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Clinico-pathologic features, treatment and outcomes of breast cancer during pregnancy or the post-partum period

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Abstract

Purpose

Breast cancer during pregnancy (BC-P) or the first year post-partum (BC-PP) is rare and whether it differs from breast cancer (BC) in young women not associated with pregnancy is uncertain.

Methods

We queried our institutional database for BC-P and BC-PP cases and matched controls with BC not associated with pregnancy diagnosed between January 1, 1985 and December 31, 2013. We performed two parallel retrospective cohort studies evaluating clinico-pathologic features, treatment and outcomes for BC-P and BC-PP cases compared to their controls.

Results

In our population of 65 BC-P cases, 135 controls for BC-P cases, 75 BC-PP cases and 145 controls for BC-PP cases, high grade and estrogen receptor-negativity were more frequent in both case groups than their controls. Among those with stage I–III BC, patterns of local therapy were similar for both case groups and their controls, with the majority undergoing surgery and radiation. Over three-fourths of those with stage I–III BC received chemotherapy. BC-P cases tolerated chemotherapy well, with the majority receiving doxorubicin/cyclophosphamide every 3 weeks. On multivariate analyses of those with stage I–III BC, BC-P cases had non-significantly higher hazards of recurrence and death compared to their controls, while BC-PP cases had non-significantly lower hazards of recurrence and death compared to their controls.

Conclusion

BC-P and BC-PP were associated with adverse clinic-pathologic features in our population. However, we did not observe inferior outcomes for BC-P or BC-PP compared to controls, likely due to receipt of aggressive multi-modality therapy.

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Funding

This work was supported by funding from the Charles Evans Foundation, Centers for Disease Control and Prevention (U58DP005410) and the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center Support Grant (P30CA006973).

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Author notes

  1. Ciara C. O’Sullivan

    Present address: Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA

  2. Sheeba Irshad

    Present address: Guy’s Cancer, Cancer and Pharmaceutical Division, King’s College London, London, UK

  3. Ciara C. O’Sullivan and Sheeba Irshad are Joint first authorship.

Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ciara C. O’Sullivan, Sheeba Irshad, Zheyu Wang, Zhuojun Tang, Christopher Umbricht, Gary L. Rosner, Mindy S. Christianson, Vered Stearns & Karen Lisa Smith

  2. Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, 5255 Loughboro Road, NW, Washington, DC, 20016, USA

    Karen Lisa Smith

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Contributions

CCO, VS, KLS: Conceptualization. CCO: Data Curation. ZW, ZT: Formal Analysis. VS: Funding Acquisition. CCO, ZW, GLR, KLS: Methodology. CU: Resources. CU: Software. VS, KLS: Supervision. CCO, KLS: Writing-original draft. SI, MSC, VS, KLS: Writing-review and editing.

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Correspondence to Karen Lisa Smith.

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Conflict of interest

Ciara C. O’Sullivan has received research support from Lilly. Gary L. Rosner owns stock in Johnson & Johnson and Novartis. Gary L. Rosner is a member of an independent data monitoring committee for Novartis. Vered Stearns has received institutional research support from Abbvie, Biocept, Pfizer, Novartis, Medimmune, and Puma Biotechnology. Vered Stearns has served as a consultant for Iridium Therapeutics, Inc. Vered Stearns is a member of a data safety monitoring board for Immunomedics, Inc. Karen Lisa Smith’s spouse with stock ownership in ABT Labs and Abbvie. Karen Lisa Smith has received research support from CancerIncite and Pfizer. The following authors declare that they have no conflicts of interest: Sheeba Irshad, Zheyu Wang, Zhuojun Tang, Christopher Umbricht and Mindy S. Christianson.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. We obtained approval from the Johns Hopkins (JH) institutional review board (IRB) to conduct this retrospective study.

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O’Sullivan, C.C., Irshad, S., Wang, Z. et al. Clinico-pathologic features, treatment and outcomes of breast cancer during pregnancy or the post-partum period. Breast Cancer Res Treat 180, 695–706 (2020). https://doi.org/10.1007/s10549-020-05585-7

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