Pregnancy associated breast cancer (PABC): Report from a gestational cancer registry from a tertiary cancer care centre, India

Abstract

Background: Pregnancy associated breast cancer (PABC) is a rare entity and defined as breast cancer diagnosed during pregnancy or one-year post-partum. There is sparse data especially from low and middle-income countries (LMIC) and merits exploration. Methods: The study (2013e2020) evaluated demographics, treatment patterns and outcomes of PABC. Results: There were 104 patients, median age of 31 years; 43 (41%) had triple-negative disease, 31(29.8%) had hormone-receptor (HR) positive and HER2 negative, 14 (13.5%) had HER2-positive and HR negative and 16(15.4%) had triple positive disease. 101(97%) had IDC grade III tumors and 74% had delayed diagnosis. 72% presented with early stage (24, EBC) or locally advanced breast cancer (53, LABC) and received either neoadjuvant (n ¼ 49) or adjuvant (n ¼ 26) chemotherapy and surgery. Trastuzumab, tamoxifen, and radiotherapy were administered post-delivery. At a median follow up of 27 (IQR:19e35) months, the estimated 3-year event-free survival (EFS) for EBC and LABC was 82% (95% CI: 65.2e100) and 56% (95% CI: 42e75.6%) and for metastatic 24% (95% CI: 10.1%e58.5%) respectively. Of the 104 patients, 34 were diagnosed antepartum (AP) and 15 had termination, 2 had preterm and 16 had full-term deliveries(FTDs). Among postpartum cohort (n ¼ 70), 2 had termination, 1 had preterm, 67 had FTDs. 83(including 17 from AP) children from both cohorts were experiencing normal milestones. Conclusion: Data from the first Indian PABC registry showed that the majority had delayed diagnosis and aggressive features(TNBC, higher grade). Treatment was feasible in majority and stage matched outcomes were comparable to non-PABCs.

Unique challenges and outcomes of young women with breast cancers from a tertiary care cancer centre in India

“…This multi-drug chemotherapy was well tolerated with grade-III toxicity similar to that reported in major studies despite the high prevalence of malnutrition among multiparous Indian women [31e34]. However, caution must be exercised to avoid intensification of treatment just based on the age as suggested by the international guidelines [1,9].The outcomes of the small subset of PABC patients in our study were similar to that seen in a larger study of 104 PABC patients published from our institute had showed comparable stage matched OS and DFS with non PABC patients [35].…”

Breast Carcinogenesis during Pregnancy: Molecular Mechanisms, Maternal and Fetal Adverse Outcomes

“…In a retrospective study of 142 women with PABC, performed by Wang et al [ 55 ], five-year overall survival (OS) and disease-free survival (DFS) rates were 76.8% and 63.5%, respectively, with T stage, N stage, and HER2 status, distinguished by univariate analysis, being significant prognostic factors for both OS and DFS. Bajpai et al [ 56 ] further demonstrated that the 3 year event-free survival (EFS) was significantly different among PABC patients with early-stage, locally advanced and metastatic breast cancer, estimated at 82% (95% CI: 65.2–100), 56% (95% CI: 42–75.6%) and 24% (95% CI: 10.1–58.5%), respectively.…”

“…PABC is also associated with an increased risk of early postnatal complications when compared to normal pregnancies, which are mainly caused by prematurity. Early neonatal complications include neonatal death, neonatal intensive care unit (NICU) admission, hematologic disturbances (especially neonatal anemia), low birth weight and other prematurity-related disorders (respiratory distress syndrome, metabolic disturbances, sepsis, infant jaundice, and necrotizing enterocolitis) [ 56 , 84 , 85 , 86 ], while low Apgar scores after birth are also more common in the neonates of PABC patients [ 84 , 87 ]. Finally, in addition to the aforementioned risk of placental metastasis from PABC, fetal metastasis can theoretically occur too, with extremely poor anticipated prognosis, however, there have been no reported cases of distant metastasis to the fetus.…”

Imaging Recommendations for Diagnosis, Staging, and Management of Breast Cancer

“…63 Pregnancy-associated BC is challenging; however, stage- and biology-matched outcomes are largely comparable if appropriately managed. 64…”