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. 2025 Aug 12.
doi: 10.1007/s10549-025-07806-3. Online ahead of print.

Worse prognosis for breast cancer diagnosed in advanced pregnancy and shortly postpartum: an update of the Dutch pregnancy-associated breast cancer cohort

Carsten F J Bakhuis  1   2 , Stefan Preković  3 , Britt B M Suelmann  2 , Janneke Verloop  4 , Pieter J Westenend  5 , Sabine C Linn  6 , Paul J van Diest  7 , Elsken van der Wall  2 , Carmen van Dooijeweert  1
Affiliations

Worse prognosis for breast cancer diagnosed in advanced pregnancy and shortly postpartum: an update of the Dutch pregnancy-associated breast cancer cohort

Carsten F J Bakhuis et al. Breast Cancer Res Treat. .

Abstract

Purpose: Breast cancer diagnosed during pregnancy (PrBC) or postpartum (PPBC) is associated with a poorer prognosis, and earlier research indicated that outcomes differ based on timing of diagnosis. We updated and expanded our Dutch nationwide pregnancy-associated breast cancer (PABC) cohort, now also including patients diagnosed within one year after an interrupted pregnancy (AABC), to compare disease characteristics and prognosis across PrBC-, PPBC- and AABC subgroups and to non-PABC patients.

Methods: All breast cancer pathology reports of women < 45 years in the Netherlands (1988-2022) were screened to identify patients diagnosed with PrBC, PPBC (< 12 months postpartum) or AABC (< 12 months after pregnancy interruption). PABC patients were 1:3 matched on age and year of diagnosis to non-PABC breast cancer patients.

Results: In our PABC cohort (N = 787), the majority was diagnosed during pregnancy (n = 471, 60%). Two distinct prognostic subgroups were observed: a favorable group including trimester 1 PrBC, PPBC 6-12 months postpartum and AABC, and an unfavorable group diagnosed later in pregnancy (trimesters 2 and 3) or shortly postpartum (< 6 months). PABC patients showed overall, in comparison to non-PABC controls, poorer histopathological characteristics (more grade III and triple negative tumors) and a significantly worse 5-year overall survival (77% vs. 85%), persisting in multivariable analysis (HR 1.6, 95% CI 1.06 - 2.33, P = 0.025).

Conclusions: PABC patients diagnosed in advanced pregnancy or shortly postpartum are most at risk for aggressive histopathology and an unfavorable prognosis. This highlights the need for in-depth analyses between specific PABC subgroups to elucidate the etiologic mechanisms involved.

Keywords: Breast cancer; Miscarriage; Postpartum; Pregnancy; Prognosis.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: As this is an observational study, our institutional Medical Research Ethics Committee (MREC) has confirmed that no further ethical approval is required (no. 19/366). All data were delivered in a pseudonymized manner by the Dutch Archive for Cyto- and Histopathology (PALGA) and the Netherlands Comprehensive Cancer Organization (IKNL). This study was also approved by the scientific and privacy committees of both PALGA and IKNL. All data were handled in compliance with the General Data Protection Regulation Act (GDPR).

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