Breast cancer in pregnancy

Abstract

Pregnancy-related breast cancer (PBC) is one of the most common malignancies during pregnancy (approx. one in 3,000 pregnancies); up to 3% of breast cancers are diagnosed in pregnancy. As maternal age at the time of pregnancy continues to increase as the incidence of breast cancer, the incidence of PBC is expected to increase. A review of the literature was performed in order to identify optimal treatment strategies. Most of the data surrounding the diagnosis and treatment PBC is small cohort studies, and there are no randomized controlled trials. Diagnostic delays are common. Preoperative histologic confirmation is required. Conservative surgery can be proposed at the end of second and third trimester, and radiotherapy is delayed after childbirth. The safety of sentinel lymph node biopsy has yet to be confirmed, and the axillary dissection is the traditional treatment of choice. The chemotherapeutic agents utilized are the same as those used in non-pregnant patients, but they should not be administered in the first trimester. Radiotherapy and endocrine therapy are recommended to be avoided during pregnancy. The treatment of PBC is multidisciplinary and necessitates active communication among the patient, obstetrician, medical, surgical, and radiation oncologists. Diagnosis is often delayed because of physiologic changes of the breast; obstetricians should perform a thorough breast examination at the first prenatal visit and maintain a high index of suspicion for cancer. Other therapies may need to be considered, although their usage now is not currently recommended owing to the paucity of safety data.