Der Gynäkologe

, Volume 50, Issue 11, pp 839–844 | Cite as

Das Mammakarzinom in der Schwangerschaft

Leitthema
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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.

Schlüsselwörter

Chemotherapie Prognose Laktation Mammaneoplasien Trastuzumab 

Breast cancer during pregnancy

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.

Keywords

Chemotherapy Prognosis Lactation Breast neoplasms Trastuzumab 

Notes

Einhaltung ethischer Richtlinien

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.

Literatur

  1. 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):3158–3168CrossRefPubMedGoogle Scholar
  2. 2.
    Amant F, Loibl S, Nevin P et al (2012) Breast cancer in pregnancy. Lancet 379(9815):570–579CrossRefPubMedGoogle Scholar
  3. 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):1824–1834CrossRefPubMedGoogle Scholar
  4. 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):2532–2539CrossRefPubMedGoogle Scholar
  5. 5.
    Andersson TM, Johansson AL, Hsieh CC et al (2009) Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol 114(3):568–572CrossRefPubMedGoogle Scholar
  6. 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):173–177CrossRefPubMedGoogle Scholar
  7. 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 38:834–842CrossRefPubMedGoogle Scholar
  8. 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):855–861CrossRefPubMedGoogle Scholar
  9. 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):1079–1085CrossRefPubMedGoogle Scholar
  10. 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):549–559CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cardonick E, Dougherty R, Grana G et al (2010) Breast cancer during pregnancy: maternal and fetal outcomes. Cancer J 16:76–82CrossRefPubMedGoogle Scholar
  12. 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):2506–2511CrossRefPubMedGoogle Scholar
  13. 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: 14.09.2017Google Scholar
  14. 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):555–563CrossRefPubMedGoogle Scholar
  15. 15.
    Leal SC, Stuart SR, Carvalho Hde A (2013) Breast irradiation and lactation: a review. Expert Rev Anticancer Ther 13(2):159–164CrossRefPubMedGoogle Scholar
  16. 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):1572–1582CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Loibl S, Han SN, von Minckwitz G et al (2012) Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 13(9):887–896CrossRefPubMedGoogle Scholar
  18. 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):R2CrossRefPubMedPubMedCentralGoogle Scholar
  19. 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):414–418CrossRefPubMedGoogle Scholar
  20. 20.
    National Toxicology Program (2013) Developmental effects and pregnancy outcomes associated with cancer chemotherapy use during pregnancy. NTP Monogr. 2013(2):i-214Google Scholar
  21. 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):1611–1618CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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):755–763CrossRefPubMedGoogle Scholar
  23. 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):207–211CrossRefPubMedGoogle Scholar
  24. 24.
    Ray JG, Vermeulen MJ, Bharatha A et al (2016) Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 316(9):952–961CrossRefPubMedGoogle Scholar
  25. 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):716–722CrossRefPubMedGoogle Scholar
  26. 26.
    Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (2015) Krebs in Deutschland 2011/2012 Bd. 10.Google Scholar
  27. 27.
    Roche (2017) Fachinformation Herceptin (Trastuzumab), März 2017Google Scholar
  28. 28.
    Ruiz R, Herrero C, Strasser-Weippl K et al (2017) Epidemiology and pathophysiology of pregnancy-associated breast cancer: a review. Breast 35:136–114CrossRefPubMedGoogle Scholar
  29. 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):45–51CrossRefPubMedGoogle Scholar
  30. 30.
    Sobotka T (2013) Pathways to low fertility: European perspectives. Expert Paper No 2013/08. United Nations Department of Economic and Social Affairs, New YorkGoogle Scholar
  31. 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):1338–1345CrossRefPubMedGoogle Scholar
  32. 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):778–784CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.GBG Forschungs GmbHNeu-IsenburgDeutschland
  2. 2.Centrum für Hämatologie und Onkologie BethanienFrankfurt/MainDeutschland

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