pregnancy after breast cancer treatment

Abstract

Breast cancer is one of the most common cancers diagnosed during pregnancy and its frequency is increasing as more women postpone their pregnancies to their thirties and forties. Breast cancer diagnosis during pregnancy and lactation is difficult and complex both for the patient and doctors. Delay in diagnosis is frequent and treatment modalities are difficult to accept for the pregnant women. The common treatment approach is surgery after diagnosis, chemotherapy after the first trimester and radiotherapy after delivery. Even though early stage breast cancers have similar prognosis, advanced stage breast cancers diagnosed during pregnancy and lactation have poorer prognosis than similar stage breast cancers diagnosed in non-pregnant women. Women who desire to become pregnant after treatment of breast cancer will have many conflicts. Although the most common concern is recurrence of breast cancer due to pregnancy, the studies conducted showed that pregnancy has no negative effect on breast cancer prognosis. In this review we search for the frequency of breast cancer during pregnancy, the histopathological findings, risk factor, diagnostic and treatment modalities. We reviewed the literature for evidence based findings to help consult the patients on the outcome of breast cancer diagnosed during pregnancy and lactation, and also inform the patients who desire to become pregnant after breast cancer according to current evidences. (J Turkish-German Gynecol Assoc 2011; 12: 247-55)

Pregnancy associated breast cancer (PABC): Aspects in diagnosis

“…Mammographic parenchymal density during pregnancy increases and diffuses, especially during lactation where is further increased so that expansion of the lactic duct seems to be nodular with hyperdensity by breast milk filling nipples [35]. Mammography is able to detect a high proportion of cancers between 63% and 90% in most series [17,34,35,37]. Although masses may not be noticeable, typical malignant microcalcifications can be detected even in extremely dense breasts.…”

“…It is thought that fetal abnormalities may occur in case of more than 0.05 Gy (5 rad). Yet, the radiation that fetus can receive through the mammography is very small as 0.004 Gy (0.4 mrad), even if there is no use of lead aprons [17,35,46]. However, except special cases, current recommendations suggest to avoid mammography during the first trimester of pregnancy and instead use ultrasound [34,35].…”

“…Over the last years, an extreme effort of showing more statistically correct and significant studies has been noticed. Insufficient data on biological features of the tumor and PABC definition [16], along with regional differences, multiple inclusion criteria and deficiency of information in cancer registries about the pregnancy status, emphasize the lack of reliable data [5,17]. The relative rarity of the disease makes impossible the conduction of large powered controlled studies [14] and therefore limited by all of the potential biases [18].…”

“…In fact, women with PABC present, more often, with larger tumors and higher incidence of lymph node metastasis at diagnosis. This has been attributed to physiologic changes in pregnancy and lactation that make physical exam difficult [17,25,30]. However, existing data indicate that factors like pregnancy-associated hormones and a delay in diagnosis in recently pregnant women, do not account alone for the high mortality associated with PABC [31].…”

Gravidez após o Cancro da Mama: Estado da Arte

“…9 No entanto, menos de 10% destas mulheres efetivamente vai engravidar, sendo que alguns estudos têm evidenciado que a percentagem de mulheres com menos de 45 anos que concebe após o final do tratamento parece variar entre 3,6% -5%. 2,10,11 A profunda e bem estabelecida heterogeneidade genética e molecular do cancro da mama coloca questões acrescidas a esta problemática, nomeadamente quando considerada a expressão dos recetores hormonais e o subtipo biológico do tumor, com implicações significativas não só no prognóstico, mas também nas opções terapêuticas e na fertilidade destas mulheres.…”