Breast cancer and pregnancy: current concepts in diagnosis and treatment

Abstract

Breast cancer is the most common malignancy occurring during pregnancy. The most important aspect associated in PABC is the fact that two lives are at risk. Therefore, a proposed plan of care must integrate the physical and emotional well being of the mother with the health of the fetus. The diagnosis of PABC is based on clinical examination, breast ultrasound mammography (with adequate abdominal shielding) and histology/cytology, similar to non-pregnant women. To obtain optimal maternal treatment, an adequate staging is mandatory. With secure protection, staging examinations can be performed safely during pregnancy. However, the cumulative radiation dose must always be taken into account. The treatment of PABC should adhere as closely as possible to standardised protocols. Breast cancer surgery can safely be performed during all trimesters of pregnancy with minimal risk to the fetus. Although there remains some controversy about its safety, radiation therapy could be performed safely during the first and second trimester of pregnancy.

Table (5): Overview of the therapeutic options during thedifferent stages of pregnancy.

Chemotherapy can safely be administered during the second and third trimester. Cyclophosphamide and doxorubicin, with or without 5-fluorouracil, is the preferred combination. To date, the use of trastuzumab and tamoxifen during pregnancy is not recommended. Per stage the prognosis for PABC seems to be similar to non-pregnant women provided the same treatment is administered. Neonatal morbidity mainly appears to be related to prematurity. Therefore, premature delivery should be avoided.