Breast Cancer Research and Treatment

, Volume 172, Issue 1, pp 113–121 | Cite as

Clinical subtypes and prognosis of pregnancy-associated breast cancer: results from the Korean Breast Cancer Society Registry database

  • Soo Youn Bae
  • Sei Joong Kim
  • JungSun Lee
  • Eun Sook Lee
  • Eun-Kyu Kim
  • Ho Young Park
  • Young Jin Suh
  • Hong Kyu Kim
  • Ji-Young You
  • Seung Pil JungEmail author
Clinical trial



We analyzed the clinicopathologic characteristics and prognosis of pregnancy-associated breast cancer (PABC) according to clinical subtypes to better understand the characteristics of PABC.


A total of 83,792 female patients between the ages of 20 and 49 were enrolled in the Korean Breast Cancer Society Registry database from January 1, 1996 to December 31, 2015. ‘PABC’ is defined as breast cancer diagnosed during pregnancy or within 1 year after delivery. Other patients were defined as ‘non-PABC’ patients.


In non-PABC patients, luminal A subtype was the most common (50.2%). In PABC patients, TNBC was the most common (40.4%) subtype, while luminal A comprised 21.2% and HER2 subtype comprised 17.3%. There was a significant difference in overall survival (OS). In non-PABC patients, TNBC had the highest HR (HR 2.3, 95% CI 2.1–2.6). In PABC patients, the luminal B subtype (HR+ HER2-high Ki67) had the highest HR at 7.0 (95% CI 1.7–29.1). In multivariate analysis of OS by subtypes, PABC patients had significantly higher HR than non-PABC patients in the HER2 subtype (HR 2.0, 95% CI 1.1–3.7) and luminal B subtype (HR+ HER2-high Ki67) (HR 4.4, 95% CI 1.6–12.3).


PABC showed different biologic features than non-PABC. PABC had a particularly poor prognosis in the luminal B (HR+ HER2-highKi67) and HER2 subtypes. To improve the prognosis of PABC, treatment should be considered according to subtype. Development of drugs that can be used during pregnancy is needed.


Pregnancy Breast cancer Subtype Prognosis 



This work was supported by the Korean Breast Cancer Society. This work was supported by the National Research Foundation of Korea (2017R1D1A1B03028103) and Korea University Grant (K1813171).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study informed consent is not required.

Supplementary material

10549_2018_4908_MOESM1_ESM.xlsx (13 kb)
Supplementary material 1 (XLSX 12 KB)


  1. 1.
    Lee YY, Roberts CL, Dobbins T, Stavrou E, Black K, Morris J, Young J (2012) Incidence and outcomes of pregnancy-associated cancer in Australia, 1994–2008: a population-based linkage study. BJOG 119(13):1572–1582CrossRefGoogle Scholar
  2. 2.
    Stensheim H, Moller B, van Dijk T, Fossa SD (2009) Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol 27(1):45–51CrossRefGoogle Scholar
  3. 3.
    Parente JT, Amsel M, Lerner R, Chinea F (1988) Breast cancer associated with pregnancy. Obstet Gynecol 71(6 Pt 1):861–864PubMedGoogle Scholar
  4. 4.
    Hartman EK, Eslick GD (2016) The prognosis of women diagnosed with breast cancer before, during and after pregnancy: a meta-analysis. Breast Cancer Res Treat 160(2):347–360CrossRefGoogle Scholar
  5. 5.
    Azim HA Jr, Peccatori FA, Brohee S, Branstetter D, Loi S, Viale G, Piccart M, Dougall WC, Pruneri G, Sotiriou C (2015) RANK-ligand (RANKL) expression in young breast cancer patients and during pregnancy. Breast Cancer Res 17:24CrossRefGoogle Scholar
  6. 6.
    Azim HA Jr, Brohee S, Peccatori FA, Desmedt C, Loi S, Lambrechts D, Dell’Orto P, Majjaj S, Jose V, Rotmensz N et al (2014) Biology of breast cancer during pregnancy using genomic profiling. Endocr Relat Cancer 21(4):545–554CrossRefGoogle Scholar
  7. 7.
    Kroman N, Mouridsen HT (2003) Prognostic influence of pregnancy before, around, and after diagnosis of breast cancer. Breast 12(6):516–521CrossRefGoogle Scholar
  8. 8.
    Woo JC, Yu T, Hurd TC (2003) Breast cancer in pregnancy: a literature review. Arch Surg (Chicago Ill: 1960) 138(1):91–98. (discussion 99).CrossRefGoogle Scholar
  9. 9.
    Johansson ALV, Andersson TM, Hsieh CC, Jirstrom K, Cnattingius S, Fredriksson I, Dickman PW, Lambe M (2018) Tumor characteristics and prognosis in women with pregnancy-associated breast cancer. Int J Cancer 142(7):1343–1354CrossRefGoogle Scholar
  10. 10.
    Ahn SH, Son BH, Kim SW, Kim SI, Jeong J, Ko SS, Han W (2007) Poor outcome of hormone receptor-positive breast cancer at very young age is due to tamoxifen resistance: nationwide survival data in Korea: a report from the Korean Breast Cancer Society. J Clin Oncol 25(17):2360–2368CrossRefGoogle Scholar
  11. 11.
    Johansson ALV, Andersson TM, Hsieh CC, Jirstrom K, Cnattingius S, Fredriksson I, Dickman PW, Lambe M (2017) Tumor characteristics and prognosis in women with pregnancy-associated breast cancer. Int J Cancer 142:1343–1354Google Scholar
  12. 12.
    Iqbal J, Amir E, Rochon PA, Giannakeas V, Sun P, Narod SA (2017) Association of the Timing of Pregnancy With Survival in Women With Breast Cancer. JAMA Oncol 3(5):659–665CrossRefGoogle Scholar
  13. 13.
    Callihan EB, Gao D, Jindal S, Lyons TR, Manthey E, Edgerton S, Urquhart A, Schedin P, Borges VF (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):549–559CrossRefGoogle Scholar
  14. 14.
    Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y, Wang Y, Marcom PK, Marks JR, Febbo PG et al (2008) Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol 26(20):3324–3330CrossRefGoogle Scholar
  15. 15.
    Ahn SH, Hwang UK, Kwak BS, Yoon HS, Ku BK, Kang HJ, Kim JS, Ko BK, Ko CD, Yoon KS et al (2004) Prevalence of BRCA1 and BRCA2 Mutations in Korean Breast Cancer Patients. J Korean Med Sci 19(2):269–274CrossRefGoogle Scholar
  16. 16.
    Anglian Breast Cancer Study G (2000) Prevalence and penetrance of BRCA1 and BRCA2 mutations in a population-based series of breast cancer cases. Br J Cancer 83(10):1301–1308CrossRefGoogle Scholar
  17. 17.
    Kan Z, Ding Y, Kim J, Jung HH, Chung W, Lal S, Cho S, Fernandez-Banet J, Lee SK, Kim SW et al (2018) Multi-omics profiling of younger Asian breast cancers reveals distinctive molecular signatures. Nat Commun 9(1):1725CrossRefGoogle Scholar
  18. 18.
    Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H (2009) Breast cancer in young women: poor survival despite intensive treatment. PLoS ONE 4(11):e7695CrossRefGoogle Scholar
  19. 19.
    Creighton CJ (2012) The molecular profile of luminal B breast cancer. Biologics 6:289–297PubMedPubMedCentralGoogle Scholar
  20. 20.
    Kozak MM, Jacobson CE, von Eyben R, Walck E, Pollom EL, Telli M, Horst KC (2018) Patterns of distant failure by intrinsic breast cancer subtype in premenopausal women treated with neoadjuvant chemotherapy. Clin Breast Cancer. CrossRefPubMedGoogle Scholar
  21. 21.
    Lee MK, Varzi LA, Chung DU, Cao MA, Gornbein J, Apple SK, Chang HR (2015) The effect of young age in hormone receptor positive breast cancer. BioMed Res Int. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Baselga J, Campone M, Piccart M, Burris HA III, Rugo HS, Sahmoud T, Noguchi S, Gnant M, Pritchard KI, Lebrun F et al (2012) Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med 366(6):520–529CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Soo Youn Bae
    • 1
  • Sei Joong Kim
    • 2
  • JungSun Lee
    • 3
  • Eun Sook Lee
    • 4
  • Eun-Kyu Kim
    • 5
  • Ho Young Park
    • 6
  • Young Jin Suh
    • 7
  • Hong Kyu Kim
    • 1
  • Ji-Young You
    • 1
  • Seung Pil Jung
    • 1
    • 8
    Email author
  1. 1.Department of Surgery, Korea University Anam HospitalKorea University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Surgery, Inha University HospitalInha University School of MedicineIncheonRepublic of Korea
  3. 3.Department of Surgery, Haeundae Paik Hospital, College of MedicineInje UniversityBusanRepublic of Korea
  4. 4.Center for Breast CancerNational Cancer CenterGoyang-siRepublic of Korea
  5. 5.Department of Surgery, Seoul National University Bundang HospitalSeoul National University College of MedicineGyeonggiRepublic of Korea
  6. 6.Department of Surgery, Kyungpook National University Medical CenterKyungpook National University School of MedicineDaeguRepublic of Korea
  7. 7.Division of Breast & Thyroid Surgical Oncology, Department of Surgery, College of Medicine, St. Vincent’s HospitalThe Catholic University of KoreaSuwonRepublic of Korea
  8. 8.Division of Breast and Endocrine Surgery, Department of Surgery, Korea University HospitalKorea University College of MedicineSeoulRepublic of Korea

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