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Management of breast cancer in pregnancy

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Abstract

The concurrent diagnosis of breast cancer and pregnancy remains a challenging clinical situation. Ethical concerns regarding maternal and fetal well-being and potential risks and harms of treatment influence the clinical decision process. Ethical considerations of treatment initiation have emphasized the role of autonomy for the patient and the concept of beneficence and non-maleficence for patient and fetus. Limited prospective data are available to assist the physician and patient in making an informed decision. Recent data on diagnosis, evaluation, and management of pregnant patients with breast cancer have informed the development of international recommendations and guidelines for management of breast cancer during pregnancy. This article reviews the epidemiology, clinical presentation, diagnosis, therapy, and outcomes of breast cancer occurring concomitantly with pregnancy.

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References and Recommended Reading

  1. Chervenak FA, McCullough LB, Knapp RC, et al.:A clinically comprehensive ethical framework for offering and recommending cancer treatment before and during pregnancy.Cancer 2004,100:215–222.

    Article  PubMed  Google Scholar 

  2. McCullough LB, Coverdale JH, Chervenak FA:A comprehensive ethical framework for responsibly designing and conducting pharmacologic research that involves pregnant women.Am J Obstet Gynecol 2005,193:901–907.

    Article  PubMed  Google Scholar 

  3. Oduncu FS, Kimmig R, Hepp H, Emmerich B:Cancer in pregnancy: maternal-fetal conflict.J Cancer Res Clin Oncol 2003,129:133–46.

    PubMed  CAS  Google Scholar 

  4. Smith LH, Dalrymple JL, Leiserowitz GS, et al.:Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997.Am J Obstet Gynecol 2001,184:1504–12.

    Article  PubMed  CAS  Google Scholar 

  5. Reis LA, Hankey BF, Miller, BA, et al.:Cancer Statistics Review 1973–1988. III.39, 91-2789. Bethesda, MD: National Cancer Institute; 1991.

    Google Scholar 

  6. White TT:Prognosis of breast cancer for pregnant and nursing women: analysis of 1,413 cases.Surg Gynecol Obstet 1955,700:661–666.

    Google Scholar 

  7. Saunders CM, Baum M:Breast cancer and pregnancy: a review.J R Soc Med 1993,86:162–165.

    PubMed  CAS  Google Scholar 

  8. Nettleton J, Long J, Kuban D, et al.:Breast cancer during pregnancy: quantifying the risk of treatment delay.Obstet Gynecol 1996,87:414–448.

    Article  PubMed  CAS  Google Scholar 

  9. Rosene-Montella K, Larson L:Obstetric monitoring: maternal and fetal testing: diagnostic testing. InMedical Care of the Pregnant Patient. Edited by Lee RV, Rosene-Montella K, Barbour LA, et al. Philadelphia: American College of Physicians, 2000:103–116.

    Google Scholar 

  10. Liberman L, Giess C, Dershaw D, et al.:Imaging of pregnancy-associated breast cancer.Radiology 1994,191:245–8.

    PubMed  CAS  Google Scholar 

  11. Samuels TH, Liu FF, Yaffe M, Haider M:Gestational breast cancer.Can Assoc Radiol J 1998,49:172–80.

    PubMed  CAS  Google Scholar 

  12. Ahn BY, Kim HH, Moon WK, et al.:Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings.J Ultrasound Med 2003,22:491–497.

    PubMed  Google Scholar 

  13. Yang WT, Dryden MJ, Gwyn K, et al.:Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy.Radiology 2006,239:52–60.

    Article  PubMed  Google Scholar 

  14. Gwyn K, Theriault R:Breast cancer during pregnancy.Oncology (Huntingt) 2001,15:39–46.

    CAS  Google Scholar 

  15. Talele AC, Slanetz PJ, Edmister WB, et al.:The lactating breast: MRI findings and literature review.Breast J 2003,9:237–240.

    Article  PubMed  Google Scholar 

  16. Middleton LP, Amin M, Gwyn K, et al.:Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features.Cancer 2003,98:1055–1060.

    Article  PubMed  Google Scholar 

  17. Hahn KM, Johnson PH, Gordon N, et al.:Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero.Cancer 2006,107:1219–26.

    Article  PubMed  Google Scholar 

  18. Giacalone P-L, Laffargue F, Benos P:Chemotherapy for breast carcinoma during pregnancy.Cancer 1999,86:2266–2272.

    Article  PubMed  CAS  Google Scholar 

  19. Ring AE, Smith IE, Ellis PA:Breast cancer and pregnancy.Ann Oncol. 2005,16:1855–1860.

    Article  PubMed  CAS  Google Scholar 

  20. Hanrahan EO, Theriault R:Pregnancy and breast cancer. InBreast Cancer, edn 2. Edited by Winchester DJ, Norton L, Winchester DP. Philadelphia: B. C. Decker, Inc.; 2006:1–14.

    Google Scholar 

  21. Gosfield E, Alavi A, Kneeland B:Comparison of radionuclide bone scans and magnetic resonance imaging in detecting spinal metastases.J Nucl Med 1993,34:2191.

    PubMed  Google Scholar 

  22. Flickinger FW, Sanal SM:Bone marrow MRI: techniques and accuracy for detecting breast cancer metastases.Magn Reson Imaging 1994,12:829–835.

    Article  PubMed  CAS  Google Scholar 

  23. Kuerer HM, Gwyn K, Ames FC, Theriault RL:Conservative surgery and chemotherapy for breast carcinoma during pregnancy.Surgery 2002,131:108–110.

    Article  PubMed  Google Scholar 

  24. Annane K, Bellocq JP, Brettes JP, Mathelin C:Infiltrative breast cancer during pregnancy and conservative surgery.Fetal Diagn Ther 2005,20:442–444.

    Article  PubMed  Google Scholar 

  25. Kal HB, Struikmans H:Radiotherapy during pregnancy: fact and fiction.Lancet Oncol 2005,6:328–333.

    Article  PubMed  Google Scholar 

  26. Edge SB, Niland JC, Bookman MA, et al.:Emergence of sentinel node biopsy in breast cancer as standard-of-care in academic comprehensive cancer centers.J Natl Cancer Inst 2003,95:1514–1521.

    PubMed  Google Scholar 

  27. Keleher A, Wendt R III, Delpassand E, et al.:The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulfur colloid.Breast J 2004,10:492–495.

    Article  PubMed  Google Scholar 

  28. Gentilini O, Cremonesi M, Trifiro G, et al.:Safety of sentinel node biopsy in pregnant patients with breast cancer.Ann Oncol 2004,15:1348–1351.

    Article  PubMed  CAS  Google Scholar 

  29. Amersi F, Hansen NM:The benefits and limitations of sentinel lymph node biopsy.Curr Treat Options Oncol 2006,7:141–151.

    Article  PubMed  Google Scholar 

  30. Rosenkranz KM, Lucci A:Surgical treatment of pregnancy associated breast cancer.Breast Dis 2005,23:87–93.

    PubMed  Google Scholar 

  31. Ring AE, Smith IE, Jones A, et al.:Chemotherapy for breast cancer during pregnancy: an 18-year experience from five London teaching hospitals.J Clin Oncol 2005,23:4192–4197.

    Article  PubMed  Google Scholar 

  32. Germann N, Goffinet F, Goldwasser F:Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients.Ann Oncol 2004,15:146–150.

    Article  PubMed  CAS  Google Scholar 

  33. Gonzalez-Angulo AM, Walters RS, Carpenter RJ Jr, Ross et al.:Paclitaxel chemotherapy in a pregnant patient with bilateral breast cancer.Clin Breast Cancer 2004,5:317–319.

    Article  PubMed  Google Scholar 

  34. Gainford MC, Clemons M:Breast cancer in pregnancy: are taxanes safe? Clin Oncol (R Coll Radiol.) 2006,18:159.

    CAS  Google Scholar 

  35. Romond EH, Suman VJ, Geyer CE Jr, et al.:Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer.N Engl J Med 2005,353:1673–1684.

    Article  PubMed  CAS  Google Scholar 

  36. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al.:Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer.N Engl J Med 2005,353:1659–1672.

    Article  PubMed  CAS  Google Scholar 

  37. Fanale M, Uyei A, Theriault RL, et al.:Treatment of metastatic breast cancer with trastuzumab and vinorelbine during pregnancy.Clin Breast Cancer 2005,6:354–356.

    Article  PubMed  CAS  Google Scholar 

  38. Watson WJ:Herceptin (trastuzumab) therapy during pregnancy: association with reversible anhydramnios.Obstet Gynecol 2005,105:642–643.

    PubMed  Google Scholar 

  39. Waterston AM, Graham J:Effect of adjuvant trastuzumab on pregnancy.J Clin Oncol 2006,21:321–322.

    Google Scholar 

  40. Loibl S, von Minckwitz G, Gwyn K, et al.:Breast carcinoma during pregnancy. International recommendations from an expert meeting.Cancer 2006,106:237–246.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, 77030, Houston, TX, USA

    Richard Theriault DO, MBA

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  1. Richard Theriault DO, MBA
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  2. Karin Hahn MD, MSc, MPH
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Correspondence to Richard Theriault DO, MBA.

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Theriault, R., Hahn, K. Management of breast cancer in pregnancy. Curr Oncol Rep 9, 17–21 (2007). https://doi.org/10.1007/BF02951421

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