Abstract
Purpose
Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during the gestational period (gp-PABC) or in the first postpartum year (pp-PABC). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments, and maternal and foetal outcomes.
Methods
This was a national, multi-site, retrospective observational study, including PABC patients treated in 12 oncology institutions from August 2001 to January 2020. Data extracted included information on patient demographics, tumour biology, staging, treatments, and maternal/foetal outcomes. Survival data for an age-matched breast cancer population over a similar time period was obtained from the National Cancer Registry of Ireland (NCRI). Standard biostatistical methods were used for analyses.
Results
We identified 155 patients—71 (46%) were gp-PABC and 84 (54%) were pp-PABC. The median age was 36 years. Forty-four patients (28%) presented with Stage III disease and 25 (16%) had metastatic disease at diagnosis. High rates of triple-negative (25%) and HER2+ (30%) breast cancer were observed. We observed an inferior 5-year overall survival (OS) rate in our PABC cohort compared to an age-matched breast cancer population in both Stage I–III (77.6% vs 90.9%) and Stage IV disease (18% vs 38.3%). There was a low rate (3%) of foetal complications.
Conclusion
PABC patients may have poorer survival outcomes. Further prospective data are needed to optimise management of these patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Amant F, Loibl S, Neven P, Van Calsteren K (2012) Breast cancer in pregnancy. Lancet 379(9815):570–579. https://doi.org/10.1016/S0140-6736(11)61092-1
Azim HA Jr, 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
Andersson TM, Johansson AL, Hsieh CC, Cnattingius S, Lambe M (2009) Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol 114(3):568–572. https://doi.org/10.1097/AOG.0b013e3181b19154
Amant F, Deckers S, Van Calsteren K, Loibl S, Halaska M, Brepoels L, Beijnen J, Cardoso F, Gentilini O, Lagae L, Mir O, Neven P, Ottevanger N, Pans S, Peccatori F, Rouzier R, Senn HJ, Struikmans H, Christiaens MR, Cameron D, Du Bois A (2010) Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer 46(18):3158–3168. https://doi.org/10.1016/j.ejca.2010.09.010
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):347–360. https://doi.org/10.1007/s10549-016-3989-3
National Cancer Registry Ireland. https://www.ncri.ie/. Accessed 21 Dec 2020
Amant F, von Minckwitz G, Han SN, Bontenbal M, Ring AE, Giermek J, Wildiers H, Fehm T, Linn SC, Schlehe B, Neven P, Westenend PJ, Muller V, Van Calsteren K, Rack B, Nekljudova V, Harbeck N, Untch M, Witteveen PO, Schwedler K, Thomssen C, Van Calster B, Loibl S (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
Vashi R, Hooley R, Butler R, Geisel J, Philpotts L (2013) Breast imaging of the pregnant and lactating patient: imaging modalities and pregnancy-associated breast cancer. Am J Roentgenol 200(2):321–328. https://doi.org/10.2214/AJR.12.9814
Schedin P (2006) Pregnancy-associated breast cancer and metastasis. Nat Rev Cancer 6(4):281–291. https://doi.org/10.1038/nrc1839
Van Calsteren K, Verbesselt R, Ottevanger N, Halaska M, Heyns L, Van Bree R, de Bruijn E, Chai D, Delforge M, Noens L, Renard V, Witteveen E, Rob L, de Hoon J, Amant F (2010) Pharmacokinetics of chemotherapeutic agents in pregnancy: a preclinical and clinical study. Acta Obstet Gynecol Scand 89(10):1338–1345. https://doi.org/10.3109/00016349.2010.512070
Rouzier R, Werkoff G, Uzan C, Mir O, Gligorov J, Selleret L, Goffinet F, Goldwasser F, Treluyer JM, Uzan S, Delaloge S (2011) Pregnancy-associated breast cancer is as chemosensitive as non-pregnancy-associated breast cancer in the neoadjuvant setting. Ann Oncol 22(7):1582–1587. https://doi.org/10.1093/annonc/mdq642
Haque W, Verma V, Hatch S, Suzanne Klimberg V, Brian Butler E, Teh BS (2018) Response rates and pathologic complete response by breast cancer molecular subtype following neoadjuvant chemotherapy. Breast Cancer Res Treat 170(3):559–567. https://doi.org/10.1007/s10549-018-4801-3
de Haan J, Verheecke M, Van Calsteren K, Van Calster B, Shmakov RG, Mhallem Gziri M, Halaska MJ, Fruscio R, Lok CAR, Boere IA, Zola P, Ottevanger PB, de Groot CJM, Peccatori FA, Dahl Steffensen K, Cardonick EH, Polushkina E, Rob L, Ceppi L, Sukhikh GT, Han SN, Amant F, International Network on Cancer, Infertility and Pregnancy (2018) Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol 19(3):337–346. https://doi.org/10.1016/S1470-2045(18)30059-7
Amant F, Van Calsteren K, Halaska MJ, Gziri MM, Hui W, Lagae L, Willemsen MA, Kapusta L, Van Calster B, Wouters H, Heyns L, Han SN, Tomek V, Mertens L, Ottevanger PB (2012) Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study. Lancet Oncol 13(3):256–264. https://doi.org/10.1016/S1470-2045(11)70363-1
Amant F, Vandenbroucke T, Verheecke M, Fumagalli M, Halaska MJ, Boere I, Han S, Gziri MM, Peccatori F, Rob L, Lok C, Witteveen P, Voigt JU, Naulaers G, Vallaeys L, Van den Heuvel F, Lagae L, Mertens L, Claes L, Van Calsteren K, International Network on Cancer, Infertility, and Pregnancy (2015) Pediatric outcome after maternal cancer diagnosed during pregnancy. N Engl J Med 373(19):1824–1834. https://doi.org/10.1056/NEJMoa1508913
Zagouri F, Sergentanis TN, Chrysikos D, Papadimitriou CA, Dimopoulos MA, Bartsch R (2013) Trastuzumab administration during pregnancy: a systematic review and meta-analysis. Breast Cancer Res Treat 137(2):349–357. https://doi.org/10.1007/s10549-012-2368-y
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
Johansson AL, Andersson TM, Hsieh CC, Cnattingius S, Dickman PW, Lambe M (2015) Family history and risk of pregnancy-associated breast cancer (PABC). Breast Cancer Res Treat 151(1):209–217. https://doi.org/10.1007/s10549-015-3369-4
Valentini A, Lubinski J, Byrski T, Ghadirian P, Moller P, Lynch HT, Ainsworth P, Neuhausen SL, Weitzel J, Singer CF, Olopade OI, Saal H, Lyonnet DS, Foulkes WD, Kim-Sing C, Manoukian S, Zakalik D, Armel S, Senter L, Eng C, Grunfeld E, Chiarelli AM, Poll A, Sun P, Narod SA, Hereditary Breast Cancer Clinical Study Group (2013) The impact of pregnancy on breast cancer survival in women who carry a BRCA1 or BRCA2 mutation. Breast Cancer Res Treat 142(1):177–185. https://doi.org/10.1007/s10549-013-2729-1
Copson ER, Maishman TC, Tapper WJ, Cutress RI, Greville-Heygate S, Altman DG, Eccles B, Gerty S, Durcan LT, Jones L, Evans DG, Thompson AM, Pharoah P, Easton DF, Dunning AM, Hanby A, Lakhani S, Eeles R, Gilbert FJ, Hamed H, Hodgson S, Simmonds P, Stanton L, Eccles DM (2018) Germline BRCA mutation and outcome in young-onset breast cancer (POSH): a prospective cohort study. Lancet Oncol 19(2):169–180. https://doi.org/10.1016/S1470-2045(17)30891-4
Funding
No funding was used for completion of this study.
Author information
Authors and Affiliations
Contributions
All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by LP, RO, ARF, MG, CW, CO, RA, WD, NA, ECO, GW, DK, JG, LK, AH, MJH, PMW and JMW. The first draft of the manuscript was written by LP, MJH and JMW and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to declare.
Ethical approval
This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Institutional Research Ethics Committee waived the need for ethics approval and the need to obtain consent for the collection, analysis and publication of the retrospectively obtained and anonymized data for this non-interventional study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Prior, L., O’Dwyer, R., Farooq, A.R. et al. Pregnancy-associated breast cancer: evaluating maternal and foetal outcomes. A national study. Breast Cancer Res Treat 189, 269–283 (2021). https://doi.org/10.1007/s10549-021-06263-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-021-06263-y