Skip to main content
SpringerLink
Log in

Das Mammakarzinom in der Schwangerschaft

Breast cancer during pregnancy

  • Topic
  • Published:
best practice onkologie Aims and scope

Zusammenfassung

Die Inzidenz des schwangerschaftsassoziierten Mammakarzinoms (PBC) steigt, da Frauen zunehmend erst nach dem 30. Lebensjahr Kinder bekommen. Die Therapie des PBC sollte sich so nah wie möglich an der für junge Brustkrebspatientinnen mit vergleichbarer Tumorbiologie und Erkrankungsstadium orientieren. Eine Frühgeburt sollte vermieden werden. Je nach Schwangerschaftsalter können viele Therapien und Untersuchungen – einschließlich bildgebender Verfahren, Operation und Chemotherapie – auch während einer Schwangerschaft erfolgen und sollten interdisziplinär geplant werden. Strahlentherapie, endokrine und Anti-HER2-Therapien sowie weitere neue Brustkrebsmedikamente sind während der Schwangerschaft und Stillzeit kontraindiziert. Die Daten von Frauen mit einem PBC sollten systematisch erfasst werden.

Abstract

Allied to the current tendency to postpone pregnancy until after the age of 30 years, the incidence of pregnancy-associated breast cancer (PBC) is becoming more frequent. Tumor stage at diagnosis and tumor biology determine the appropriate treatment approach, which should adhere as much as possible to the treatment of young non-pregnant female patients. Premature birth should be avoided. Many diagnostic methods and treatment options including imaging procedures, surgery and chemotherapy are also possible during pregnancy depending on the gestational stage at diagnosis; therefore, diagnostic and therapeutic strategies should be established in a multidisciplinary setting. Radiotherapy, endocrine and anti-HER2 therapy as well as new forms of breast cancer treatment are contraindicated during pregnancy and the lactation period. The data from women with PBC should be collected in a systematic way.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Amant F, Deckers S, Van Calsteren K et al (2010) Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer 46(18):3158–3168

    Article  Google Scholar 

  2. Amant F, Loibl S, Nevin P et al (2012) Breast cancer in pregnancy. Lancet 379(9815):570–579

    Article  Google Scholar 

  3. Amant F, Vandenbroucke T, Verheecke M et al (2015) Pediatric outcome after maternal cancer diagnosed during pregnancy. International network on cancer, infertility, and pregnancy (INCIP). N Engl J Med 373(19):1824–1834

    Article  CAS  Google Scholar 

  4. Amant F, von Minckwitz G, Han SN et al (2013) Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol 31(20):2532–2539

    Article  Google Scholar 

  5. Andersson TM, Johansson AL, Hsieh CC et al (2009) Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol 114(3):568–572

    Article  Google Scholar 

  6. Avilés A, Neri N (2001) Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma 2(3):173–177

    Article  Google Scholar 

  7. Azim HA Jr, Santoro L, Russell-Edu W et al (2012) Prognosis of pregnancy-associated breast cancer: a meta-analysis of 30 studies. Cancer Treat Rev 38:834–842

    Article  Google Scholar 

  8. Berry DL, Theriault RL, Holmes FA et al (1999) Management of breast cancer during pregnancy using a standardized protocol. J Clin Oncol 17(3):855–861

    Article  CAS  Google Scholar 

  9. Bines J, Earl H, Buzaid AC (2014) Anthracyclines and taxanes in the neo/adjuvant treatment of breast cancer: does the sequence matter? Ann Oncol 25(6):1079–1085

    Article  CAS  Google Scholar 

  10. Callihan EB, Gao D, Jindal S et al (2013) Postpartum diagnosis demonstrates a high risk for metastasis and merits an expanded definition of pregnancy-associated breast cancer. Breast Cancer Res Treat 138(2):549–559

    Article  Google Scholar 

  11. Cardonick E, Dougherty R, Grana G et al (2010) Breast cancer during pregnancy: maternal and fetal outcomes. Cancer J 16:76–82

    Article  Google Scholar 

  12. Gropper AB, Calvillo KZ, Dominici L et al (2014) Sentinel lymph node biopsy in pregnant women with breast cancer. Ann Surg Oncol 21(8):2506–2511

    Article  Google Scholar 

  13. ClinicalTrials.gov (2017) Pregnancy outcome and safety of interrupting therapy for women with endocrine responsive breast cancer (POSITIVE). https://clinicaltrials.gov/ct2/show/NCT02308085. Zugegriffen: 14.09.2017

    Google Scholar 

  14. Huang J, Barbera L, Brouwers M et al (2003) Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 21(3):555–563

    Article  Google Scholar 

  15. Leal SC, Stuart SR, Carvalho Hde A (2013) Breast irradiation and lactation: a review. Expert Rev Anticancer Ther 13(2):159–164

    Article  CAS  Google Scholar 

  16. Lee YY, Robets CL, Dobbins T et al (2012) Incidence and outcomes of pregnancy-associated cancer in Australia, 1994–2008: a population-based linkage study. BJOG 119(13):1572–1582

    Article  CAS  Google Scholar 

  17. Loibl S, Han SN, von Minckwitz G et al (2012) Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 13(9):887–896

    Article  CAS  Google Scholar 

  18. McCready J, Arendt LM, Glover E et al (2014) Pregnancy-associated breast cancers are driven by differences in adipose stromal cells present during lactation. Breast Cancer Res 16(1):R2

    Article  Google Scholar 

  19. Nettleton J, Long J, Kuban D et al (1996) A Breast cancer during pregnancy: quantifying the risk of treatment delay. Obstet Gynecol 87(3):414–418

    Article  CAS  Google Scholar 

  20. National Toxicology Program (2013) Developmental effects and pregnancy outcomes associated with cancer chemotherapy use during pregnancy. NTP Monogr. 2013(2):i-214

    Google Scholar 

  21. Nulman I, Laslo D, Fried S et al (2001) Neurodevelopment of children exposed in utero to treatment of maternal malignancy. Br J Cancer 85(11):1611–1618

    Article  CAS  Google Scholar 

  22. Otake M, Schull WJ, Lee S (1996) Threshold for radiation-related severe mental retardation in prenatally exposed A‑bomb survivors: a re-analysis. Int J Radiat Biol 70(6):755–763

    Article  CAS  Google Scholar 

  23. Pistilli B, Bellettini G, Giovannetti E et al (2013) Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev 39(3):207–211

    Article  CAS  Google Scholar 

  24. Ray JG, Vermeulen MJ, Bharatha A et al (2016) Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 316(9):952–961

    Article  Google Scholar 

  25. Robbins J, Jeffries D, Roubidoux M et al (2011) Accuracy of diagnostic mammography and breast ultrasound during pregnancy and lactation. AJR Am J Roentgenol 196(3):716–722

    Article  Google Scholar 

  26. Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (2015) Krebs in Deutschland 2011/2012 Bd. 10.

    Google Scholar 

  27. Roche (2017) Fachinformation Herceptin (Trastuzumab), März 2017

  28. Ruiz R, Herrero C, Strasser-Weippl K et al (2017) Epidemiology and pathophysiology of pregnancy-associated breast cancer: a review. Breast 35:136–114

    Article  Google Scholar 

  29. Stensheim H, Moller B, van Dijk T et al (2009) Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol 27(1):45–51

    Article  Google Scholar 

  30. Sobotka T (2013) Pathways to low fertility: European perspectives. Expert Paper No 2013/08. United Nations Department of Economic and Social Affairs, New York

    Google Scholar 

  31. Van Calsteren K, Verbesselt R, Ottevanger N (2010) Pharmacokinetics of chemotherapeutic agents in pregnancy: a preclinical and clinical study. Acta Obstet Gynecol Scand 89(10):1338–1345

    Article  Google Scholar 

  32. Wang PI, Chong ST, Kielar AZ et al (2012) Imaging of pregnant and lactating patients: part 1, evidence-based review and recommendations. AJR Am J Roentgenol 198(4):778–784

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. GBG Forschungs GmbH, Martin-Behaim-Straße 12, 63263, Neu-Isenburg, Deutschland

    S. Seiler & S. Loibl

  2. Centrum für Hämatologie und Onkologie Bethanien, Frankfurt/Main, Deutschland

    S. Loibl

Authors
  1. S. Seiler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Loibl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Seiler.

Ethics declarations

Interessenkonflikt

S. Seiler und S. Loibl geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Dieser Beitrag ist zuerst erschienen in: Der Gynäkologe 2017 · 8:839–844 https://doi.org/10.1007/s00129-017-4152-x; Springer Medizin Verlag GmbH 2017.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seiler, S., Loibl, S. Das Mammakarzinom in der Schwangerschaft . best practice onkologie 14, 224–232 (2019). https://doi.org/10.1007/s11654-019-0134-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11654-019-0134-x

Schlüsselwörter

Keywords

Search

Navigation