Opinion statement
The concurrent diagnosis of breast cancer and pregnancy is a challenging clinical situation that historically has placed the welfare of the mother in conflict with that of the fetus. Modified radical mastectomy, the preferred surgical option in women with breast cancer during pregnancy, can be accomplished with minimal fetal risk. Although breast-conserving surgery (lumpectomy or quadrantectomy) can be performed, the radiation therapy required to complete local therapy for the breast must be delayed until after delivery because of the risks associated with fetal exposure to radiation. Although much of the literature on the pharmacologic treatment of breast cancer during pregnancy is anecdotal, recently published data from our institution support the premise that breast cancer can be treated safely during the second and third trimesters of pregnancy with combination chemotherapy consisting of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC). Therapeutic abortion does not appear to improve survival for the mother, but it may be an option if maternal health is jeopardized or fetal anomalies are seen or suspected.
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References and Recommended Reading
Ries LAG, Hankey BF, Miller BA, et al.: Cancer Statistics Review 1973-1988. Bethesda, MD: National Cancer Institute; 1991. NIH publication 91-2789, III.39.
Ventura SJ: First births to older mothers, 1970-86. Am J Public Health 1989, 79:1675–1677.
Crosby CH, Barclay THC: Carcinoma of the breast: surgical management of patients with special conditions. Cancer 1971, 28:1628–1636.
Noyes RD, Spanos WJ, Montague ED: Breast cancer in women aged 30 and under. Cancer 1982, 49:1302–1307.
Andersen 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.
White TT: Prognosis of breast cancer for pregnant and nursing women: analysis of 1,413 cases. Surg Gynecol Obstet 1955, 100:661–666.
Saunders CM, Baum M: Breast cancer and pregnancy: a review. J R Soc Med 1993, 86:162–165.
Anderson JM: Mammary cancers and pregnancy. BMJ 1979, 1:1124–1127.
Ishida T, Yokoe T, Kasumi F, et al.: Clinicopathologic characteristics and prognosis of breast cancer patients associated with pregnancy and lactation: analysis of case-control study in Japan. Jpn J Cancer Res 1992, 83:1143–1149.
Petrek JA, Dukoff R, Rogatko A: Prognosis of pregnancy-associated breast cancer. Cancer 1991, 67:869–872.
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.
Theriault RL: Breast cancer during pregnancy. In Advanced Therapy of Breast Disease. Edited by Singletary ES, Robb GL. Hamilton, Ontario: BC Decker; 2000:167-173. {cmThis book chapter provides a very current overview to the diagnosis and treatment of breast cancer during pregnancy}.
van der Vange N, van Dongen JA: Breast cancer and pregnancy. Eur J Surg Oncol 1991, 17:1–8.
Mazze RI, Kallen B: Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol 1989, 161:1178–1185.
Pedersen H, Finster M: Anesthetic risk in the pregnant surgical patient. Anesthesiology 1979, 51:439–451.
Gianopoulos JG: Establishing the criteria for anesthesia and other precautions for surgery during pregnancy. Surg Clin North Am 1995, 75:33–45.
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. This article describes the prospective series of pregnant breast cancer patients treated and followed at the M.D. Anderson Cancer Center using the chemotherapeutic regimen FAC.
Ebert U, Loffler H, Kirch W: Cytotoxic therapy and pregnancy. Pharmacol Ther 1997, 74:207–220. This review summarizes reported cases of the use of chemotherapeutic agents during pregnancy for a variety of malignancies, including the hematologic malignancies. The chemotherapeutic agents used and the subsequent fetal outcomes for the reported cases are described.
Doll DC, Ringenberg QS, Yarbro JW: Antineoplastic agents and pregnancy. Semin Oncol 1989, 16:337–346.
Gemignani ML, Petrek JA, Borgen PI: Breast cancer and pregnancy. Surg Clin North Am 1999, 79:1157–1169. This review provides a thorough overview of the topic of breast cancer during pregnancy. It addresses issues of diagnosis, staging, and treatment.
Code of Federal Regulations: Title 21, Volume 4, Parts 200 to 299, revised April 1, 1997.
Lacy CF, Armstrong LL, Godman MP, Lance LL: Drug Information Handbook. Hudson: Lexi-Comp Inc.; 1999.
PDR® Online; accessed 5/7/2000; site updated with information from the 2000 PDR Main Edition.
Brent RL: The effect of embryonic and fetal exposure to x-ray, microwaves, and ultrasound: counseling the pregnant and nonpregnant patient about these risks. Semin Oncol 1989, 16:347–368.
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Gwyn, K.M., Theriault, R.L. Breast cancer during pregnancy. Curr. Treat. Options in Oncol. 1, 239–243 (2000). https://doi.org/10.1007/s11864-000-0035-8
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DOI: https://doi.org/10.1007/s11864-000-0035-8