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Current approaches in the clinical management of pregnancy-associated breast cancer—pros and cons

Abstract

Malignancies are one of the leading causes of mortality in women during their reproductive life. Treatment of gynecological malignant tumors during pregnancy is possible but not simple, since it creates a conflict between care of the mother and the fetus. BC is the most prevalent malignancy diagnosed in pregnancy, ranking up to 21% of all pregnancy-related malignancies. Due to its stets increasing prevalence, aggressive cancer subtype, and severe ethical and psychological aspects linked to the disease, experts raise an alarm for an acute necessity to improve the overall management of the PABC—the issue which has strongly motivated our current paper. Comprehensive research data and clinical experience accumulated in recent years have advanced our understanding of the disease complexity. PABC treatment must be individualized with an emphasis on optimal care of the mother, while observing standard treatment protocols with regard to safety of the fetus. Treatment protocols should be elaborated based on the individualized patient profile, bearing in mind the acute danger to the mother, maximizing the therapy efficacy and minimizing harmful effects to the fetus. Complex consulting on treatment options, their impacts on pregnancy and potential teratogenic effects requires tight “doctor-patient” collaboration. Complications that may arise due to the treatment of breast cancer in pregnancy require a multiprofessional expertise including oncologists, neonatologists, perinatologists, obstetricians, teratologists, and toxicologists, and an extensive psychological support throughout the pregnancy and after giving birth. Thereby, specifically psychological aspects of PABC diagnosis and follow-up are frequently neglected, being not yet adequately explored in the entire disease management approach. Herewith, we update the status quo regarding the currently available diagnostic modalities, complex treatment algorithms, and novel clinical approaches which altogether argue for an urgent necessity of a paradigm shift moving away from reactive to predictive, preventive, and personalized medical approach in the overall management of PABC meeting the needs of young populations, persons at high risk, affected patients, and families as the society at large.

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Acknowledgements

This work has been supported by the following organizations: European Association for Predictive, Preventive, and Personalized Medicine, EPMA, Brussels, Belgium; Slovak Research and Development Agency (under contract no. APVV-16-0021), the Scientific Grant Agency, Ministry of Education, Science, and Research, Slovak Republic; and the VEGA Grant Agency (1/0124/17), Ministry of Education, Science and Research, Slovak Republic

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Pavol Zubor and Peter Kubatka co-first/equal authorship

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Zubor, P., Kubatka, P., Kapustova, I. et al. Current approaches in the clinical management of pregnancy-associated breast cancer—pros and cons. EPMA Journal 9, 257–270 (2018). https://doi.org/10.1007/s13167-018-0139-5

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Keywords

  • Pregnancy
  • Breast cancer
  • Diagnostics
  • Treatment
  • Chemotherapy
  • Radiotherapy
  • Psychological aspects
  • Preventive predictive personalized medicine