Survival of breast cancer patients diagnosed during pregnancy or lactation

Abstract

Summary This survival study includes 20 breast cancer patients diagnosed during pregnancy and 15 patients diagnosed during the lactation period. The survival rate of these patients is compared with that of ordinary breast cancer patients taking stage of the disease, age and calendar-year at diagnosis into account. The pregnancy group showed a significantly. poorer prognosis compared with the control groups. Only 3 out of 20 survived more than 4 years. The tendency of a worse prognosis for the lactation group than for the control group was, however, not significant.Breast cancer patients diagnosed during pregnancy and lactation represent a special group. Therapeutic attitudes have changed from regarding these patients as incurable (Haagensen, 1956), to the more optimistic approach demonstrated by Peters (1968) Histological grading was carried out on all cases and for one control per case matched on stage, calendar time and age. In two cases the material was unsuitable and hence the matching controls were not graded. Two or three specimens were taken from each primary tumour. Slides stained with haematoxylin and eosin were graded according to WHO definitions (Scharff & Torloni, 1968).The WHO grading is based on the following factors: Tubule formation, hyperchromatism, mitosis and irregularity of size, shape and staining of nuclei. A number system is used, from I to 3 for each factor according to the extent of the changes. These numbers are then added together, a total of 3-5 indicating low malignancy (grade I), [6][7] In the pregnancy group the median diagnosis delay was 2.5 months (95% CI: 1, 4.5) and in the lactating group 6 months (95% CI: 2.5, 12). The majority of women in the lactating group gave the time of the first symptom as the time of delivery. Figure 1 shows survival in per cent by time (months) after diagnosis in the pregnancy group and the two control groups. More than 60% of the pregnant breast cancer patients died within 2 years from diagnosis and only 3 out of 20 were alive 4 years after diagnosis. The survival rate is significantly lower than in the control group 1, (P<0.05).The similarity in survival rate between control groups lp and IIp shows that anxiety about overmatching was unnecessary. Figure I demonstrates that pregnancy is a strong prognostic Br.

Overall survival from breast cancer in women pregnant or lactating at or after diagnosis

“…Their results showed no difference in survival for pregnant patients compared with matched controls of the same age, whereas when those under 40 were compared with patients over 40 years old, there was a significant decrease in 5-year survival in the younger group. Other studies have not used age-matched controls, though Tretli et al (1988) in a study of 20 breast cancer patients diagnosed during pregnancy found a significantly poorer prognosis for these women after taking stage of disease, age and calendar year at diagnosis into account.…”

Increased Mortality in Women with Breast Cancer Detected during Pregnancy and Different Periods Postpartum

“…Several studies have found evidence of a diagnostic delays in pregnant women (2-7), which may explain why results from some, but not all, studies show that women with PABC have larger tumors and are more likely to have positive nodes, metastases and vascular invasion compared with nonpregnant women with breast cancer (2,5,(8)(9)(10). A poor prognosis in PABC (4,(8)(9)(10)(11)(12)(13)(14) has previously primarily been attributed to diagnostic delays (7,15). However, few studies have investigated whether the prognosis varies by time of diagnosis (during pregnancy and different postpartum time intervals).…”

“…However, few studies have investigated whether the prognosis varies by time of diagnosis (during pregnancy and different postpartum time intervals). Some studies have distinguished between pregnant and lactating women (2,4,5,10,14), while most investigators have focused on cancers diagnosed after childbirth in 1-year intervals following delivery (8,9,12,13). In all these studies, ranging in size from 35 to 708 cases of PABC, proximity to pregnancy was associated with a worse prognosis.…”

Pregnancy associated breast cancer and pregnancy after breast cancer treatment

“…In contrast, Ives et al found an average of one month (1-104 weeks) from symptom to diagnosis in pregnant breast cancer cases and Ibrahim et al found symptom to diagnosis time to be shorter in pregnant breast cancer cases than the nonpregnant cases (5.6 months versus 9.4 months respectively) (40,41). The summary of studies on this issue is presented in Table 1 (13,16,(39)(40)(41)(42)(43)(44). For early diagnosis of PABC, all pregnant women should have a breast examination during the first antenatal visit.…”