Breast Cancer And Pregnancy
  • 2.2 / 10,000 pregnancies
  • Later age for pregnancy ⇒ higher # of Breast Ca → ( 1 in 1,000 pregnancies )
  • Delay in diagnosis
  • Nodularity of the breast as a normal physiologic changes
  • Increased density in the breast parenchyma⇒ Mammogram is not useful
  • Investigation limited for XRT → MRI
  • Usually high-grade infiltrating ductal carcinomas.

A prospective study

  • 38 pregnant women
  • 28% had ER-positive tumors & 24% PR-positive tumors
  • In general similar to normal population

Data from retrospective case control series

  • After adjusting for age and disease stage, ⇒ little difference in prognosis
  • Pregnancy Termination if cancer occurs in 1st or 2nd trimester (chemo… XRT )
  • Effect of delaying RT on local recurrence, in the absence of systemic therapy, is unknown and is of concern.
  • Appropriate approach for cancers diagnosed in the third trimester
  • Case-by-case basis for cancers diagnosed earlier in pregnancy
  • Lymphatic mapping and sentinel node biopsy
    • Isosulfan blue dye is not approved
    • technetium RAD has been estimated to be low
  • Axillary dissection remains the standard management strategy as the safety is not sure
  • The risk of congenital malformation from cytotoxic chemotherapy varies with the fetal age at exposure and the agent used.
  • Exposure in the first trimester is associated with risks of 10% to 20% —> decline to less than 2% with exposure in the second and third trimesters
  • A prospective study of 24 pregnant women treated with fluorouracil, doxorubicin, and cyclophosphamide during the second and third trimesters of pregnancy, no complications were observed for the fetus or infant.
  • Experience with the taxanes in pregnancy is very limited, but to date fetal toxicity has not been described.
  • A case report of the use of trastuzumab in pregnancy documented reversible anhydramnois
  • Methotrexate should be avoided during pregnancy because of the risk of abortion and severe fetal malformation.
  • Tamoxifen should be withheld until after delivery since its safety is uncertain
  • When chemotherapy or tamoxifen is given postpartum, breastfeeding should be avoided as these agents may be excreted in the breast milk.