General Information
Breast cancer is the most common cancer in pregnant and postpartum women,
occurring in about 1 in 3,000 pregnant women. The average patient is between 32
to 38 years of age and, with many women choosing to delay childbearing, it is
likely that the incidence of breast cancer during pregnancy will increase.
Breast cancer pathology is similar in age-matched pregnant and nonpregnant
women. Hormone receptor assays are usually negative in pregnant breast cancer
patients, but this may be the result of receptor binding by high serum estrogen
levels associated with the pregnancy. Enzyme immunocytochemical
receptor assays, however, are more sensitive than competitive binding assays. A study
using binding methods indicated similar receptor positivity between pregnant
and nonpregnant women with breast cancer.[1] The study concluded that
increased estrogen levels during pregnancy could result in a higher incidence
of receptor positivity detected with immunohistochemistry than is detected by
radiolabeled ligand binding, which is because of competitive inhibition by high levels of
endogenous estrogen.
The natural tenderness and engorgement of the breasts of pregnant and lactating
women may hinder detection of discrete masses, and therefore, early diagnoses
of breast cancer. Delays in diagnoses are common, with an average reported
delay of 5 to 15 months from the onset of symptoms.[2-5] Because of this
delay, cancers are typically detected at a later stage than in a nonpregnant,
age-matched population.[6] To detect breast cancer, pregnant and lactating
women should practice self-examination and undergo a breast examination as part
of the routine prenatal examination by a doctor. If an abnormality is found,
diagnostic approaches such as ultrasound and mammography may be used. With
proper shielding, mammography poses little risk of radiation exposure to the
fetus.[7] Mammograms should only be used, however, to evaluate dominant masses
and to locate occult carcinomas in the presence of other suspicious physical
findings.[7] Since at least 25% of mammograms in pregnancy may be negative in
the presence of cancer, a biopsy is essential for the diagnosis of any palpable
mass. Diagnosis may be safely accomplished with a fine-needle aspiration, core biopsy, or
excisional biopsy under local anesthesia. To avoid a false-positive diagnosis
as a result of misinterpretation of pregnancy-related changes, the pathologist
should be advised that the patient is pregnant.[8]
Overall survival of pregnant women with breast cancer may be worse than in
nonpregnant women at all stages;[7] however, this may be due primarily to delayed diagnoses.[9]
Termination of pregnancy has not been shown to have any beneficial effect on
breast cancer outcome and is not usually considered as a therapeutic
option.[2,3,5,10,11] Termination of pregnancy, however, may be considered, based on
the age of the fetus, and if maternal treatment options, such as chemotherapy and
radiation therapy, are significantly limited by the continuation of the
pregnancy.
References
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Elledge RM, Ciocca DR, Langone G, et al.: Estrogen receptor, progesterone receptor, and HER-2/neu protein in breast cancers from pregnant patients. Cancer 71 (8): 2499-506, 1993.
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Hoover HC Jr: Breast cancer during pregnancy and lactation. Surg Clin North Am 70 (5): 1151-63, 1990.
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Gwyn K, Theriault R: Breast cancer during pregnancy. Oncology (Huntingt) 15 (1): 39-46; discussion 46, 49-51, 2001.
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Moore HC, Foster RS Jr: Breast cancer and pregnancy. Semin Oncol 27 (6): 646-53, 2000.
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Rugo HS: Management of breast cancer diagnosed during pregnancy. Curr Treat Options Oncol 4 (2): 165-73, 2003.
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Clark RM, Chua T: Breast cancer and pregnancy: the ultimate challenge. Clin Oncol (R Coll Radiol) 1 (1): 11-8, 1989.
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Yang WT, Dryden MJ, Gwyn K, et al.: Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology 239 (1): 52-60, 2006.
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Middleton LP, Amin M, Gwyn K, et al.: Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features. Cancer 98 (5): 1055-60, 2003.
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Petrek JA, Dukoff R, Rogatko A: Prognosis of pregnancy-associated breast cancer. Cancer 67 (4): 869-72, 1991.
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Barnavon Y, Wallack MK: Management of the pregnant patient with carcinoma of the breast. Surg Gynecol Obstet 171 (4): 347-52, 1990.
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Gallenberg MM, Loprinzi CL: Breast cancer and pregnancy. Semin Oncol 16 (5): 369-76, 1989.
[PUBMED Abstract]
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