Breast cancer and pregnancy
Keywords:breast cancer, BC, pregnancy, treatment of breast cancer in pregnant women, diagnosis of breast cancer in pregnant women
Actuality. Today, the urgency of the problem of breast cancer (breast cancer) can not be said much. The steady increase in the incidence among the female population around the world and the figures are self-evident. In particular, in Ukraine more than 15 thousand new cases of breast cancer are recorded annually. The percentage of breast cancer in pregnant women ranges from 8 to 15% of cases in different countries of Europe.
Diagnosis of breast cancer in pregnant women has a number of difficulties in terms of visualization. First of all, it is connected with morphological and structural changes in the breast tissue during pregnancy and lactation. A number of changes in palpation in pregnant and lactating women can be mistakenly regarded by clinicians as tumor formations and, more dangerously, it can happen the other way around when a woman complains of a clear compaction with specific symptoms, and the clinician neglects it and recommends observation without sending it to additional research. Safe and most informative methods of examination are ultrasound of the mammary glands in combination with a biopsy.
Treatment of breast cancer in pregnant and lactating women is a rather complex and not fully understood issue.
There are three main tactical concepts for the treatment of breast cancer in pregnant women:
1) the concept of fetal preservation – is aimed at eliminating any risks to the fetus, treatment of breast cancer is postponed until the natural end of pregnancy;
2) the concept of saving the mother – the immediate termination of pregnancy (abortion, cesarean section, removal of the uterus with appendages) and the beginning of breast cancer treatment;
3) compromise concept – breast cancer is treated without interruption of pregnancy, as well as in its absence, with the exception of chemotherapy (not performed in the I trimester of pregnancy), radiation therapy , endocrine and targeted therapy (excluded throughout pregnancy).
The most justified and taking into account the interests of all parties to date is a compromise concept, on the basis of which it can be said that the presence of breast cancer in the first trimester of pregnancy in the early stages of the disease can be accompanied by a surgical stage of treatment, and the planning of chemotherapy should be transferred to II and III trimesters. If the patient is diagnosed with stage III–IV disease, premature termination of pregnancy with subsequent complex treatment of breast cancer according to generally accepted standards will be optimal. Treatment of pregnant women in the II and III trimesters can be accompanied by both radical surgery and chemotherapy. Conduction of radiation therapy is not recommended at any term of pregnancy and is recommended in the postpartum period.
- Cancer in Ukraine, 2015–2016. Ukrainian cancer registry statistics, 2017.
- Ring, A.E., Smith, I.A., Jones, A., et al. Chemotherapy for breast cancer during pregnancy: an 18-year experience from five London teaching hospitals.” J Clin Oncol 23 (2005): 4192–7.
- Jacobs, A.J., et al. “Management of the pregnant patient with Hodgkin’s disease.” Ann Intern Med 95 (1981): 669–75.
- Smith, L.H., Dalrymple, J.L., Leiserowitz, G.S., et al. “Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997.” Am J Obstet Gynecol 184 (2001): 1504–12.
- Dieci, M.V., Orvieto, E., Dominici, M., et al. “Rare breast cancer subtypes: histological, molecular, and clinical peculiarities.” Oncologist 19 (2014): 805–13.
- Brinton, L.A., Devesa, S.S. “Incidence, Demographics, and Environmental Factors.” In: Harris, J.R., Morrow, M., Lippman, M.E., et al., eds. Diseases of the Breast. Lippincott-Raven Publishers. Philadelphia, Pa (1996): 159–68.
- Swain, S.M., Baselga, J., Kim, S.B., et al. “Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer.” N Engl J Med 372 (2015): 724–34.
- Slanetz, P.J., Freer, P.E., Birdwell, R.L. “Breast-density legislation – practical considerations.” N Engl J Med 372 (2015): 593–5.
- Tavani, A., Gallus, S., La Vecchia, C., et al. “Risk factors for breast cancer in women under 40 years.” Eur J Cancer 35.9 (1999): 1361–7.
- Faupel-Badger, J.M., Arcaro, K.F., Balkam, J.J., et al. “Postpartum remodeling, lactation, and breast cancer risk: summary of a National Cancer Institute-sponsored workshop.” J Natl Cancer Inst 105 (2013): 166–74.
- Jernstrom, H., Lerman, C., Ghadirian, P., et al. “Pregnancy and risk of early breast cancer in carriers of BRCA1 and BRCA2.” Lancet 354.9193 (1999): 1846–50.
- Anderson, W.F., Rosenberg, P.S., Prat, A., et al. “How many etiological subtypes of breast cancer: two, three, four, or more?” J Natl Cancer Inst 106.8 (2014).
- Wohlfahrt, J., Melbye, M. “Age at any birth is associated with breast cancer risk.” Epidemiology 12.1 (2001): 68–73.
- Newcomb, P.A., Egan, K.M., Titus-Ernstoff, L., et al. “Lactation in relation to postmenopausal breast cancer.” Am J Epidemiol 150.2 (1999): 174–82.
- Liu, Y., Nguyen, N., Colditz, G.A. “Links between alcohol consumption and breast cancer: a look at the evidence.” Women’s Health (London, Eng land) 11 (2015): 65–77.
- TNM classification of Malignant Tumors. Fifth edition. Willey-Liss (1997): 227 p.
- Yang, W.T., Dryden, M.J., Gwyn, K., et al. “Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy.” Radiology 239 (2006): 52–60.
- King, R.M., Welch, J.S., Martin, J.L., et al. “Carcinoma of the breast associated with pregnancy.” Surg Gynecol Obstet 160 (1985): 228. 2983447
- Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (USA). “Research Data with Delay-Adjustment, Malignant Only, Nov 2014 Sub (1992–2012).” Available from: [http://www.seer.cancer.gov].
- Kushi, L.H., Doyle, C., McCullough, M., et al. “American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity.” CA Cancer J Clin 62 (2012): 30–67.
- Elledge, R.M., Ciocca, D.R., Langone, G., et al. “Estrogen receptor, progesterone receptor, and HER-2/neu protein in breast cancers from pregnant patients.” Cancer 71.8 (1993): 2499–509.
- Gwyn, K., Theriault, R. “Breast cancer during pregnancy.” Oncology (Williston Park) 15 (2001): 39–46.
- Middleton, L.P., Amin, M., Gwyn, K., et al. “Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features.” Cancer 98 (2003):1055–60.
- Trinh, T., Christensen, S.E., Brand, J.S., et al. “Background risk of breast cancer influences the association between alcohol consumption and mammographic density.” British J Cancer 113 (2015): 113: 159–65.
- Campova-Polevaya, E.B. “Breast cancer in young women.” Thesis abstract for PhD degree. Moscow (1975): 239 p.
- Cancer Genome Atlas Network. “Comprehensive molecular portraits of human breast tumours.” Nature 490 (2012): 61–70.
- Petrek, J.A. “Breast cancer and pregnancy.” In: Harris, J.R., Morrow, M., Lippman, M.E., et al., eds. Diseases of the Breast. Lippincott-Raven Publishers. Philadelphia, Pa (1996): 883–92.
- Kampova-Polevaya, E.B., Parokonnaya, A.A. “Localized breast cancer – the possibilities of organ-preserving treatment.” In: Breast Cancer. Tashkent (2002): 109.
- Harris, J.R., Morrow, M., Lippman, M.E., et al., eds. Diseases of the Breast. Lippincott-Raven Publishers. Philadelphia, Pa (1996).
- Ezzat, A., Raja, M.A., Berry, J., et al. “Impact of pregnancy on non-metastatic breast cancer: a case control study.” Clin Oncol (R Coll Radiol) 8.6 (1996): 367–70.
- Gemignani, M.L., Petrek, J.A., Borgen, P.I. “Breast cancer and pregnancy.” Surg Clin North Am 79.5 (1999): 1157–69.
- Bonnier, P., Romain, S., Dilhuydy, J.M., et al. “Influence of pregnancy on the outcome of breast cancer: a case-control study.” Int J Cancer 72.5 (1997): 720–7.
- Turner, N.C., Ro, J., Andre, F., et al. “Palbociclib in Hormone-Receptor-Positive Advanced Breast Cancer.” N Engl J Med 373 (2015): 209–19.
- Runowicz, C.D., Leach, C.R., Henry, L.N., et al. “American Cancer Society / American Society of Clinical Oncology breast cancer survivorship care guideline.” J Clin Oncol 34 (2016): 611–35.
- Anderson, B.O., Petrek, J.A., Byrd, D.R., et al. “Pregnancy influences breast cancer stage at diagnosis in women 30 years of age and younger.” Ann Surg Oncol 3.2 (1996): 204–11.
- Ibrahim, E.M., Ezzat, A.A., Baloush, A., et al. “Pregnancy-associated breast cancer: a case-control study in a young population with a high-fertility rate.” Med Oncol 17.4 (2000): 293–300.
- Berry, D.L., Theriault, R.L., Holmes, F.A., et al. “Management of breast cancer during pregnancy using a standardized protocol.” J Clin Oncol 17.3 (1999): 855–61.
- Gelber, S., Coates, A.S., Goldhirsch, A., et al. “Effect of pregnancy on overall survival after the diagnosis of early-stage breast cancer.” J Clin Oncol 19.6 (2001): 1671–5.
- Kuerer, H.M., Gwyn, K., Ames, F.C., Theriault, R.L. “Conservative surgery and chemotherapy for breast carcinoma during pregnancy.” Surgery 131 (2002): 108–10.
- Nettleton, J., Long, J., Kuban, D., et al. “Breast cancer during pregnancy: quantifying the risk of treatment delay.” Obstetrics and Gynecology 87.3 (1996): 414–8.
- Buekers, T.E., Lallas, T.A. “Chemotherapy in pregnancy. Obstet Gynecol Clin North Am 25.2 (1998): 323–9.
- Annane, K., Bellocq, J.P., Brettes, J.P., Mathelin, C. “Infiltrative breast cancer during pregnancy and conservative surgery.” Fetal Diagn Ther 20 (2005): 442–4.
- Kaiser, H.E., Nawab, E., Nasir, A., et al. “Neoplasms during the progression of pregnancy.” In Vivo 14.1 (2000): 277–85.
- Newcomb, P.A. “Lactation and breast cancer risk.” J Mammary Gland Biol Neoplasia 2.3 (1997): 311–8.
- Nugent, P., O`Connell, T.X. “Breast cancer and pregnancy.” Arch Surg 120 (1985): 1221.
- Clark, R.M., Chua, T. “Breast cancer and pregnancy: the ultimate challenge.” ClinOncol 1 (1989): 11.
- Barnard, M.E., Boeke, C.E., Tamimi, R.M. “Established breast cancer risk factors and risk of intrinsic tumor subtypes.” Biochim Biophys Acta 1856.1 (2015): 73–85.
- Potter, J.F., Schoeneman, M. “Metastases of maternal cancer to the placenta and fetus.” Cancer 25 (1970): 380.
- Kroman, N., Jensen, M.B., Melbye, M., et al. “Should women be advised against pregnancy after breast-cancer treatment?” Lancet 350.9074 (1997): 319–22.
- Finn, R.S., Crown, J.P., Lang, I., et al. “The cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18): a randomised phase 2 study.” Lancet Oncol 16 (2015): 25–35.
- Berry, D.L., Theriault, R.L., Holmes, F.A., et al. “Management of breast cancer during pregnancy using a standardized protocol.” J Clin Oncol 17.3 (1999): 855–61.
- Brinton, L.A., Scoccia, B., Moghissi, K.S., et al. “Long-term relationship of ovulation-stimulating drugs to breast cancer risk.” Cancer Epidemiol Biomarkers Prev 23 (2014): 584–93.
- Doll, D.C., Ringenberg, Q.S., Yarbro, J.W. “Antineoplastic agents and pregnancy.” Semin Oncol 16 (1989): 337–46.
- Ebert, U., Loffler, H., Kirch, W. “Cytotoxic therapy and pregnancy.” Pharmacol Ther 74 (1997): 207–20.
- Shrim, A., Garcia-Bournissen, F., Maxwell, C., et al. “Favorable pregnancy outcome following Trastuzumab (Herceptin) use during pregnancy –Case report and updated literature review.” Reprod Toxicol 23 (2007): 611–3.
- Velentgas, P., Daling, J.R., Malone, K.E., et al. “Pregnancy after breast carcinoma: outcomes and influence on mortality.” Cancer 85.11 (1999): 2424–32.
- Hahn, K.M.E., Johnson, P.H., Gordon, N., et al. “Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero.” Cancer 107 (2006): 1219–26.
- Germann, N., Goffinet, F., Goldwasser, F. “Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients.” Ann Oncol 15 (2004): 146–50.
- Johnson, P.H., Gwyn, K., Gordon, N., et al. “The treatment of pregnant women with breast cancer and the outcomes of the children exposed to chemotherapy in utero [abstract].” J Clin Oncol 23.16 (2005): Abstract 540.
- Wallack, M.K., Wolf, J.A. Jr, Bedwinek, J., et al. “Gestational carcinoma of the female breast.” Curr Probl Cancer 7.1 (1983).
- Gainford, M.C., Clemons, M. “Breast cancer in pregnancy: are taxanes safe?” Clinical Oncol (R Coll Radiol) 18 (2006): 159.
- Garcia-Manero, M., Royo, M.P., Espinos, J., et al. “Pregnancy associated breast cancer.” Eur J Surg Oncol 35 (2009): 215–8.
- Gonzalez-Angulo, A.M., Walters, R.S., Carpenter, R.J., et al. “Paclitaxel chemotherapy in a pregnant patient with bilateral breast cancer.” Clin Breast Cancer 5 (2004): 317–9.
- Mir, O., Berveiller, P., Ropert, S., et al. “Emerging therapeutic options for breast cancer chemotherapy during pregnancy.” Ann Oncol 19 (2008): 607–13.
- NCCN guidelines, Version 2.2017. Breast Cancer 2017; 141-144, PREG-1.
- Bader, A.A., Schlembach, D., Tamussino, K.F., et al. “Anhydramnios associated with administration of trastuzumab and paclitaxel for metastatic breast cancer during pregnancy.” Lancet Oncol 8 (2007): 79–81.
- Fanale, M.A., Uyei, A.R., Theriault, R.L., et al. “Treatment of metastatic breast cancer with trastuzumab and vinorelbine during pregnancy.” Clin Breast Cancer 6 (2005): 354–6.
- Pant, S., Landon, M.B., Blumenfeld, M., et al. “Treatment of breast cancer with trastuzumab during pregnancy.” J Clin Oncol 26 (2008): 1567–9.
- Sekar, R., Stone, P.R. “Trastuzumab use for metastatic breast cancer in pregnancy.” Obstet Gynecol 110 (2007): 507–10.
- Waterston, A.M., Graham, J. “Effect of Adjuvant Trastuzumab on Pregnancy.” J Clin Oncol 24 (2006): 321–2.
- Watson, W.J. “Herceptin (trastuzumab) therapy during pregnancy: association with reversible anhydramnios.” Obstet Gynecol 105 (2005): 642–3.
- Witzel, I.D., Müller, V., Harps, E., et al. “Trastuzumab in pregnancy associated with poor fetal outcome.” Ann Oncol 19 (2008): 191–2.
- Giacalone, P.L., Laffargue, F., Benos, P. “Chemotherapy for breast carcinoma during pregnancy: A French national survey.” Cancer 86.11 (1999): 2266–72.
- Khera, S.Y., Kiluk, J.V., Hasson, D.M., et al. “Pregnancy-associated breast cancer patients can safely undergo lymphatic mapping.” Breast J 14 (2008): 250–4.
- Mondi, M.M., Cuenca, R.E., Ollila, D.W., et al. “Sentinel lymph node biopsy during pregnancy: initial clinical experience.” Ann Surg Oncol 14 (2007): 218–21.
- Filippakis, G.M., Zografos, G. “Contraindications of sentinel lymph node biopsy: are there any really?” World J Surg Oncol 5 (2007): 10.
- Gentilini, O., Cremonesi, M., Trifiro, G., et al. “Safety of sentinel node biopsy in pregnant patients with breast cancer.” Ann Oncol 15 (2004): 1348–51.
- Keleher, A., Wendt, R., Delpassand, E., et al. “The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulfur colloid.” Breast J 10 (2004): 492–5.
- Pandit-Taskar, N., Dauer, L.T., Montgomery, L., et al. “Organ and fetal absorbed dose estimates from 99mTc-sulfur colloid lymphoscintigraphy and sentinel node localization in breast cancer patients.” J Nucl Med 47 (2006): 1202–8.
- Bajpai Jyoti, Chauhan Bharat, Nachanker Ankita, at al.“Pregnancy on tamoxifen: Case-report and review of literature.” South Asian J Cancer 5.4 (2016): 209–10.
- Kelly, H., Graham, M., Humes, E., et al. “Delivery of a healthy baby after first-trimester maternal exposure to lapatinib.” Clin Breast Cancer 7 (2006): 339–41.
- Greskovich, J.F. Jr, Macklis, R.M. “Radiation therapy in pregnancy: risk calculation and risk minimization.” Semin Oncol 27.6 (2000): 633–45.
- Letyagin, V.P., Laktionov, K.P., Visotskaya, I.V., et al.Breast cancer. Moscow. Medicine (1996): 150 p.
How to Cite
Copyright (c) 2018 Т. Ф Татарчук, Д. В. Поминчук, О. В. Шулига-Недайхлебова
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.