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Review
. 2023 Feb 7;13(4):604.
doi: 10.3390/diagnostics13040604.

Pregnancy-Associated Breast Cancer: A Diagnostic and Therapeutic Challenge

Francesca Galati  1 , Valentina Magri  1 , Paula Andrea Arias-Cadena  1   2 , Giuliana Moffa  1 , Veronica Rizzo  1 , Marcella Pasculli  1 , Andrea Botticelli  1 , Federica Pediconi  1
Affiliations
Review

Pregnancy-Associated Breast Cancer: A Diagnostic and Therapeutic Challenge

Francesca Galati et al. Diagnostics (Basel). .

Abstract

Pregnancy-associated breast cancer (PABC) is commonly defined as a breast cancer occurring during pregnancy, throughout 1 year postpartum, or during lactation. Despite being a rare circumstance, PABC is one of the most common types of malignancies occurring during pregnancy and lactation, with growing incidence in developed countries, due both to decreasing age at onset of breast cancer and to increasing maternal age. Diagnosis and management of malignancy in the prenatal and postnatal settings are challenging for practitioners, as the structural and functional changes that the breast undergoes may be misleading for both the radiologist and the clinician. Furthermore, safety concerns for the mother and child, as well as psychological aspects in this unique and delicate condition, need to be constantly considered. In this comprehensive review, clinical, diagnostic, and therapeutic aspects of PABC (including surgery, chemotherapy and other systemic treatments, and radiotherapy) are presented and fully discussed, based on medical literature, current international clinical guidelines, and systematic practice.

Keywords: PABC; breast cancer treatment; breast imaging; lactation; pregnancy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A 36-year-old patient, 6th week of pregnancy. (a) Hypoechoic mass with irregular margins in the inner lower quadrant of the left breast. (b) An ipsilateral axillary suspicious lymph node is seen, with cortical thickening (7 mm), which is an index of disease spread to the lymph nodes.
Figure 2
Figure 2
A 42-year-old patient, seventh week of pregnancy. Standard mammography including (a) mediolateral oblique view and (b) craniocaudal view of the left breast.
Figure 3
Figure 3
A 36-year-old breastfeeding patient, 6th month postpartum. (a) Craniocaudal view (b) and mediolateral oblique view of the right breast, characterized by increased density due to breastfeeding.
Figure 4
Figure 4
A 36-year-old breastfeeding patient, 6th month postpartum. CE-MRI of the breast shows (a) multiple enlarged highly suspicious lymph nodes in the right axilla and (b–d) a voluminous and heterogeneous mass enhancement, with central areas of necrosis and not circumscribed margins, located between the inner quadrants of the right breast. Histological examination revealed a G2 invasive lobular carcinoma; ER = 98%, PR = 1%, HER2-negative, Ki67 = 50% at immunohistochemistry.
Figure 5
Figure 5
Major recommendations about systemic treatment during pregnancy and lactation.
See this image and copyright information in PMC

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