The management of breast cancer during pregnancy
Manejo del cáncer de mama durante el embarazo
Article Sidebar
PDF (Español (España))
FLIP
Main Article Content
Abstract
Introduction: breast cancer during pregnancy is uncommon, however its incidence has increased as women are choosing to delay childbearing. Objective: to analyze the management of breast cancer during pregnancy. Materials and methods: online biomedical scientific literature databases were examined to identify eligible articles on women with breast cancer during pregnancy, published in the last 15 years. Results: a diagnosis of breast cancer during pregnancy is a challenging situation. Treatment should follow the protocols used in non-pregnant women while minimizing risks for the fetus. Ultrasound is the ideal imaging method. Mammography can also be performed for it poses low radiation exposure to the fetus. Modified radical mastectomy is the recommended treatment during the first trimester. Neoadjuvant or adjuvant chemotherapy can be administered during the second or third trimesters, with minimal fetal risks. The use of both radiation therapy and endocrine therapy is contraindicated. Pregnancy does not affect recurrence and survival in treated patients. Conclusion: the incidence of pregnancy-associated breast cancer has increased. Treatment should try to follow the guidelines described for non-pregnant women, appearing not to affect prognosis. A multidisciplinary approach is mandatory.
Keywords:
Downloads
Article Details
References
Boere I, Lok C, Poortmans P, Koppert L, Painter R, Vd Heuvel-Eibrink MM, Amant F. Breast cancer during pregnancy: epidemiology, phenotypes, presentation during pregnancy and therapeutic modalities. Best Pract Res Clin Obstet Gynaecol. 2022;82:46-59. https://doi.org/10.1016/j.bpobgyn.2022.05.001.
Peccatori FA, Lambertini M, Scarfone G, Del Pup L, Codacci-Pisanelli G. Biology, staging, and treatment of breast cancer during pregnancy: reassessing the evidences. Cancer Biol Med. 2018;15(1):6-13. https://doi.org/10.20892/j.issn.2095-3941.2017.0146.
Suelmann BBM, van Dooijeweert C, van der Wall E, Linn S, van Diest PJ. Pregnancy-associated breast cancer: nationwide Dutch study confirms a discriminatory aggressive histopathologic profile. Breast Cancer Res Treat. 2021;186(3):699-704. https://doi.org/10.1007/s10549-021-06130-w.
Sekhon JS, Naik N, Bansal P, Bansal I, Dhull A, Goel A, Ramachandran CS, Shinde S, Aggarwal S, Parikh PM. Practical consensus recommendations for gestational breast cancer. South Asian J Cancer. 2018;7(2):115-117. https://doi.org/10.4103/sajc.sajc_115_18.
Macdonald HR. Pregnancy associated breast cancer. Breast J. 2020;26(1):81-85. https://doi.org/10.1111/tbj.13714.
Arvanitakis K, Siargkas A, Germanidis G, Dagklis T, Tsakiridis I. Adverse pregnancy outcomes in women with celiac disease: a systematic review and meta-analysis. Ann Gastroenterol. 2023;36(1):12-24. https://doi.org/10.20524/aog.2022.0764.
Jain C. ACOG Committee Opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2019;133(1):186. https://doi.org/10.1097/AOG.0000000000003049.
Ramesh P, Srikumar S, Mahendran V, Nair SS, Radhamany K. Pregnancy-associated breast cancer: A realistic approach. J Obstet Gynaecol India. 2019;69(6):514-519. https://doi.org/10.1007/s13224-019-01249-9.
Labriola B. Treatment of pregnancy-associated breast cancer. J Adv Pract Oncol. 2019;10(7):692-700. https://doi.org/10.6004/jadpro.2019.10.7.5.
Franceschini G, Di Leone A, Terribile D, Sanchez MA, Masetti R. Bilateral prophylactic mastectomy in BRCA mutation carriers: what surgeons need to know. Ann Ital Chir. 2019;90:1-2.
Liberale V, Tripodi E, Ottino L, Biglia N. Surgery on breast cancer in pregnancy. Transl Cancer Res. 2019;8(Suppl 5): S493-S502. https://doi.org/10.21037/tcr.2019.07.16.
Poggio F, Tagliamento M, Pirrone C, Soldato D, Conte B, Molinelli C, Cosso M, Fregatti P, Del Mastro L, Lambertini M. Update on the management of breast cancer during pregnancy. Cancers (Basel). 2020;12(12):3616. https://doi.org/10.3390/cancers12123616.
Blundo C, Giroda M, Fusco N, Sajjadi E, Venetis K, Leonardi MC, Vicini E, Despini L, Rossi CF, Runza L, Sfondrini MS, Piciotti R, Di Loreto E, Scarfone G, Guerini-Rocco E, Viale G, Veronesi P, Buonomo B, Peccatori FA, Galimberti VE. Early breast cancers during pregnancy treated with breast-conserving surgery in the first trimester of gestation: A feasibility study. Front Oncol. 2021;11:723693. https://doi.org/10.3389/fonc.2021.723693.
Lambertini M, Kim HJ, Poorvu P. Editorial: Breast cancer in young women: dedicated research efforts are needed. Front Oncol. 2022;12:913167. https://doi.org/10.3389/fonc.2022.913167.
Alfasi A, Ben-Aharon I. Breast Cancer during Pregnancy-Current Paradigms, Paths to Explore. Cancers (Basel). 2019;11(11):1669. https://doi.org/10.3390/cancers11111669.
Crown A, McCartan D, Curry MA, Patil S, Kamer S, Goldfarb S, Gemignani ML. Pregnancy-associated breast cancer: does timing of presentation affect outcome? Breast Cancer Res Treat. 2023;198(2):283-294. https://doi.org/10.1007/s10549-022-06833-8.
Kataoka A, Ueno T, Yamauchi H, Uehiro N, Takahata C, Takahashi Y, Nakashima E, Ogiya A, Sakai T, Kitagawa D, Morizono H, Miyagi Y, Iwase T, Kitano A, Fukatsu Y, Tamura N, Kawano J, Bando H, Tamaki K, Shiota K, Ozawa M, Kobayashi M, Ohno S. Characteristics, treatment trends, and long-term outcomes of Japanese patients with pregnancy-associated breast cancer (PABC). Breast Cancer. 2022;29(5):825-834. https://doi.org/10.1007/s12282-022-01362-0.
De Wilde RL, Devassy R, Torres-de la Roche LA, Krentel H, Tica V, Cezar C. Guidance and standards for breast cancer care in Europe. J Obstet Gynaecol India. 2020;70(5):330-336. https://doi.org/10.1007/s13224-020-01316-6.
Yp Z, J D, Xw Z, J L, Y S. Maternal and neonatal outcomes of cancer during pregnancy: a multi-center observational study. J Cancer. 2019;10(23):5727-5734. https://doi.org/10.7150/jca.33746.
Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, Halaska MJ, Hasenburg A, Johansson ALV, Lambertini M, Lok CAR, Maggen C, Morice P, Peccatori F, Poortmans P, Van Calsteren K, Vandenbroucke T, van Gerwen M, van den Heuvel-Eibrink M, Zagouri F, Zapardiel I. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol. 2019;30(10):1601-1612. https://doi.org/10.1093/annonc/mdz228.
Goller SS, Markert UR, Fröhlich K. Trastuzumab in the treatment of pregnant breast cancer patients - an overview of the literature. Geburtshilfe Frauenheilkd. 2019;79(6):618-625. https://doi.org/10.1055/a-0880-9295.
Cubillo A, Morales S, Goñi E, Matute F, Muñoz JL, Pérez-Díaz D, de Santiago J, Rodríguez-Lescure Á. Multidisciplinary consensus on cancer management during pregnancy. Clin Transl Oncol. 2021;23(6):1054-1066. https://doi.org/10.1007/s12094-020-02491-8.
Benoit L, Mir O, Vialard F, Berveiller P. Cancer during pregnancy: A review of preclinical and clinical transplacental transfer of anticancer agents. Cancers (Basel). 2021;13(6):1238. https://doi.org/10.3390/cancers13061238.
Tang T, Liu Y, Yang C, Ma L. Diagnosis and treatment of advanced HER2-positive breast cancer in young pregnant female: A case report. Medicine (Baltimore). 2020;99(44):e22929. https://doi.org/10.1097/MD.0000000000022929.
Wang Y, Jiang L, Li B, Zhao Y. Management of chronic myeloid leukemia and pregnancy: A bibliometric analysis (2000-2020). Front Oncol. 2022;12:826703. https://doi.org/10.3389/fonc.2022.826703.
Buonomo B, Noli SA, Santini A, Alviggi C, Peccatori FA. Can we trust tumour markers in pregnancy after breast cancer? A case of elevated CA 15-3 in the third trimester of pregnancy normalising after delivery. Ecancermedicalscience. 2019;13:979. https://doi.org/10.3332/ecancer.2019.979.
Sajjadi E, Venetis K, Noale M, Azim HA Jr, Blundo C, Bonizzi G, Di Loreto E, Scarfone G, Ferrero S, Maggi S, Barberis M, Veronesi P, Galimberti VE, Viale G, Fusco N, Peccatori FA, Guerini-Rocco E. Breast cancer during pregnancy as a special type of early-onset breast cancer: analysis of the tumor immune microenvironment and risk profiles. Cells. 2022;11(15):2286. https://doi.org/10.3390/cells11152286.