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Management of breast cancer diagnosed during pregnancy

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Opinion statement

Breast cancer during pregnancy is generally defined as cancer occurring during pregnancy or within 1 year of delivery, although treatment options are the most complicated when the disease is diagnosed during gestation. The challenges of treatment during gestation are discussed in this article. In general, a pregnant woman with breast cancer should be treated similarly to the nonpregnant patient, with specific recommendations tailored to gestational age at diagnosis, stage of the tumor, and the personal preferences of the patient. Despite the increasing literature focusing on treatment decisions, there are little prospective data regarding treatment or long-term outcome information to provide toxicity data that can be used to advise patients and guide decisions. Most of the retrospective and anecdotal data are based on the possibility of fetal loss or demise with specific treatment or treatment administered at specific times during pregnancy. Therefore, it is impossible to accurately quantify risks to the fetus or the mother, and decisions should be made after careful discussion between the patient, her family, and the medical team. The physician must have a clear understanding of the pharmacology and teratogenic potential of individual agents, thus limiting risks.

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References and Recommended Reading

  1. Donegan WL: Cancer and pregnancy. CA Cancer J Clin 1983, 33:194–214.

    Article  PubMed  CAS  Google Scholar 

  2. Gwyn K, Theriault R: Breast cancer during pregnancy. Oncology (Huntingt) 2001, 15:39–46. This recent overview provides a summary of pathologic findings, prognosis, and treatment options.

    CAS  Google Scholar 

  3. Crivellari D, Lombardi D, Scuderi C, et al.: Breast cancer and pregnancy. Tumori 2002, 88:187–192. This paper is a recent comprehensive review of breast cancer and pregnancy.

    PubMed  Google Scholar 

  4. Moore HC, Foster RS Jr: Breast cancer and pregnancy. Semin Oncol 2000, 27:646–653.

    PubMed  CAS  Google Scholar 

  5. Donegan WL: Breast cancer and pregnancy. Obstet Gynecol 1977, 50:244–252.

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  7. Bernik SF, Bernik TR, Whooley BP, Wallack MK: Carcinoma of the breast during pregnancy: a review and update on treatment options. Surg Oncol 1998, 7:45–49.

    Article  PubMed  CAS  Google Scholar 

  8. Wallack MK, Wolf JA Jr, Bedwinek J, et al.: Gestational carcinoma of the female breast. Curr Probl Cancer 1983, 7:1–58.

    Article  PubMed  CAS  Google Scholar 

  9. Smith LH, Dalrymple JL, Leiserowitz GS, et al.: Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol 2001, 184:1504–1512.

    Article  PubMed  CAS  Google Scholar 

  10. Helewa M, Levesque P, Provencher D, et al.: Breast cancer, pregnancy, and breastfeeding. J Obstet Gynaecol Can 2002, 24:164–180.

    PubMed  Google Scholar 

  11. Nettleton J, Long J, Kuban D, et al.: Breast cancer during pregnancy: quantifying the risk of treatment delay. Obstet Gynecol 1996, 87:414–418.

    Article  PubMed  CAS  Google Scholar 

  12. Zemlickis D, Lishner M, Degendorfer P, et al.: Maternal and fetal outcome after breast cancer in pregnancy. Am J Obstet Gynecol 1992, 166:781–787.

    PubMed  CAS  Google Scholar 

  13. Anderson BO, Petrek JA, Byrd Dr, et al.: Pregnancy influences breast cancer stage at diagnosis in women 30 years of age and younger. Ann Surg Oncol 1996, 3:204–211.

    Article  PubMed  CAS  Google Scholar 

  14. Guinee VF, Olsson H, Moller T, et al.: Effect of pregnancy on prognosis for young women with breast cancer. Lancet 1994, 343:1587–1589.

    Article  PubMed  CAS  Google Scholar 

  15. Bonnier P, Romain S, Dilhuydy JM, et al.: Influence of pregnancy on the outcome of breast cancer: a case-control study. Societe Francaise de Senologie et de Pathologie Mammaire Study Group. Int J Cancer 1997, 72:720–727.

    Article  PubMed  CAS  Google Scholar 

  16. Petrek JA, Dukoff R, Rogatko A: Prognosis of pregnancy-associated breast cancer. Cancer 1991, 67:869–872. One of the first publications indicating that pregnancy does not adversely affect prognosis of breast cancer, including patients examined at Memorial Sloan-Kettering Cancer Center.

    Article  PubMed  CAS  Google Scholar 

  17. Gemignani ML, Petrek JA: Pregnancy-associated breast cancer: diagnosis and treatment. Breast J 2000, 6:68–73.

    Article  PubMed  Google Scholar 

  18. Ibrahim EM, Ezzat AA, Baloush A, et al.: Pregnancyassociated breast cancer: a case-control study in a young population with a high-fertility rate. Med Oncol 2000, 17:293–300.

    PubMed  CAS  Google Scholar 

  19. Lethaby AE, O’Neill MA, Mason BH, et al.: Overall survival from breast cancer in women pregnant or lactating at or after diagnosis. Auckland Breast Cancer Study Group. Int J Cancer 1996, 67:751–755.

    Article  PubMed  CAS  Google Scholar 

  20. Ezzat A, Raja MA, Berry J, et al.: Impact of pregnancy on non-metastatic breast cancer: a case control study. Clin Oncol (R Coll Radiol) 1996, 8:367–370.

    CAS  Google Scholar 

  21. Shousha S: Breast carcinoma presenting during or shortly after pregnancy and lactation. Arch Pathol Lab Med 2000, 124:1053–1060.

    PubMed  CAS  Google Scholar 

  22. Elledge RM, Ciocca DR, Langone G, McGuire WL: Estrogen receptor, progesterone receptor, and HER-2/ neu protein in breast cancers from pregnant patients. Cancer 1993, 71:2499–2506.

    Article  PubMed  CAS  Google Scholar 

  23. Keleher AJ, Theriault RL, Gwyn KM, et al.: Multidisciplinary management of breast cancer concurrent with pregnancy. J Am Coll Surg 2002, 194:54–64. Recent article describing the benefits of a multidisciplinary approach to treatment based on the MD Anderson (Houston, TX) model.

    Article  PubMed  Google Scholar 

  24. Novotny DB, Maygarden SJ, Shermer RW, Frable WJ: Fine needle aspiration of benign and malignant breast masses associated with pregnancy. Acta Cytol 1991, 35:676–686.

    PubMed  CAS  Google Scholar 

  25. Schackmuth EM, Harlow CL, Norton LW: Milk fistula: a complication after core breast biopsy. AJR Am J Roentgenol 1993, 161:961–962.

    PubMed  CAS  Google Scholar 

  26. Burstein HJ, Partridge AH, Lesnikoski BA: Treatment of breast cancer during pregnancy. Expert Opin Pharmacother 2002, 3:423–428. Excellent review of treatment options for breast cancer occurring during pregnancy.

    Article  PubMed  Google Scholar 

  27. Falkenberry SS: Breast cancer in pregnancy. Obstet Gynecol Clin North Am 2002, 29:225–232.

    Article  PubMed  Google Scholar 

  28. Mulvihill JJ, McKeen EA, Rosner F, Zarrabi MH: Pregnancy outcome in cancer patients. Experience in a large cooperative group. Cancer 1987, 60:1143–1150.

    Article  PubMed  CAS  Google Scholar 

  29. Giannakopoulou C, Manoura A, Hatzidaki E, et al.: Multimodal cancer chemotherapy during the first and second trimester of pregnancy: a case report. Eur J Obstet Gynecol Reprod Biol 2000, 91:95–97.

    Article  PubMed  CAS  Google Scholar 

  30. Gianopoulos JG: Establishing the criteria for anesthesia and other precautions for surgery during pregnancy. Surg Clin North Am 1995, 75:33–45.

    PubMed  CAS  Google Scholar 

  31. Fenig E, Mishaeli M, Kalish Y, Lishner M: Pregnancy and radiation. Cancer Treat Rev 2001, 27:1–7.

    Article  PubMed  CAS  Google Scholar 

  32. Recht A, Come SE, Henderson IC, et al.: The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer. N Engl J Med 1996, 334:1356–1361.

    Article  PubMed  CAS  Google Scholar 

  33. Kuerer HM, Gwyn K, Ames FC, Theriault RL: Conservative surgery and chemotherapy for breast carcinoma during pregnancy. Surgery 2002, 131:108–110. A series of four women diagnosed with breast cancer during pregnancy were treated with breast-conserving surgery with a good outcome. Three were treated with neoadjuvant chemotherapy, followed by surgery in the postpartum period.

    Article  PubMed  Google Scholar 

  34. Singletary SE: New approaches to surgery for breast cancer. Endocr Relat Cancer 2001, 8:265–286.

    Article  PubMed  CAS  Google Scholar 

  35. Giacalone PL, Laffargue F, Benos P: Chemotherapy for breast carcinoma during pregnancy: a French national survey. Cancer 1999, 86:2266–2272. A large series of patients were evaluated retrospectively. Pregnancy did not appear to affect prognosis, and there were no reported malformations in infants exposed to chemotherapy in utero.

    Article  PubMed  CAS  Google Scholar 

  36. Petrek JA: Pregnancy-associated breast cancer. Semin Surg Oncol 1991, 7:306–310.

    Article  PubMed  CAS  Google Scholar 

  37. Berry DL, Theriault RL, Holmes FA, et al.: Management of breast cancer during pregnancy using a standardized protocol. J Clin Oncol 1999, 17:855–861. The only prospective series treating women with breast cancer diagnosed during pregnancy. Twenty-four women were treated with FAC (5-fluorouracil, doxorubicin, and cyclophosphamide) chemotherapy, followed by definitive surgery. Data on maternal and fetal outcome is presented.

    PubMed  CAS  Google Scholar 

  38. Partridge AH, Garber JE: Long-term outcomes of children exposed to antineoplastic agents in utero. Semin Oncol 2000, 27:712–726.

    PubMed  CAS  Google Scholar 

  39. Meyer-Wittkopf M, Barth H, Emons G, Schmidt S: Fetal cardiac effects of doxorubicin therapy for carcinoma of the breast during pregnancy: case report and review of the literature. Ultrasound Obstet Gynecol 2001, 18:62–66.

    Article  PubMed  CAS  Google Scholar 

  40. Doll DC, Ringenberg QS, Yarbro JW: Antineoplastic agents and pregnancy. Semin Oncol 1989, 16:337–346.

    PubMed  CAS  Google Scholar 

  41. Ebert U, Loffler H, Kirch W: Cytotoxic therapy and pregnancy. Pharmacol Ther 1997, 74:207–220.

    Article  PubMed  CAS  Google Scholar 

  42. Williams SF, Schilsky RL: Antineoplastic drugs administered during pregnancy. Semin Oncol 2000, 27:618–622. A summary of available data on the safety of antineoplastic drugs during pregnancy and breast-feeding, including data on fetal outcome.

    PubMed  CAS  Google Scholar 

  43. Wiebe VJ, Sipila PE: Pharmacology of antineoplastic agents in pregnancy. Crit Rev Oncol Hematol 1994, 16:75–112.

    PubMed  CAS  Google Scholar 

  44. Micromedex Healthcare Series. http://www.micromedex. com. Accessed December 2002.

  45. Turchi JJ, Villasis C: Anthracyclines in the treatment of malignancy in pregnancy. Cancer 1988, 61:435–440.

    Article  PubMed  CAS  Google Scholar 

  46. De Santis M, Lucchese A, De Carolis S, et al.: Metastatic breast cancer in pregnancy: first case of chemotherapy with docetaxel. Eur J Cancer Care (Engl) 2000, 9:235–237.

    Article  Google Scholar 

  47. Cuvier C, Espie M, Extra JM, Marty M: Vinorelbine in pregnancy. Eur J Cancer 1997, 33:168–169.

    Article  PubMed  CAS  Google Scholar 

  48. Halakivi-Clarke L, Choe E, Onojafe I, Liao DJ: Maternal exposure to tamoxifen during pregnancy increases carcinogen-induced mammary tumorigenesis among female rat offspring. Clin Cancer Res 2000, 6:305–308.

    PubMed  CAS  Google Scholar 

  49. Tewari K, Bonebrake RG, Asrat T, Shanberg AM: Ambiguous genitalia in infant exposed to tamoxifen in utero. Lancet 1997, 350:183.

    Article  PubMed  CAS  Google Scholar 

  50. Kuerer HM, Cunningham JD, Brower ST, Tartter PI: Breast carcinoma associated with pregnancy and lactation. Surg Oncol 1997, 6:93–98.

    Article  PubMed  CAS  Google Scholar 

  51. Antypas C, Sandilos P, Kouvaris J, et al.: Fetal dose evaluation during breast cancer radiotherapy. Int J Radiat Oncol Biol Phys 1998, 40:995–999.

    Article  PubMed  CAS  Google Scholar 

  52. Nicklas AH, Baker ME: Imaging strategies in the pregnant cancer patient. Semin Oncol 2000, 27:623–632.

    PubMed  CAS  Google Scholar 

  53. MacDougall MK, LeGrand SB, Walsh D: Symptom control in the pregnant cancer patient. Semin Oncol 2000, 27:704–711. A review of safe treatments for symptom control during pregnancy and breast-feeding.

    PubMed  CAS  Google Scholar 

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  1. University of California San Francisco, Comprehensive Cancer Center, 1600 Divisadero Avenue, Second Floor, Box 1710, 94115, San Francisco, CA, USA

    Hope S. Rugo MD

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Rugo, H.S. Management of breast cancer diagnosed during pregnancy. Curr. Treat. Options in Oncol. 4, 165–173 (2003). https://doi.org/10.1007/s11864-003-0018-7

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