Skip to main content

Advertisement

SpringerLink
Log in

Pregnancy-associated breast cancer: a multicenter study comparing clinicopathological factors, diagnosis and treatment outcomes with non-pregnant patients

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Pregnancy-associated breast cancer (PABC), defined as breast carcinoma diagnosed during pregnancy or in the first post-partum year, is one of the most common gestation-related malignancies with reported differences in tumor characteristics and outcomes. This multicenter study aims to review cases of PABC in Singapore, including their clinicopathological features, treatment, and clinical outcomes compared to non-PABC patients.

Methods

Demographic, histopathologic and clinical outcomes of 93 PABC patients obtained from our database were compared to 1424 non-PABC patients.

Results

PABC patients presented at a younger age. They had higher tumor and nodal stages, higher tumor grade, were more likely to be hormone receptor negative and had a higher incidence of multicentric and multifocal tumors. Histological examination after definitive surgery showed no significant difference in tumor size and number of positive lymph nodes suggesting similar neoadjuvant treatment effects. Despite this, PABC patients had worse outcomes with poorer overall survival and disease-free survival, OS (P < 0.0001) and DFS (P < 0.0001). Termination of pregnancy did not improve survival.

Conclusion

Patients with PABC present at a higher stage with more aggressive disease and have poorer outcomes compared to non-PABC patients. Reducing delay in diagnosis and treatment may help improve survival.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

References

  1. Navrozoglou I, Vrekoussis T, Kontostolis E et al (2008) Breast cancer during pregnancy: a mini-review. Eur J Surg Oncol 34(8):837–843. https://doi.org/10.1016/j.ejso.2008.01.029

    Article  CAS  Google Scholar 

  2. Pavlidis NA (2002) Coexistence of Pregnancy and Malignancy. Oncologist 7(4):279–287. https://doi.org/10.1634/theoncologist.2002-0279

    Article  Google Scholar 

  3. Sekine M, Kobayashi Y, Tabata T et al (2018) Malignancy during pregnancy in Japan: an exceptional opportunity for early diagnosis. BMC Pregnancy Childbirth 18(1):4–8. https://doi.org/10.1186/s12884-018-1678-4

    Article  Google Scholar 

  4. Parazzini F, Franchi M, Tavani A, Negri E, Peccatori FA (2017) Frequency of pregnancy related cancer: a population based linkage study in Lombardy. Italy Int J Gynecol Cancer 27(3):613–619. https://doi.org/10.1097/IGC.0000000000000904

    Article  Google Scholar 

  5. Shechter Maor G, Czuzoj-Shulman N, Spence AR, Abenhaim HA (2019) Neonatal outcomes of pregnancy-associated breast cancer: population-based study on 11 million births. Breast J 25(1):86–90. https://doi.org/10.1111/tbj.13156

    Article  Google Scholar 

  6. Salani R, Billingsley CC, Crafton SM (2014) Cancer and pregnancy: an overview for obstetricians and gynecologists. Am J Obstet Gynecol 211(1):7–14. https://doi.org/10.1016/j.ajog.2013.12.002

    Article  Google Scholar 

  7. Vinatier E, Merlot B, Poncelet E, Collinet P, Vinatier D (2009) Breast cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol 147(1):9–14. https://doi.org/10.1016/j.ejogrb.2009.06.030

    Article  Google Scholar 

  8. Cardonick E, Dougherty R, Grana G, Gilmandyar D, Ghaffar S, Usmani A (2010) Breast cancer during pregnancy: maternal and fetal outcomes. Cancer J 16(1):76–82. https://doi.org/10.1097/ppo.0b013e3181ce46f9

    Article  Google Scholar 

  9. Rojas KE, Bilbro N, Manasseh DM, Borgen PI (2019) A review of pregnancy-associated breast cancer: diagnosis, local and systemic treatment, and prognosis. J Women’s Heal 28(6):778–784. https://doi.org/10.1089/jwh.2018.7264

    Article  Google Scholar 

  10. Royal College of Obstetricians and Gynaecologists (2011) Pregnancy and breast cancer. Green-top Guideline No. 12. London: Royal College of Obstetricians and Gynaecologists.https://www.rcog.org.uk/media/2q4jb0kz/gtg_12.pdf

  11. Fajdić J, Gotovac N, Hrgović Z, Fassbender WJ (2008) Diagnosis and therapy of gestational breast cancer: a review. Adv Med Sci 53(2):167–171. https://doi.org/10.2478/v10039-008-0037-5

    Article  Google Scholar 

  12. Poggio F, Tagliamento M, Pirrone C et al (2020) Update on the management of breast cancer during pregnancy. Cancers (Basel) 12(12):1–17. https://doi.org/10.3390/cancers12123616

    Article  CAS  Google Scholar 

  13. Ring AE, Smith IE, Jones A, Shannon C, Galani E, Ellis PA (2005) Chemotherapy for breast cancer during pregnancy: an 18-year experience from five London teaching hospitals. J Clin Oncol 23(18):4192–4197. https://doi.org/10.1200/JCO.2005.03.038

    Article  Google Scholar 

  14. Shah NM, Scott DM, Kandagatla P et al (2019) Young women with breast cancer: fertility preservation options and management of pregnancy-associated breast cancer. Ann Surg Oncol 26(5):1214–1224. https://doi.org/10.1245/s10434-019-07156-7

    Article  Google Scholar 

  15. Lohsiriwat V, Peccatori FA, Martella S et al (2013) Immediate breast reconstruction with expander in pregnant breast cancer patients. Breast 22(5):657–660. https://doi.org/10.1016/j.breast.2013.06.005

    Article  Google Scholar 

  16. Caragacianu DL, Mayer EL, Chun YS et al (2016) Immediate breast reconstruction following mastectomy in pregnant women with breast cancer. J Surg Oncol 114(2):140–143. https://doi.org/10.1002/jso.24308

    Article  Google Scholar 

  17. Balaya V, Bonsang-Kitzis H, Ngo C et al (2018) What about sentinel lymph node biopsy for early breast cancer during pregnancy? J Gynecol Obstet Hum Reprod 47(5):205–207. https://doi.org/10.1016/j.jogoh.2018.03.003

    Article  CAS  Google Scholar 

  18. Azim HA, Santoro L, Russell-Edu W, Pentheroudakis G, Pavlidis N, Peccatori FA (2012) Prognosis of pregnancy-associated breast cancer: a meta-analysis of 30 studies. Cancer Treat Rev 38(7):834–842. https://doi.org/10.1016/j.ctrv.2012.06.004

    Article  Google Scholar 

  19. CC O'Sullivan, S Irshad, Z Wang, Z Tang C Umbricht et al. Clinico-pathologic features, treatment and outcomes of breast cancer during pregnancy or the post-partum period. Breast Cancer Res Treat 180(3):695–706. https://doi.org/10.1007/s10549-020-05585-7

    Article  CAS  Google Scholar 

  20. 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. https://doi.org/10.1200/JCO.2012.45.6335

    Article  Google Scholar 

  21. Schedin P (2006) Pregnancy-associated breast cancer and metastasis. Nat Rev Cancer 6(4):281–291. https://doi.org/10.1038/nrc1839

    Article  CAS  Google Scholar 

  22. Murphy CG, Mallam D, Stein S et al (2012) Current or recent pregnancy is associated with adverse pathologic features but not impaired survival in early breast cancer. Cancer 118(13):3254–3259. https://doi.org/10.1002/cncr.26654

    Article  Google Scholar 

  23. Genin AS, Lesieur B, Gligorov J, Antoine M, Selleret L, Rouzier R (2012) Pregnancy-associated breast cancers: Do they differ from other breast cancers in young women? Breast 21(4):550–555. https://doi.org/10.1016/j.breast.2012.05.002

    Article  Google Scholar 

  24. Suelmann BBM, van Dooijeweert C, van der Wall E, Linn S, van Diest PJ (2021) Pregnancy-associated breast cancer: nationwide Dutch study confirms a discriminatory aggressive histopathologic profile. Breast Cancer Res Treat 186(3):699–704. https://doi.org/10.1007/s10549-021-06130-w

    Article  CAS  Google Scholar 

  25. Lee GE, Mayer EL, Partridge A (2017) Prognosis of pregnancy-associated breast cancer. Breast Cancer Res Treat 163(3):417–421. https://doi.org/10.1007/s10549-017-4224-6

    Article  Google Scholar 

  26. Moreira WB, Brandão EC, Soares AN, de Lucena CEM, Antunes CMF (2010) Prognosis for patients diagnosed with pregnancy-associated breast cancer: a paired case-control study. Sao Paulo Med J 128(3):119–124. https://doi.org/10.1590/s1516-31802010000300003

    Article  Google Scholar 

  27. Genin AS, De Rycke Y, Stevens D et al (2016) Association with pregnancy increases the risk of local recurrence but does not impact overall survival in breast cancer: a case–control study of 87 cases. Breast 30:222–227. https://doi.org/10.1016/j.breast.2015.09.006

    Article  CAS  Google Scholar 

  28. Dimitrakakis C, Zagouri F, Tsigginou A et al (2013) Does pregnancy-associated breast cancer imply a worse prognosis? a matched case-case study. Breast Care 8(3):203–207. https://doi.org/10.1159/000352093

    Article  Google Scholar 

  29. Teran-Porcayo MA, Gomez-Del Castillo-Rangel AC, Barrera-Lopez N, Zeichner-Gancz I (2008) Cancer during pregnancy: 10-Year experience at a regional cancer reference center in Mexico. Med Oncol 25(1):50–53. https://doi.org/10.1007/s12032-007-0020-1

    Article  CAS  Google Scholar 

  30. Han BY, Li XG, Zhao HY, Hu X, Ling H (2020) Clinical features and survival of pregnancy-associated breast cancer: a retrospective study of 203 cases in China. BMC Cancer 20(1):1–8. https://doi.org/10.1186/s12885-020-06724-5

    Article  CAS  Google Scholar 

  31. Allouch S, Gupta I, Malik S, Al Farsi HF, Vranic S, Al Moustafa AE (2020) Breast cancer during pregnancy: a marked propensity to triple-negative phenotype. Front Oncol 10:1–11. https://doi.org/10.3389/fonc.2020.580345

    Article  Google Scholar 

  32. Yang YL, Chan KA, Hsieh FJ, Chang LY, Wang MY (2014) Pregnancy-associated breast cancer in Taiwanese women: potential treatment delay and impact on survival. PLoS ONE 9(11):1–13. https://doi.org/10.1371/journal.pone.0111934

    Article  CAS  Google Scholar 

  33. Basaran D, Turgal M, Beksac K, Ozyuncu O, Aran O, Beksac MS (2014) Pregnancy-associated breast cancer: clinicopathological characteristics of 20 cases with a focus on identifiable causes of diagnostic delay. Breast Care 9(5):355–359. https://doi.org/10.1159/000366436

    Article  Google Scholar 

  34. Rasmussen CB, Kjær SK, Ejlertsen B et al (2014) Incidence of metachronous contralateral breast cancer in Denmark 1978–2009. Int J Epidemiol 43(6):1855–1864. https://doi.org/10.1093/ije/dyu202

    Article  Google Scholar 

  35. Wong RX, Kwok L, Wong FY (2017) Screening uptake differences are not implicated in poorer breast cancer outcomes among Singapore Malay women. J Breast Cancer 20(2):183–191. https://doi.org/10.4048/jbc.2017.20.2.183

    Article  Google Scholar 

  36. Muñoz-Montaño WR, Cabrera-Galeana P, De la Garza-Ramos C et al (2021) Prognosis of breast cancer diagnosed during pregnancy and early postpartum according to immunohistochemical subtype: a matched case–control study. Breast Cancer Res Treat 188(2):489–500. https://doi.org/10.1007/s10549-021-06225-4

    Article  CAS  Google Scholar 

  37. Cardonick E (2014) Pregnancy-associated breast cancer: optimal treatment options. Int J Womens Health 6:935–943. https://doi.org/10.2147/IJWH.S52381

    Article  Google Scholar 

  38. Loibl S, Schmidt A, Gentilini O et al (2015) Breast cancer diagnosed during pregnancy adapting recent advances in breast cancer care for pregnant patients. JAMA Oncol 1(8):1145–1153. https://doi.org/10.1001/jamaoncol.2015.2413

    Article  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Author notes

  1. Qing Ting Tan and Veronica Siton Alcantara are co-first authors.

Authors and Affiliations

  1. Breast Department, KK Women’s and Children’s Hospital, Singapore, Singapore

    Qing Ting Tan & Veronica Siton Alcantara

  2. Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore

    Rehena Sultana

  3. Medical Oncology, Penang Adventist Hospital, Pulau Pinang, Malaysia

    Kiley Wei-Jen Loh

  4. Medical Oncology, Curie Oncology, Singapore, Singapore

    Kiley Wei-Jen Loh

  5. Department of Surgery, Chong Hua Hospital, Cebu, Philippines

    Aura Lynn Go

  6. Division of Radiation Oncology, Cancer Informatics, National Cancer Centre Singapore, Singapore General Hospital, Singapore, Singapore

    Fuh Yong Wong

Authors
  1. Qing Ting Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Veronica Siton Alcantara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rehena Sultana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kiley Wei-Jen Loh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aura Lynn Go
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fuh Yong Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by QTT, VSA, KWJL, ALG and FYW. Data analysis was performed by RS, QTT, VSA and FYW. QTT and VSA contributed equally to the first draft of the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Qing Ting Tan.

Ethics declarations

Conflict of interests

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, Q.T., Alcantara, V.S., Sultana, R. et al. Pregnancy-associated breast cancer: a multicenter study comparing clinicopathological factors, diagnosis and treatment outcomes with non-pregnant patients. Breast Cancer Res Treat 198, 53–66 (2023). https://doi.org/10.1007/s10549-022-06855-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-022-06855-2

Keywords

Search

Navigation