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Cancers du sein associés à la grossesse

Pregnancy-associated breast cancer (PABC)

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Oncologie

Abstract

The occurrence of pregnancy-associated breast cancer (PABC) is rare but increasing. Its management is challenging: to treat the patient without compromising fetal prognosis. Usually, PABC is diagnosed at a more advanced stage compared to non-pregnant patients of the same age. The diagnostic approach should fit with the recommendations for nonpregnant women except CT scan or isotopic exploration, which are performed only if absolutely necessary. Similarly, the therapeutic management should be close to guidelines: surgical treatment and sentinel lymph node procedure (without blue patent), chemotherapy beyond the first trimester, and radiotherapy during the 1st and 2nd trimesters. Targeted therapy and hormonal therapy are not recommended during pregnancy. After this treatment, the prognosis of PABC is comparable to nonpregnant patients with similar clinical, histological, and radiological characteristics.

Résumé

La survenue d’un cancer durant la grossesse est une situation rare mais en augmentation. Sa prise en charge est difficile, car les enjeux sont doubles: traiter au mieux la patiente sans compromettre le pronostic foetal. Le diagnostic est posé à un stade généralement plus avancé par rapport aux patientes du même âge non enceintes. La démarche diagnostiquedoit se calquer sur les recommandations faites pour les femmes non enceintes à l’exception des explorations scanographique ou isotopique (bilan d’extension) qui ne sont réalisées qu’en cas d’absolue nécessité. De même, la prise en charge thérapeutique doit se rapprocher autant que possible des référentiels: traitement chirurgical avec procédure du ganglion sentinelle (sans bleu patenté), chimiothérapie au-delà du premier trimestre et radiothérapie aux premier et deuxième trimestres pour certains. Les thérapies ciblées et l’hormonothérapie sont contre-indiquées pendant la grossesse. À l’issue de cette prise en charge, le pronostic maternel semble comparable à celui des patientes non enceintes ayant les mêmes caractéristiques cliniques, histologiques et radiologiques.

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Authors and Affiliations

  1. Service de gynécologie-obstétrique, hôpital Tenon, Paris, université Pierre-et-Marie-Curie Paris-VI, Paris, France

    C. Bonneau, A. Maulard & L. Selleret

  2. Service de chirurgie, institut Curie, Paris-Saint-Cloud, université Versailles-Saint-Quentin-en-Yvelines, Paris, France

    R. Rouzier

  3. Service d’oncologie médicale, centre Oscar-Lambret, Lille, France

    L. Vanlemmens

Authors
  1. C. Bonneau
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  2. A. Maulard
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  3. L. Vanlemmens
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  4. L. Selleret
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  5. R. Rouzier
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Correspondence to C. Bonneau.

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Bonneau, C., Maulard, A., Vanlemmens, L. et al. Cancers du sein associés à la grossesse. Oncologie 15, 232–236 (2013). https://doi.org/10.1007/s10269-013-2280-z

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  • DOI: https://doi.org/10.1007/s10269-013-2280-z

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