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Treating Breast Cancer During Pregnancy

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Summary

The occurrence of breast cancer during pregnancy is a rare clinical situation. However, if it is diagnosed, a multidisciplinary approach involving an obstetrician, a medical oncologist and a surgeon is needed. In this situation, breast cancer should be treated according to the same principles applied in nonpregnant patients. Termination of pregnancy does not improve survival. Decisions regarding abortion should be based on the desires of the patient and on therapeutic necessities.

If required, surgery is always possible, but radiation therapy should be avoided because of the risk of fetal toxicity. Antineoplastic drug therapy, if indicated, is possible after the first trimester.

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References

  1. Betson JR, Golden ML. Cancer and pregnancy. Am J Obstet Gynecol 1961; 81: 718–28

    Google Scholar 

  2. Moolgavkarsh, Day NE, Stevens RG. Two-stage model for carcinogenesis. Epidemiology of breast cancer in females. J Natl Cancer Inst 1980; 65: 559–69

    Google Scholar 

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

    Article  CAS  Google Scholar 

  4. Anderson JM. Mammary cancers and pregnancy. BMJ 1979; 1: 1124–7

    Article  PubMed  CAS  Google Scholar 

  5. Treves N, Holleb AI. A report of 549 cases of breast cancer in women 35 years of age or younger. Surg Gynecol Obstet 1958; 107: 271–83

    PubMed  CAS  Google Scholar 

  6. Birks DM, Crawford GM, Elleson LG, et al. Carcinoma of the breast in women 30 years of age or less. Surg Gynecol Obstet 1973; 137: 21–7

    PubMed  CAS  Google Scholar 

  7. Hoover H. Breast cancer during pregnancy and lactation. Surg Clin North Am 1990; 70: 1151–63

    PubMed  Google Scholar 

  8. Barnavon Y, Wallack M. Management of the pregnant patient with carcinoma of the breast. Surg Gynecol Obstet 1990; 171: 347–52

    PubMed  CAS  Google Scholar 

  9. Sickles EA, Filly A, Callen PW. Breast cancer detection with sonography and mammography: comparison using state-of-the-art equipment. AJR 1983; 140: 843

    PubMed  CAS  Google Scholar 

  10. Max MH, Klamer TW. Pregnancy and breast cancer. South Med J 1983; 76: 1088–90

    Article  PubMed  CAS  Google Scholar 

  11. Finley JL, Silverman JF, Lannin DR. Fine needle aspiration cytology of breast masses in pregnant and lactating women. Diag Cytopathol 1989; 5: 255–60

    Article  CAS  Google Scholar 

  12. Majmudar B, Rosales-Quintana S. Infarction of breast fibroadenomas during pregnancy. JAMA 1975; 231: 963–4

    Article  PubMed  CAS  Google Scholar 

  13. Byrd BF, Bayer DS, Robertson JC, et al. Treatment of breast tumors associated with pregnancy and lactation. Ann Surg 1962; 155: 940–7

    PubMed  Google Scholar 

  14. White TT. Carcinoma of the breast and pregnancy. Ann Surg 1954; 139: 9–18

    Article  PubMed  CAS  Google Scholar 

  15. Petrek JA, Dukoff R, Rogatko A. Prognosis of pregnancy-associated breast cancer. Cancer 1991; 67: 869–72

    Article  PubMed  CAS  Google Scholar 

  16. Clark RM, Reid J. Carcinoma of the breast in pregnancy and lactation. Int J Radiation 1978; 4: 693–8

    Article  CAS  Google Scholar 

  17. Giacalone PL, Bonnier P, Laffargue F, et al. Cancer du sein pendant la grossesse: etude multicentrique à propos de 178 cas. XVI Journées Nationales de la Société Française de Sénologie et de Pathologie Mammaire. 1994 Oct; Dijon: 275–92

    Google Scholar 

  18. Petrek JA. Breast cancer during pregnancy. Cancer 1994; 74: 518–27

    Article  PubMed  CAS  Google Scholar 

  19. Applewhite R, Smith LR, Divicenti F. Carcinoma of the breast with pregnancy and lactation. Am Surg 1973; 39: 101–4

    PubMed  CAS  Google Scholar 

  20. Nagent P, O’Connell TX. Breast cancer and pregnancy. Arch Surg 1985; 120: 1221–4

    Article  Google Scholar 

  21. Adami HO, Malker B, Holmberg L, et al. The relation between survival and age at diagnosis in breast cancer. N Engl J Med 1986; 315: 559–63

    Article  PubMed  CAS  Google Scholar 

  22. Host H, Lund E. Age as a prognostic factor in breast cancer. Cancer 1986; 57: 2217–21

    Article  PubMed  CAS  Google Scholar 

  23. Schoultz E, Johansson H, Wilking N. Influence of prior and subsequent pregnancy on breast cancer prognosis. J Clin Oncol 1995; 13: 430–4

    Google Scholar 

  24. Miller R, Mulvihill S. Small head size after atomic radiation. Teratology 1976; 14: 355–7

    Article  PubMed  CAS  Google Scholar 

  25. Barron WM. The pregnant surgical patient: medical evaluation and management. Ann Intern Med 1984; 101: 683–91

    PubMed  CAS  Google Scholar 

  26. Stewart A, Webb D, Giles D, et al. Malignant disease in childhood and diagnostic irradiation in utero. Lancet 1956; 1:447–8

    Article  Google Scholar 

  27. Mattison DR, Angtraco T. Magnetic resonance imaging in prenatal diagnosis. Clin Obstet Gynecol 1988; 31: 353–89

    Article  PubMed  CAS  Google Scholar 

  28. Inbar MJ, Ron IG. Breast-conserving surgery and adjuvant chemotherapy in pregnancy. Acta Obstet Gynecol Scand 1996; 75: 765–7

    Article  PubMed  CAS  Google Scholar 

  29. Timothy AR, Saunders JE. Radiation and pregnancy. In: Allen HH, Nisker JA, editors. Cancer in pregnancy: therapeutic guidelines. Mount Kisco, New York: Futura Publishing Co., 1986: 35–67

    Google Scholar 

  30. Saunders CM, Baum M. Breast cancer and pregnancy: a review J R Soc Med 1993; 86: 162–5

    PubMed  CAS  Google Scholar 

  31. Doll DC, Ringenberg QS, Yarbro JW. Antineoplastic agents and pregnancy. Semin Oncol 1989; 16(5): 337–46

    PubMed  CAS  Google Scholar 

  32. Greenberg LH, Tanaka KR. Congenital anomalies probably induced by cyclophosphamide. JAMA 1964; 188: 423–6

    Article  PubMed  CAS  Google Scholar 

  33. Pirani BBK, Campbell DM, Macgillivary I. Plasma volume in normal first pregnancy. J Obstet Gynaecol Br Commonw 1973; 80: 884–7

    Article  PubMed  CAS  Google Scholar 

  34. Wan SH, Huffman DH, Azarnoff DL, et al. Effect of route of administration and effusions on methotrexate pharmacokinetics. Cancer Res 1974; 34: 3487–91

    PubMed  CAS  Google Scholar 

  35. Redmond GP. Physiological changes during pregnancy and their implications for pharmacological treatment. Clin Invest Med 1985; 8: 317–22

    PubMed  CAS  Google Scholar 

  36. Roboz J, Gleicher N, Wu K, et al. Does doxorubicin cross the placenta? Lancet 1979; II: 1382–3

    Article  Google Scholar 

  37. Karp GI, von Oyen P, Roboz J, et al. Doxorubicin in pregnancy: possible transplacental passage. Cancer Treat Rep 1983; 67: 773–7

    PubMed  CAS  Google Scholar 

  38. Gaillard B, Leng JJ, Grellet J, et al. Passage transplacentaire de l’épirubicine. J Gynecol Obstet Biol Reprod 1995; 24: 63–8

    CAS  Google Scholar 

  39. Nicholson HO. Cytotoxic drugs in pregnancy. J Obstet Gynaecol Br Commonw 1968; 75: 307–12

    Article  PubMed  CAS  Google Scholar 

  40. Schapira DV, Chudley AE. Successful pregnancy following continuous treatment with combination chemotherapy before conception and throughout pregnancy. Cancer 1984; 54: 800–3

    Article  PubMed  CAS  Google Scholar 

  41. Doll DC, Ringenberg S, Yarbro DW. Management of cancer during pregnancy. Arch Intern Med 1988; 148: 2058–64

    Article  PubMed  CAS  Google Scholar 

  42. Willemse PHB, van der Sijde R, Sleijer DIH. Combination chemotherapy and radiation for stage IV breast cancer during pregnancy. Gynecol Oncol 1990; 36: 281–4

    Article  PubMed  CAS  Google Scholar 

  43. Gilliland J, Weinstein L. The effects of cancer chemotherapeutic agents on the developing fetus. Obstet Gynecol Surv 1983; 38: 6–13

    Google Scholar 

  44. Toledo TM, Harper RC, Moser RH. Fetal effects during cyclophosphamide and irradiation therapy. Ann Intern Med 1971; 74: 87–91

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  46. Zemlickis D, Lishner M, Degendorfer P, et al. Fetal outcome after in utero exposure to cancer chemotherapy. Arch Intern Med 1992; 152: 573–6

    Article  PubMed  CAS  Google Scholar 

  47. Sutcliffe SB. Treatment of neoplastic disease during pregnancy: maternal and fetal effects. Clin Invest Med 1985; 8: 333–8

    PubMed  CAS  Google Scholar 

  48. Schaison G, Jacquillat C, Auclert G, et al. Les risques foetoembryonnaires des chimiothérapies. Bull Cancer 1979; 66: 165–70

    PubMed  CAS  Google Scholar 

  49. Barber HRK. Fetal and neonatal effects of cytotoxic agents. Obstet Gynecol 1981; 58: 41S–7S

    PubMed  CAS  Google Scholar 

  50. Reynoso E, Sheperd F, Messner H, et al. Acute leukemia in pregnancy: the Toronto leukemia study group experience with long-term follow-up of children exposed in utero to chemotherapeutic agents. J Clin Oncol 1987; 5: 1098–106

    PubMed  CAS  Google Scholar 

  51. Cuvier C, Espié M, Extra JM, et al. Vinorelbine in pregnancy. Eur J Cancer 1997; 33(1): 168–9

    Article  PubMed  CAS  Google Scholar 

  52. Barni S, Ardizzola A, Zanetta G, et al. Weekly doxorubicin chemotherapy for breast cancer in pregnancy: a case report. Tumori 1992; 78: 349–50

    PubMed  CAS  Google Scholar 

  53. Dreicer R, Love R. High total dose — fluorouracil treatment during pregnancy. Wis Med J 1991; 90(10): 582–3

    PubMed  CAS  Google Scholar 

  54. Meador JM, Armentrout SA, Slater LM. Third trimester chemotherapy and neonatal hematopoiesis. Cancer Chemother Pharmacol 1987; 19: 177–9

    Article  PubMed  CAS  Google Scholar 

  55. Blatt J, Bleyer WA. Late effects of childhood cancer and its treatment. In: Pizzo PA, Poplack DG, editors. Principles and practice of pediatric oncology. Philadelphia: Lippincott, 1989: 1003–25

    Google Scholar 

  56. Aviles A, Niz J. Long-term follow-up of children born to mothers with acute leukemia during pregnancy. Med Pediatr Oncol 1988; 16: 3–6

    Article  PubMed  CAS  Google Scholar 

  57. Aviles A, Diaz-Maqueo JC, Talavera A, et al. Growth and development of children of mothers treated with chemotherapy during pregnancy: current status of 43 children. Am J Hematol 1991; 36: 243–8

    Article  PubMed  CAS  Google Scholar 

  58. Mulvihill JJ, Byrne J, Steinhorn SA, et al. Genetic disease in offspring of survivors of cancer in the young. Am J Hum Genet 1986; 39 Suppl.: A72

    Google Scholar 

  59. Garber JE. Long-term follow-up of children exposed in utero to antineoplastic agents. Semin Oncol 1989; 16(5): 437–44

    PubMed  CAS  Google Scholar 

  60. King RM, Welch JS, Martin JL, et al. Carcinoma of the breast associated with pregnancy. Surg Gynecol Obstet 1985; 160: 228–32

    PubMed  CAS  Google Scholar 

  61. Clark RM, Chua T. Breast cancer and pregnancy the ultimate challenge. Clin Oncol 1989; 1: 11–8

    Article  CAS  Google Scholar 

  62. Hochman A, Schneber H. Pregnancy and cancer of the breast. Obstet Gynecol 1953; 2: 268–76

    PubMed  CAS  Google Scholar 

  63. Bunker ML, Peters MV. Breast cancer associated with pregnancy or lactation. Am J Obstet Gynecol 1963; 85: 312–21

    PubMed  CAS  Google Scholar 

  64. Cullins SL, Pridjian G, Sutherland CM. Goldenhars syndrome associated with tamoxifen given to the mother during gestation. JAMA 1994; 271(24): 1905–6

    Article  PubMed  CAS  Google Scholar 

  65. Dildy GA, Moise KJ, Carpenter RJ. Maternal malignancy metastatic to the products of conception: a review. Obstet Gynecol Surv 1989; 44: 535–40

    Article  PubMed  Google Scholar 

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Espié, M., Cuvier, C. Treating Breast Cancer During Pregnancy. Drug-Safety 18, 135–142 (1998). https://doi.org/10.2165/00002018-199818020-00005

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