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Suelmann BBM, Bakhuis CFJ, van Dooijeweert C, Verloop J, Zweemer R, Linn S, van der Wall E, van Diest PJ. Prognosis of pregnancy-associated breast cancer: inferior outcome in patients diagnosed during second and third gestational trimesters and lactation. Breast Cancer Res Treat 2022; 192:175-189. [PMID: 35039951 DOI: 10.1007/s10549-021-06471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/01/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Pregnancy-associated breast cancer, although most commonly defined as breast cancer diagnosed during pregnancy or ≤1 year following delivery, knows a variety of definitions, likely related to the diversity of reported clinicopathological features and prognosis. More insight into the different breast cancer subgroups during pregnancy, time after delivery and the postpartum period is therefore warranted. METHODS Patients with breast cancer diagnosed during pregnancy or ≤6 months postdelivery were included, and subdivided according to gestational trimester, and postpartum patients according to lactational status. Subgroups were compared to matched non-PABC patients, to investigate the influence of pregnancy and lactation on clinical course and outcome. RESULTS Overall, 662 PABC patients were included (median age 34 years, median follow-up 6.5 years). PABC patients showed an advanced stage at diagnosis and an inferior 5-years-OS (75.4% vs. 83.2%, p = 0.000) compared to 1392 matched non-PABC patients. In subgroup analysis, first trimester PABC patients showed a significantly lower tumor size and stage as compared to other trimesters. Patients diagnosed during the first trimester and postpartum non-lactating patients had a relatively good OS (81.3% and 77.9%, respectively) versus patients diagnosed during the second and third trimesters and during lactation (OS 60.0%, 64.9% and 65.6%, respectively, p = 0.003). CONCLUSION In this large (uniquely specified) PABC cohort, an inferior outcome was found for patients diagnosed within the second and third gestational trimesters and during lactation. These findings indicate that PABC is clinically a heterogeneous group of breast cancer patients that should be redefined based on trimester of diagnosis and lactational status.
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Affiliation(s)
- B B M Suelmann
- Department of Medical Oncology, University Medical Center Utrecht, PO Box 95500, 2509 GA, Utrecht, The Netherlands.
| | - C F J Bakhuis
- Department of Medical Oncology, University Medical Center Utrecht, PO Box 95500, 2509 GA, Utrecht, The Netherlands
| | - C van Dooijeweert
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Verloop
- Department of Breast Cancer Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - R Zweemer
- Department of Gynecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Linn
- Department of Medical Oncology, Netherlands Cancer Institute (AVL-NKI), Amsterdam, The Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, PO Box 95500, 2509 GA, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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Viuff JH, Greiber IK, Karlsen MA, Storgaard L, Kroman N, Jensen MB, Eibye S, Hjortshøj CS, Ejlertsen B, Winther JF, Kjær SK, Mellemkjær L. Survival in Women Diagnosed With Breast Cancer During Pregnancy. Clin Breast Cancer 2021; 22:e517-e525. [PMID: 34963614 DOI: 10.1016/j.clbc.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/20/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Pregnancy rarely coincides with breast cancer, but when it does, uncertainties remain about how survival is affected. In a nation-wide study, we investigated survival in women diagnosed with breast cancer during pregnancy. MATERIALS AND METHODS Through health registries, we identified women with breast cancer at ages 15-44 years from 1973-2016 in Denmark and included 156 who were pregnant at diagnosis and 11,110 who were not. We compared overall mortality in pregnant and non-pregnant women using multivariate Cox regression stratified by time since cancer: <2 and ≥2 years. RESULTS During the first 2 years after diagnosis, the hazard ratio of overall death was 2.28 (95% CI: 1.48-3.52) for pregnant versus non-pregnant breast cancer patients after adjustment for age and calendar period and 1.62 (95% CI: 1.05-2.50) after further adjustment for extent of disease. Adjusting for additional tumor characteristics, the hazard ratio was still significantly increased. Beyond the first 2 years, there was no excess mortality. CONCLUSION Our study identifies the early period after breast cancer as a period of particular interest in future studies on survival after breast cancer in pregnancy. We found no evidence that survival is affected by pregnancy when 2 or more years have passed since diagnosis.
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Affiliation(s)
- Jakob H Viuff
- Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Iben K Greiber
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mona Aa Karlsen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone Storgaard
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Simone Eibye
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Cristel S Hjortshøj
- Department of Pediatrics, Section of Pediatric Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Susanne K Kjær
- Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Mellemkjær
- Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
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Bakhuis CFJ, Suelmann BBM, van Dooijeweert C, Linn S, van der Wall E, van Diest PJ. Receptor status of breast cancer diagnosed during pregnancy: A literature review. Crit Rev Oncol Hematol 2021; 168:103494. [PMID: 34715316 DOI: 10.1016/j.critrevonc.2021.103494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022] Open
Abstract
The definition of PABC is inconsistently given as either breast cancer diagnosed exclusively during pregnancy, or combined with breast cancer diagnosed within six months to five years after delivery, and sometimes even longer. The longer away from the delivery date breast cancer is diagnosed, the less clear this association with pregnancy may become. Therefore, breast cancer diagnosed during pregnancy (BCdP) may not necessarily be the same disease entity as PABC. This review aims to provide an overview of BCdP receptor status, as this has not been assessed before. BCdP tumors were predominantly ER negative (56.6 %), PR negative (57.2 %) or both ER and PR negative (47.9 %). Moreover, HER2-overexpression was seen in 33.2 % of BCdP patients and 27.6 % had triple negative disease. This predominantly ER and PR negative profile with more often HER2 overexpression is aggressive and distinct from non-pregnant similar-aged patients, warranting future comparative research.
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Affiliation(s)
- Carsten F J Bakhuis
- Department of Medical Oncology, University Medical Center Utrecht, the Netherlands
| | - Britt B M Suelmann
- Department of Medical Oncology, University Medical Center Utrecht, the Netherlands.
| | | | - Sabine Linn
- Department of Medical Oncology, Netherlands Cancer Institute (AVL-NKI), the Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, the Netherlands
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Clinical Presentation, Diagnosis and Prognosis of Pregnancy-Associated Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:87-93. [PMID: 32816266 DOI: 10.1007/978-3-030-41596-9_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Breast cancer in pregnancy is a rare entity generally presenting as a persistent breast mass, but is often a delayed finding due to the expected physiologic changes in the breast related to pregnancy and lactation. The preferred diagnostic workup of a persistent breast mass involves a combination of mammographic and ultrasonographic evaluation in addition to tissue diagnosis via core biopsy ; breast MRI is not recommended. Surgical excision should be reserved for definitive treatment in order to minimize fetal exposure to anesthesia. Evaluation for distant metastatic spread can be performed using radiographs and ultrasound to limit fetal radiation exposure . Similar to the non-pregnant patient, prognosis is primarily driven by tumor biology, however, there is limited and conflicting data regarding the impact of pregnancy on breast cancer outcomes with a distinct difference in survival among patients with breast cancer during pregnancy compared to those diagnosed postpartum.
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Shao C, Yu Z, Xiao J, Liu L, Hong F, Zhang Y, Jia H. Prognosis of pregnancy-associated breast cancer: a meta-analysis. BMC Cancer 2020; 20:746. [PMID: 32778072 PMCID: PMC7418189 DOI: 10.1186/s12885-020-07248-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Pregnancy-associated breast cancer (PABC) is defined as breast cancer that is diagnosed during pregnancy and/or the postpartum period. Definitions of the duration of the postpartum period have been controversial, and this variability may lead to diverse results regarding prognosis. Moreover, evidence on the dose-response association between the time from the last pregnancy to breast cancer diagnosis and overall mortality has not been synthesized. METHODS We systematically searched PubMed, Embase, and the Cochrane Library for observational studies on the prognosis of PABC published up to June 1, 2019. We estimated summary-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs). Subgroup analyses based on diagnosis time, PABC definition, geographic region, year of publication and estimation procedure for HR were performed. Additionally, dose-response analysis was conducted by using the variance weighted least-squares regression (VWLS) trend estimation. RESULTS A total of 54 articles (76 studies) were included in our study. PABC was associated with poor prognosis for overall survival (OS), disease-free survival (DFS) and cause-specific survival (CSS), and the pooled HRs with 95% CIs were 1.45 (1.30-1.63), 1.39 (1.25-1.54) and 1.40 (1.17-1.68), respectively. The corresponding reference category was non-PABC patients. According to subgroup analyses, the varied definition of PABC led to diverse results. The dose-response analysis indicated a nonlinear association between the time from the last delivery to breast cancer diagnosis and the HR of overall mortality (P < 0.001). Compared to nulliparous women, the mortality was almost 60% higher in women with PABC diagnosed at 12 months after the last delivery (HR = 1.59, 95% CI 1.30-1.82), and the mortality was not significantly different at 70 months after the last delivery (HR = 1.14, 95% CI 0.99-1.25). This finding suggests that the definition of PABC should be extended to include patients diagnosed up to approximately 6 years postpartum (70 months after the last delivery) to capture the increased risk. CONCLUSION This meta-analysis suggests that PABC is associated with poor prognosis, and the definition of PABC should be extended to include patients diagnosed up to approximately 6 years postpartum.
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Affiliation(s)
- Chunchun Shao
- Center of Evidence-based Medicine, Institute of Medical Sciences, The Second Hospital of Shandong University, Jinan, 250033 Shandong PR China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, 250033 Shandong PR China
| | - Juan Xiao
- Center of Evidence-based Medicine, Institute of Medical Sciences, The Second Hospital of Shandong University, Jinan, 250033 Shandong PR China
| | - Liyuan Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, 250033 Shandong PR China
| | - Fanzhen Hong
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, 250033 Shandong PR China
| | - Yuan Zhang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, 250012 Shandong PR China
- Clinical Research Center of Shandong University, Jinan, 250012 Shandong PR China
| | - Hongying Jia
- Center of Evidence-based Medicine, Institute of Medical Sciences, The Second Hospital of Shandong University, Jinan, 250033 Shandong PR China
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Han BY, Li XG, Zhao HY, Hu X, Ling H. Clinical features and survival of pregnancy-associated breast cancer: a retrospective study of 203 cases in China. BMC Cancer 2020; 20:244. [PMID: 32293328 PMCID: PMC7092544 DOI: 10.1186/s12885-020-06724-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Pregnancy-associated breast cancer (PABC) is an aggressive disease, and since Chinese authority began to encourage childbearing in 2015, the incidence of PABC has increased. This study investigated the characteristics and survival of PABC patients. Methods Patients with PABC who underwent surgery at Fudan University, Shanghai Cancer Center between 2005 and 2018 were enrolled. Data concerning the tumor characteristics, maternal state (whether first or non-first pregnancy) and survival outcome were recorded. Pearson Chi-square tests were used to compare the characteristics of the tumors, and Kaplan-Meier methods were used to perform the survival analysis. Results Overall, 203 PABC patients were recruited. Since 2015, 65.5% of non-first pregnant women were diagnosed with breast cancer, it’s 5.7 fold of the incidence of PABC in non-first pregnant women. No significant differences in tumor characteristics were observed between the patients who were in their first pregnancy and those in non-first pregnancy. Among the entire PABC population, luminal B breast cancer accounted for the largest proportion (38.4%), followed by triple-negative breast cancer (TNBC, 30.0%). The distribution of the molecular subtypes of PABC and non-PABC differed (P < 0.001) as follows: in the PABC patients, Luminal B 38.4%, Triple negative breast cancer (TNBC) 30.1%, Human Epidermal Growth Factor Receptor 2 (HER-2) overexpression 15.8%, and Luminal A 10.8%; in the non-PABC patients, Luminal A 50.9%, Luminal B 20.1%, TNBC 17.4%, and HER-2 overexpression 8.0%. The 3-year disease free survival (DFS) of all PABC patients was 80.3%. The 3-year DFS of the patients in the first-pregnancy group was 78.4%, and that of the patients in the non-first-pregnancy group was 83.7% (P = 0.325). Conclusions Our study proved that the proportion of women who developed PABC during the second or third pregnancy was extremely high relative to the newborn populations. The patients in the PABC population tended to present more luminal B and TNBC breast cancer than the non-PABC patients.
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Affiliation(s)
- Bo-Yue Han
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, 270 Dong-an Rd, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiao-Guang Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
| | - Hai-Yun Zhao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
| | - Xin Hu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
| | - Hong Ling
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, 270 Dong-an Rd, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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7
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Froehlich K, Schmidt A, Heger JI, Al-Kawlani B, Aberl CA, Jeschke U, Loibl S, Markert UR. Breast cancer, placenta and pregnancy. Eur J Cancer 2019; 115:68-78. [PMID: 31121525 DOI: 10.1016/j.ejca.2019.03.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/03/2019] [Accepted: 03/29/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Breast cancer is one of the most frequently diagnosed malignancies during pregnancy. Tumours often present characteristics of high malignancy and are hormone receptor negative/HER2 positive or triple negative. In general, pregnancy, including the postpartum period, is associated with a transiently increased risk of developing breast cancer but followed by a long-lasting protective period. Placental metastases are very rare and, thus far, breast cancer metastases in the foetal compartment have not been described. To discuss these apparently contradictory observations, this narrative review resumes immunological and hormonal alterations during pregnancy potentially affecting breast cancer risk as well as tumour growth and behaviour. OBSERVATIONS Upregulation of breast cancer-associated genes involved in immunological and reproductive processes has been observed in parous women and is potentially responsible for a transiently increased risk in pregnancy. In contrast, maternal immunisation and immunoglobulin production against antigens expressed on trophoblast cells, such as specific glycosylation patterns of mucin-1 or RCAS1-associated truncated glycans, seem to prevent breast cancer development in later years. Animal and human studies indicate that T cells are involved in these processes. Several placenta-derived factors, especially kisspeptin, have direct anti-tumour effects. The pregnancy-related increase of estrogen, progesterone, and other hormones influence growth and characteristics of breast cancer while the role of further placenta-secreted factors is still controversially discussed. CONCLUSION Several factors and cells are involved in altered breast cancer risk during and after pregnancy and have potential for developing novel treatment strategies in future.
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Affiliation(s)
- Karolin Froehlich
- University Hospital Jena, Department of Obstetrics, Placenta Lab, Am Klinikum 1, 07747, Jena, Germany
| | - André Schmidt
- University Hospital Jena, Department of Obstetrics, Placenta Lab, Am Klinikum 1, 07747, Jena, Germany
| | - Julia Isabell Heger
- University Hospital Jena, Department of Obstetrics, Placenta Lab, Am Klinikum 1, 07747, Jena, Germany
| | - Boodor Al-Kawlani
- University Hospital Jena, Department of Obstetrics, Placenta Lab, Am Klinikum 1, 07747, Jena, Germany
| | - Caroline Anna Aberl
- LMU München, Department of Obstetrics and Gynecology, Ludwig Maximilians University of Munich, Maistrasse 11, 80337, Munich, Germany
| | - Udo Jeschke
- LMU München, Department of Obstetrics and Gynecology, Ludwig Maximilians University of Munich, Maistrasse 11, 80337, Munich, Germany
| | - Sibylle Loibl
- German Breast Group, c/o GBG-Forschungs GmbH, Martin-Behaim-Str 12, 63263, Neu-Isenburg, Germany
| | - Udo Rudolf Markert
- University Hospital Jena, Department of Obstetrics, Placenta Lab, Am Klinikum 1, 07747, Jena, Germany.
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Suleman K, Osmani AH, Al Hashem H, Al Twegieri T, Ajarim D, Jastaniyah N, Al Khayal W, Al Malik O, Al Sayed A. Behavior and Outcomes of Pregnancy Associated Breast Cancer. Asian Pac J Cancer Prev 2019; 20:135-138. [PMID: 30678424 PMCID: PMC6485574 DOI: 10.31557/apjcp.2019.20.1.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction: Pregnancy Associated Breast cancer (PABC) is associated with poor prognosis and a decreased overall survival. A retrospective review was conducted to review the experience and outcome in a tertiary care hospital, and to compare those seen in a matched group for year of diagnosis. Materials and Methods: This is a retrospective review of a prospectively collected breast cancer registry. The study was conducted in a tertiary care hospital in Riyadh, Saudi Arabia from January to Decamber 2014 . Female patients with PABC were identified and matched with similar cohort of non-pregnant breast cancer patients that were diagnosed between 2001-2010. Clinical data including age, tumor biology, clinical stage, follow up and outcomes (disease free survival, DFS) were analyzed and compared between the two groups using SAS 9.3 and R-2.14.1 Results: A total of 110 patients in Group 1 and 114 patients in Group II were analyzed. In both groups, the patient age ranged was between 20 to 45 years; the median follow up was 34 months in PABC and 54 months in non-pregnant cohort. PABC were statistically more likely to be triple negative (p value-0.05) and diagnosed at advanced stage (stage 3 and 4) (p value-0.02). There was no difference in the occurrence of Her-2 positive disease. In pregnant patients there was a 5-year survival rate of 65% compared to non-pregnant cohort of 82% with p value of 0.002 and DFS was also 47.5% versus 65.4% with a p value .002 which is statistically significant. Conclusion: Pregnancy associated breast cancer (PABC) is diagnosed at a more advanced stage and tends to be triple negative and they are associated with a worse DFS and overall survival. Early detection during pregnancy may improve outcome.
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Affiliation(s)
- Kausar Suleman
- Section Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Johansson ALV, Weibull CE, Fredriksson I, Lambe M. Diagnostic pathways and management in women with pregnancy-associated breast cancer (PABC): no evidence of treatment delays following a first healthcare contact. Breast Cancer Res Treat 2018; 174:489-503. [PMID: 30552644 PMCID: PMC6422971 DOI: 10.1007/s10549-018-05083-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/03/2018] [Indexed: 12/02/2022]
Abstract
Background Women with pregnancy-associated breast cancer (PABC), i.e. diagnosed during or within 2 years of pregnancy, have a poor prognosis. We compared symptoms, diagnostics, treatments, and waiting times from first symptoms to treatment initiation in women diagnosed with PABC and non-PABC. Materials and methods Women diagnosed with PABC and non-PABC at ages 15–44 were identified in Swedish healthcare registers. Chart information was retrieved for 546 women (273 PABC cases and 273 age- and hospital-matched non-PABC controls) treated at 11 hospitals across Sweden between 1992 and 2009. Distributions of symptoms, diagnostics and treatments were compared. Median waiting times from initial symptoms to start of treatment, and time periods within, were estimated from Kaplan–Meier curves. Results Initial symptoms in women with PABC and non-PABC were similar. Women with PABC more often underwent biopsy and ultrasound than mammography at initial examination. Compared to non-PABC, rates of mastectomy and axillary clearance were higher in women with PABC, while endocrine treatment was less common. The time from symptoms to first healthcare contact was non-significantly longer in women diagnosed during or within 6 months of pregnancy. Waiting times from contact with healthcare to diagnosis and treatment were shorter or similar in women with PABC compared to women with non-PABC. Conclusions These findings do not support the notion that diagnostic and treatment delays following a first healthcare contact are more common in women diagnosed with breast cancer during or shortly after pregnancy. However, there was some evidence of delays in seeking healthcare among pregnant and lactating women. Electronic supplementary material The online version of this article (10.1007/s10549-018-05083-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. .,Cancer Registry of Norway, Oslo, Norway.
| | - Caroline E Weibull
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Irma Fredriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
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Abstract
Pregnancy-associated breast cancer is defined as invasive breast cancer diagnosed during gestation, within 1 year postpartum, or during lactation. Of particular interest is the treatment of invasive breast cancer during gestation; standard treatment protocols must take into account the health of the fetus. This article reviews the literature and emerging data regarding the treatment of pregnancy-associated breast cancer. Existing staging and treatment practices need slight modification in the setting of pregnancy. The timing of surgery and the administration of cytotoxic chemotherapy must take into account age of gestation, but these modalities are safe in pregnancy.
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Affiliation(s)
- Michael R Shafique
- From the H. Lee Moffitt Cancer Center and Research Institute, Breast Oncology Program, Tampa, Florida
| | - Marie Catherine Lee
- From the H. Lee Moffitt Cancer Center and Research Institute, Breast Oncology Program, Tampa, Florida
| | - Hyo Sook Han
- From the H. Lee Moffitt Cancer Center and Research Institute, Breast Oncology Program, Tampa, Florida
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11
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Prognosis of pregnancy-associated breast cancer. Breast Cancer Res Treat 2017; 163:417-421. [DOI: 10.1007/s10549-017-4224-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
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12
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13
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Hartman EK, Eslick GD. The prognosis of women diagnosed with breast cancer before, during and after pregnancy: a meta-analysis. Breast Cancer Res Treat 2016; 160:347-360. [DOI: 10.1007/s10549-016-3989-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/19/2016] [Indexed: 11/28/2022]
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14
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Raphael J, Trudeau ME, Chan K. Outcome of patients with pregnancy during or after breast cancer: a review of the recent literature. ACTA ACUST UNITED AC 2015; 22:S8-S18. [PMID: 25848342 DOI: 10.3747/co.22.2338] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND An increasing number of young women are delaying childbearing; hence, more are diagnosed with breast cancer (bca) before having a family. No clear recommendations are currently available for counselling such a population on the safety of carrying a pregnancy during bca or becoming pregnant after treatment for bca. METHODS Using a Web-based search of PubMed we reviewed the recent literature about bca and pregnancy. Our objective was to report outcomes for patients diagnosed with bca during pregnancy, comparing them with outcomes for non-pregnant women, and to evaluate prognosis in women diagnosed with and treated for bca who subsequently became pregnant. RESULTS "Pregnancy and bca" should be divided into two entities. Pregnancy-associated bca tends to be more aggressive and advanced in stage at diagnosis than bca in control groups; hence, it has a poorer prognosis. With respect to pregnancy after bca, there is, despite the bias in reported studies and meta-analyses, no clear evidence for a different or worse disease outcome in bca patients who become pregnant after treatment compared with those who do not. CONCLUSIONS Pregnancy-associated bca should be treated as aggressively as and according to the standards applicable in nonpregnant women; pregnancy after bca does not jeopardize outcome. The guidelines addressing risks connected to pregnancy and bca lack a high level of evidence for better counselling young women about pregnancy considerations and preventing unnecessary abortions. Ideally, evidence from large prospective randomized trials would set better guidelines, and yet the complexity of such studies limits their feasibility.
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Affiliation(s)
- J Raphael
- Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - M E Trudeau
- Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - K Chan
- Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON
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Yang YL, Chan KA, Hsieh FJ, Chang LY, Wang MY. Pregnancy-associated breast cancer in Taiwanese women: potential treatment delay and impact on survival. PLoS One 2014; 9:e111934. [PMID: 25415309 PMCID: PMC4240543 DOI: 10.1371/journal.pone.0111934] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/05/2014] [Indexed: 01/07/2023] Open
Abstract
This study investigated the clinicopathologic characteristics and survival of women diagnosed with pregnancy-associated breast cancer (PABC) in Taiwan. PABC is defined as breast cancer diagnosed during pregnancy or within 1 year after obstetric delivery. Our sample of PABC patients (N = 26) included all patients diagnosed at a major medical center in northern Taiwan from 1984 through 2009. Among these patients, 15 were diagnosed during pregnancy and 11 were diagnosed within 1 year after delivery. The comparison group included 104 patients within the same age range as the PABC patients and diagnosed with breast cancer not associated with pregnancy from 2004 through 2009 at the same hospital. Patients' initiating treatment delayed, 5-year and 10-year overall survival were delineated by stratified Kaplan-Meier estimates. Patients' characteristics were associated with initiating treatment delayed was evaluated with multivariate proportional hazards modeling. Antepartum PABC patients were younger and had longer time between diagnosis and treatment initiation than postpartum PABC patients. The predictor of treatment delayed was including birth parity, cancer stage, and pregnancy. The PABC group had larger tumors, more advanced cancer stage, and tumors with less progesterone receptor than the comparison group. The antepartum PABC patients had higher mortality than postpartum PABC and comparison groups within 5 years after diagnosis. Based on these results, we confirmed that pregnant women with breast cancer were more likely to delay treatment. Therefore, we recommend that breast cancer screening should be integrated into the prenatal and postnatal routine visits for early detection of the women's breast problems.
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Affiliation(s)
- Ya-Ling Yang
- Department of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Sec 1, Taipei 10051, Taiwan
| | - K. Arnold Chan
- Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10051, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Sec 1, Taipei 10051, Taiwan
| | - Fon-Jou Hsieh
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Sec 1, Taipei 10051, Taiwan
| | - Li-Yun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10051, Taiwan
| | - Ming-Yang Wang
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10051, Taiwan
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Abstract
Cancer is diagnosed approximately once per 1,000 pregnancies; most commonly due to the reproductive age of the women, these include breast, cervical, melanoma, thyroid, and Hodgkin’s lymphoma diagnoses. As a single diagnosis, breast cancer is the most common cancer diagnosed during pregnancy. Cancer is expected to complicate pregnancy more often due to the trend for women to delay child bearing to later maternal ages. Delayed first birth is itself a risk factor for breast cancer. Termination of pregnancy has not been shown to afford a survival benefit. While protecting the interests of mother and unborn fetus, breast cancer can be safely diagnosed, staged, and treated during pregnancy with good outcomes for both. Some modification of the protocols used for nonpregnant women with suspicious palpable breast masses is required. This article reviews the challenges for physicians in making the diagnosis of breast cancer during pregnancy and upon diagnosis, counseling patients about treatment options. The consequences of diagnostic investigations and cancer treatment for the exposed fetus are also addressed.
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Affiliation(s)
- Elyce Cardonick
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA
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17
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Cardonick E. Specific challenges in treating breast cancer in pregnant women. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY A cancer diagnosis during pregnancy presents a challenge to practitioners and patients. Often diagnosis is delayed. There are limited prospective case series and scant long-term neonatal and maternal data on which to base treatment plans. Also, the majority of pregnancy-associated case series include women diagnosed with breast cancer up to 1 year postpartum. The later-diagnosed group has a poorer prognosis and should be evaluated separately. To avoid attributing breast masses to pregnancy-related changes, masses should be evaluated as if the patient were not pregnant. Mammography, MRI, ultrasound, mastectomy and lumpectomy, axillary dissection, sentinel lymph node biopsy and even chemotherapy during the second and third trimesters can be considered for the pregnant patient with breast cancer.
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Michieletto S, Saibene T, Evangelista L, Barbazza F, Grigoletto R, Rossi G, Ghiotto C, Bozza F. Preliminary monocentric results of biological characteristics of pregnancy associated breast cancer. Breast 2014; 23:19-25. [DOI: 10.1016/j.breast.2013.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 08/09/2013] [Accepted: 10/12/2013] [Indexed: 12/11/2022] Open
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Dimitrakakis C, Zagouri F, Tsigginou A, Marinopoulos S, Sergentanis TN, Keramopoulos A, Zografos GC, Ampela K, Mpaltas D, Papadimitriou C, Dimopoulos MA, Antsaklis A. Does pregnancy-associated breast cancer imply a worse prognosis? A matched case-case study. ACTA ACUST UNITED AC 2014; 8:203-7. [PMID: 24415971 DOI: 10.1159/000352093] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Significant controversy exists in the literature regarding the role of pregnancy in the prognosis of breast cancer. We designed a matched case-case study, matching pregnancy-associated breast cancer (PABC) cases with breast cancer cases for stage, age, and year of diagnosis. PATIENTS AND METHODS 39 consecutive cases of PABC were matched with 39 premenopausal cases of breast cancer. Univariate and multivariate survival analyses followed by adjustment for stage, grade, estrogen receptor status, and age at diagnosis, were performed. RESULTS Regarding overall survival (OS), univariate analysis pointed to longer OS in non-PABC cases vs. PABC cases. Accordingly, a more advanced stage predicted shorter survival. In the multivariate analysis, the independent aggravating effect mediated by pregnancy persisted. Interestingly, a post hoc nested analysis within PABC cases indicated that the 3rd trimester pointed to shorter OS. The aforementioned results on OS were also replicated during the examination of relapse-free survival. CONCLUSION Implementing a matched case-case design, the present study points to pregnancy as a poor prognostic factor for breast cancer.
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Affiliation(s)
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Greece
| | - Alexandra Tsigginou
- Department of Obstetrics and Gynecology Alexandra Hospital, University of Athens, Greece
| | - Spyros Marinopoulos
- Department of Obstetrics and Gynecology Alexandra Hospital, University of Athens, Greece
| | | | - Antonis Keramopoulos
- Department of Obstetrics and Gynecology Alexandra Hospital, University of Athens, Greece
| | - George C Zografos
- 1st Propaedeutic Surgical Department, Hippocrateio Hospital, University of Athens, Greece
| | - Konstantina Ampela
- Department of Obstetrics and Gynecology Alexandra Hospital, University of Athens, Greece
| | - Dimosthenis Mpaltas
- Department of Obstetrics and Gynecology Alexandra Hospital, University of Athens, Greece
| | | | | | - Aris Antsaklis
- Department of Obstetrics and Gynecology Alexandra Hospital, University of Athens, Greece
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20
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Valentini A, Lubinski J, Byrski T, Ghadirian P, Moller P, Lynch HT, Ainsworth P, Neuhausen SL, Weitzel J, Singer CF, Olopade OI, Saal H, Lyonnet DS, Foulkes WD, Kim-Sing C, Manoukian S, Zakalik D, Armel S, Senter L, Eng C, Grunfeld E, Chiarelli AM, Poll A, Sun P, Narod SA. The impact of pregnancy on breast cancer survival in women who carry a BRCA1 or BRCA2 mutation. Breast Cancer Res Treat 2013; 142:177-85. [PMID: 24136669 DOI: 10.1007/s10549-013-2729-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/25/2022]
Abstract
Physicians are often approached by young women with a BRCA mutation and a recent history of breast cancer who wish to have a baby. They wish to know if pregnancy impacts upon their future risks of cancer recurrence and survival. To date, there is little information on the survival experience of women who carry a mutation in one of the BRCA genes and who become pregnant. From an international multi-center cohort study of 12,084 women with a BRCA1 or BRCA2 mutation, we identified 128 case subjects who were diagnosed with breast cancer while pregnant or who became pregnant after a diagnosis of breast cancer. These women were age-matched to 269 mutation carriers with breast cancer who did not become pregnant (controls). Subjects were followed from the date of breast cancer diagnosis until the date of last follow-up or death from breast cancer. The Kaplan-Meier method was used to estimate 15-year survival rates. The hazard ratio for survival associated with pregnancy was calculated using a left-truncated Cox proportional hazard model, adjusting for other prognostic factors. Among women who were diagnosed with breast cancer when pregnant or who became pregnant thereafter, the 15-year survival rate was 91.5 %, compared to a survival of 88.6 % for women who did not become pregnant (adjusted hazard ratio = 0.76; 95 % CI 0.31-1.91; p = 0.56). Pregnancy concurrent with or after a diagnosis of breast cancer does not appear to adversely affect survival among BRCA1/2 mutation carriers.
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21
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Amant F, von Minckwitz G, Han SN, Bontenbal M, Ring AE, Giermek J, Wildiers H, Fehm T, Linn SC, Schlehe B, Neven P, Westenend PJ, Müller V, Van Calsteren K, Rack B, Nekljudova V, Harbeck N, Untch M, Witteveen PO, Schwedler K, Thomssen C, Van Calster B, Loibl S. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol 2013; 31:2532-9. [PMID: 23610117 DOI: 10.1200/jco.2012.45.6335] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We aimed to determine the prognosis of patients with breast cancer diagnosed during pregnancy (BCP). PATIENTS AND METHODS In this cohort study, a multicentric registry of patients with BCP (from Cancer in Pregnancy, Leuven, Belgium, and GBG 29/BIG 02-03) compiled pro- and retrospectively between 2003 and 2011 was compared with patients who did not have associated pregnancies, using an age limit of 45 years. Patients with a diagnosis postpartum were excluded. The main analysis was performed using Cox proportional hazards regression of disease-free survival (DFS) and overall survival (OS) on exposure (pregnant or not), adjusting for age, stage, grade, hormone receptor status, human epidermal growth factor 2 status, histology, type of chemotherapy, use of trastuzumab, radiotherapy, and hormone therapy. RESULTS The registry contained 447 women with BCP, mainly originating from Germany and Belgium, of whom 311 (69.6%) were eligible for analysis. The nonpregnant group consisted of 865 women. Median age was 33 years for the pregnant and 41 years for the nonpregnant patients. Median follow-up was 61 months. The hazard ratio of pregnancy was 1.34 (95% CI, 0.93 to 1.91; P = .14) for DFS and 1.19 (95% CI, 0.73 to 1.93; P = .51) for OS. Cox regression estimated that the 5-year DFS rate for pregnant patients would have increased from 65% to 71% if these patients had not been pregnant. Likewise, the 5-year OS rate would have increased from 78% to 81%. CONCLUSION The results show similar OS for patients diagnosed with BCP compared with nonpregnant patients. This information is important when patients are counseled and supports the option to start treatment with continuation of pregnancy.
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Affiliation(s)
- Frédéric Amant
- Multidisciplinary Breast Cancer Center, University Hospitals Leuven and Department of Oncology, Katholieke Universiteit Leuven, UZ Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
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22
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Berretta M, Di Francia R, Lleshi A, De Paoli P, Li Volti G, Bearz A, Del Pup L, Tirelli U, Michieli M. Antiblastic treatment, for solid tumors, during pregnancy: a crucial decision. Int J Immunopathol Pharmacol 2013; 25:1S-19S. [PMID: 23092516 DOI: 10.1177/03946320120250s201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer is the second leading cause of death during the reproductive years complicating between 0.02 percent and 0.1 percent of pregnancies. The incidence is expected to rise with the increase in age of childbearing. The most common types of pregnancy-associated cancers are: cervical cancer, breast cancer, malignant melanoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma and ovarian cancer. The relatively rare occurrence of pregnancy-associated cancer precludes conducting large, prospective studies to examine diagnostic, management and outcome issues. The treatment of pregnancy-associated cancer is complex since it may be associated with adverse fatal effects. In pregnant patients diagnosed with cancer during the first trimester, treatment with multidrug anti-cancer chemotherapy is associated with an increased risk of congenital malformations, spontaneous abortions or fetal death, and therefore, should follow a strong recommendation for pregnancy termination. Second and third trimester exposure is not associated with teratogenic effect but increases the risk of intrauterine growth retardation and low birth weight. There are no sufficient data regarding the teratogenicity of most cytotoxic drugs. Almost all chemotherapeutic agents were found to be teratogenic in animals and for some drugs only experimental data exist. Moreover, no pharmacokinetic studies have been conducted in pregnant women receiving chemotherapy in order to understand whether pregnant women should be treated with different doses of chemotherapy. This article reviews the available data regarding the different aspects of the treatment of cancer during pregnancy.
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Affiliation(s)
- M Berretta
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy.
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23
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Cardonick E, Bhat A, Gilmandyar D, Somer R. Maternal and fetal outcomes of taxane chemotherapy in breast and ovarian cancer during pregnancy: case series and review of the literature. Ann Oncol 2012; 23:3016-3023. [PMID: 22875836 DOI: 10.1093/annonc/mds170] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the use of taxane chemotherapy during pregnancy and compare maternal and neonatal outcomes with those in women who did not receive taxanes during pregnancy, and review current existing data. STUDY DESIGN This is a retrospective cohort study in which women were identified from the Cancer and Pregnancy Registry at Robert Wood Johnson Medical Center. A retrospective chart analysis and an independent t-test were carried out comparing patient outcomes. A literature search in Ovid, Medline and PubMed was then carried out using the terms 'breast or ovarian cancer', 'pregnancy', 'paclitaxel', 'docetaxel', 'taxanes' and 'chemotherapy'. RESULTS Twelve of 129 women with breast cancer were exposed to taxanes during pregnancy. Three of nine women with ovarian cancer received taxane-based treatment during pregnancy. Birth weight, gestational age at delivery, rate of growth restriction, congenital anomalies and incidence of maternal and neonatal neutropenia were not statistically different between the two groups. CONCLUSIONS Taxane-based chemotherapy does not appear to increase the risk of fetal or maternal complications when compared with conventional chemotherapy in the small cohort of women in our Registry.
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Affiliation(s)
- E Cardonick
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cooper Medical School at Rowan University, Camden.
| | - A Bhat
- Division of Hematology and Medical Oncology, Department of Medicine, Cooper Medical School at Rowan University, Camden
| | - D Gilmandyar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, USA
| | - R Somer
- Division of Hematology and Medical Oncology, Department of Medicine, Cooper Medical School at Rowan University, Camden
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24
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Azim HA, Santoro L, Russell-Edu W, Pentheroudakis G, Pavlidis N, Peccatori FA. Prognosis of pregnancy-associated breast cancer: a meta-analysis of 30 studies. Cancer Treat Rev 2012; 38:834-42. [PMID: 22785217 DOI: 10.1016/j.ctrv.2012.06.004] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/09/2012] [Accepted: 06/17/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pregnancy-associated breast cancer (PABC) is relatively rare with considerable controversy regarding its prognosis. PATIENTS & METHODS Two of the authors independently performed a literature search with no date or language restrictions. Eligible studies were control-matched, population-based and hospital-based studies that addressed the outcome of patients diagnosed during pregnancy or 1-year afterwards. The primary and secondary end-points were overall and disease-free survival respectively. Pooling of data was done using the random effect model. RESULTS 30 studies were included in this meta-analysis (3,628 cases and 37,100 controls). PABC patients had a significantly higher risk of death compared to those with non-pregnancy-related breast cancer (pooled hazard ratio (pHR): 1.44; 95% CI [1.27-1.63]). The same results were encountered on restricting the analysis to HRs of multivariate analyses (pHR: 1.40 [1.17-1.67]). A clearer trend of poorer outcome was seen in those diagnosed postpartum (pHR: 1.84; 95% CI [1.28-2.65]) than those diagnosed during pregnancy (pHR: 1.29; 95% CI [0.74-2.24]). DFS analysis showed a significantly higher risk of relapse associated with PABC as well (pHR: 1.60 [1.19-2.16]). CONCLUSION Our results show that PABC is independently associated with poor survival particularly those diagnosed shortly post-partum. This underscores a possible impact of the pregnant breast microenvironment on the biology and consequently the prognosis of these tumors.
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Affiliation(s)
- Hatem A Azim
- Breast Cancer Translational Research Laboratory J.C. Heuson, Université Libre de Bruxelles, Institut Jules Bordet, 1000 Brussels, Belgium.
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25
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Cancer during pregnancy: perinatal outcome after in utero exposure to chemotherapy. Arch Gynecol Obstet 2012; 286:283-6. [PMID: 22410958 DOI: 10.1007/s00404-012-2287-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/01/2012] [Indexed: 12/29/2022]
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Ali SA, Gupta S, Sehgal R, Vogel V. Survival outcomes in pregnancy associated breast cancer: a retrospective case control study. Breast J 2012; 18:139-44. [PMID: 22356297 DOI: 10.1111/j.1524-4741.2011.01201.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pregnancy-associated breast cancer (PABC) has been defined as breast cancer diagnosed during pregnancy or within one year of delivery. It is believed that after adjusting for age and stage, the 5-year survival rates are the same in both pregnant and nonpregnant women. We conducted a retrospective case-control study among patients treated at our institution between 1990 and 2005 to compare the 5-year survival outcomes for PABC with women treated for breast cancer who were not pregnant. Overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method, and log rank tests were used to assess the associations between OS, DFS and pregnancy status, HER-2 status, ER/PR status, and family history. The median age was 33 years (range 24-42) for both groups. Twenty-two (55%) patients with PABC were ER/PR receptor positive compared with 20 (50%) for the controls. Ninety percent of patients with PABC received chemotherapy compared with 87.5% in the nonpregnant group. 91.5% of patients with PABC had breast-conserving surgery and 8.5% had mastectomies compared with 86% and 14%, respectively, for the control group. The median OS was 4.9 years in the PABC group compared with 6 years for the controls (p = 0.02). The median DFS was 2.7 years for the PABC group compared with 5.1 years for the controls (p = 0.01). The most common site of relapse was bone for the PABC group (27%) and local recurrence (33%) for the controls. Univariate analysis revealed that OS and DFS were associated with pregnancy status, family history, ER/PR status, and stage. After adjusting for age and stage, PABC patients had higher risk of both death (p = 0.01) and recurrence (p = 0.02) compared with nonpregnant controls. Women with PABC had significantly shorter OS and DFS compared with nonpregnant age and stage-matched controls.
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Affiliation(s)
- Sheikh Asim Ali
- Department of Medical Oncolgy, Temple University Hospital, Philadelphia, PA 19140, USA.
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27
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Doğer E, Calışkan E, Mallmann P. Pregnancy associated breast cancer and pregnancy after breast cancer treatment. J Turk Ger Gynecol Assoc 2011; 12:247-55. [PMID: 24592003 DOI: 10.5152/jtgga.2011.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 09/11/2011] [Indexed: 12/11/2022] Open
Abstract
Breast cancer is one of the most common cancers diagnosed during pregnancy and its frequency is increasing as more women postpone their pregnancies to their thirties and forties. Breast cancer diagnosis during pregnancy and lactation is difficult and complex both for the patient and doctors. Delay in diagnosis is frequent and treatment modalities are difficult to accept for the pregnant women. The common treatment approach is surgery after diagnosis, chemotherapy after the first trimester and radiotherapy after delivery. Even though early stage breast cancers have similar prognosis, advanced stage breast cancers diagnosed during pregnancy and lactation have poorer prognosis than similar stage breast cancers diagnosed in non-pregnant women. Women who desire to become pregnant after treatment of breast cancer will have many conflicts. Although the most common concern is recurrence of breast cancer due to pregnancy, the studies conducted showed that pregnancy has no negative effect on breast cancer prognosis. In this review we search for the frequency of breast cancer during pregnancy, the histopathological findings, risk factor, diagnostic and treatment modalities. We reviewed the literature for evidence based findings to help consult the patients on the outcome of breast cancer diagnosed during pregnancy and lactation, and also inform the patients who desire to become pregnant after breast cancer according to current evidences.
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Affiliation(s)
- Emek Doğer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Eray Calışkan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Universitäts-Frauenklinik, Köln, Germany
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28
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Murphy CG, Mallam D, Stein S, Patil S, Howard J, Sklarin N, Hudis CA, Gemignani ML, Seidman AD. Current or recent pregnancy is associated with adverse pathologic features but not impaired survival in early breast cancer. Cancer 2011; 118:3254-9. [PMID: 22086863 DOI: 10.1002/cncr.26654] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 06/30/2011] [Accepted: 08/16/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pregnancy-associated breast cancer (PABC) may be defined as breast cancer diagnosed during pregnancy or within 1 year of giving birth. Conflicting data exist regarding the impact of pregnancy on clinical features and prognosis of breast cancer. METHODS A single-institution retrospective chart review was performed of 99 patients identified with PABC between 1992 and 2007. Non-PABC controls were matched 2:1 to PABC cases by year of diagnosis and age. The differences in clinical features were compared between cases and controls using chi-square tests. Univariate and multivariate analyses were performed to assess the effect of PABC on survival. RESULTS Of the 99 PABC cases, breast cancer was diagnosed during pregnancy in 36 patients, and after delivery in 63. PABC cases were more likely than controls to be negative for estrogen receptor (59% vs 31%, P < .0001) and negative for progesterone receptor (72% vs 40%, P < .0001). Cases were also more likely to have advanced T class (P = .0271) and N class (P = .0104) and higher grade tumors (P = .0115). With a median follow-up of 6.3 years for cases and 4.7 years for controls, overall survival did not differ between cases and controls (P = .0787). On multivariate analysis, the independent prognostic factors for overall survival were estrogen receptor status (P = .0031) and N class (P = .0003). The diagnosis of PABC was not an independent prognostic factor (P = .1317). CONCLUSIONS PABC is associated with more adverse tumor features than non-PABC matched for age and year of diagnosis. After correcting for pathologic features, the diagnosis of PABC is not in itself an adverse prognostic factor for survival.
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Affiliation(s)
- Conleth G Murphy
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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29
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Abstract
Currently, it is estimated that approximately one in every 3,000 births are from women who have or are being treated for breast cancer. Although rare, the incidence of pregnancy-associated breast cancer (PABC) is increasing as women are delaying childbirth. Diagnostic and treatment recommendations have been mainly based on evidence from retrospective single institutional and collective series and expert consensus, as randomized trials on this entity are understandably lacking. PABC is often associated with a poor outcome, but this is mainly due to delay in diagnosis and initiation of treatment. For the most part, women with PABC should be managed like non-pregnant breast cancer patients and should expect a similar outcome, without causing harm to the unborn child. Increased awareness and knowledge of how to assess symptomatic breast problems in pregnancy and a specialized multidisciplinary team approach for established PABC is likely to improve outcomes. This review analyses the evidence on the diagnosis, treatment and prognosis of patients with PABC.
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30
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Dank M. [Pregnancy and breast cancer]. Magy Onkol 2010; 54:267-8. [PMID: 20870603 DOI: 10.1556/monkol.54.2010.3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Magdolna Dank
- Semmelweis Egyetem Radiológiai és Onkoterápiás Klinika, Budapest
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31
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Albrektsen G, Heuch I, Thoresen SØ. Histological type and grade of breast cancer tumors by parity, age at birth, and time since birth: a register-based study in Norway. BMC Cancer 2010; 10:226. [PMID: 20492657 PMCID: PMC2889893 DOI: 10.1186/1471-2407-10-226] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 05/21/2010] [Indexed: 11/16/2022] Open
Abstract
Background Some studies have indicated that reproductive factors affect the risk of histological types of breast cancer differently. The long-term protective effect of a childbirth is preceded by a short-term adverse effect. Few studies have examined whether tumors diagnosed shortly after birth have specific histological characteristics. Methods In the present register-based study, comprising information for 22,867 Norwegian breast cancer cases (20-74 years), we examined whether histological type (9 categories) and grade of tumor (2 combined categories) differed by parity or age at first birth. Associations with time since birth were evaluated among 9709 women diagnosed before age 50 years. Chi-square tests were applied for comparing proportions, whereas odds ratios (each histological type vs. ductal, or grade 3-4 vs. grade 1-2) were estimated in polytomous and binary logistic regression analyses. Results Ductal tumors, the most common histological type, accounted for 81.4% of all cases, followed by lobular tumors (6.3%) and unspecified carcinomas (5.5%). Other subtypes accounted for 0.4%-1.5% of the cases each. For all histological types, the proportions differed significantly by age at diagnoses. The proportion of mucinous and tubular tumors decreased with increasing parity, whereas Paget disease and medullary tumors were most common in women of high parity. An increasing trend with increasing age at first birth was most pronounced for lobular tumors and unspecified carcinomas; an association in the opposite direction was seen in relation to medullary and tubular tumors. In age-adjusted analyses, only the proportions of unspecified carcinomas and lobular tumors decreased significantly with increasing time since first and last birth. However, ductal tumors, and malignant sarcomas, mainly phyllodes tumors, seemed to occur at higher frequency in women diagnosed <2 years after first childbirth. The proportions of medullary tumors and Paget disease were particularly high among women diagnosed 2-5 years after last birth. The high proportion of poorly differentiated tumors in women with a recent childbirth was partly explained by young age. Conclusion Our results support previous observations that reproductive factors affect the risk of histological types of breast cancer differently. Sarcomas, medullary tumors, and possible also Paget disease, may be particularly susceptible to pregnancy-related exposure.
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Affiliation(s)
- Grethe Albrektsen
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Moreira WB, Brandão EC, Soares AN, Lucena CEMD, Antunes CMF. Prognosis for patients diagnosed with pregnancy-associated breast cancer: a paired case-control study. SAO PAULO MED J 2010; 128:119-24. [PMID: 20963362 PMCID: PMC10938955 DOI: 10.1590/s1516-31802010000300003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 06/30/2008] [Accepted: 05/10/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Previous studies have suggested that the occurrence of pregnancy concomitantly with a diagnosis of breast cancer may affect the evolution of the neoplasia. The present study aimed to compare pregnancy-associated breast cancer (PABC) patients with non-pregnant cancer patients (controls) in relation to the time taken to diagnose the disease, tumor characteristics and mortality. DESIGN AND SETTING A retrospective, paired case-control study was conducted at the Hospital da Santa Casa de Misericórdia and Centro de Quimioterapia Antiblástica e Imunoterapia in Belo Horizonte, Brazil. METHODS The study involved 87 PABC and 252 control patients. The influence of covariables (interval between first symptoms and diagnosis, tumor histology, size of primary tumor, distant metastasis, grade of malignancy, hormone receptor status and axillary lymph node involvement) and the pregnancy variable on overall survival was investigated using univariate and multivariate analyses. RESULTS The median overall survival for PABC patients of 30.1 months (95% confidence interval, CI: 19.4-40.9 months) was significantly different (P = 0.005) from that of the control group (53.1 months; 95% CI: 35.1-71.0 months). The cumulative overall survivals after five and ten years were, respectively, 29.7 and 19.2% for PABC patients, and 47.3 and 34.8% for control patients (P = 0.005). Tumor size, grade of malignancy, distant metastasis and pregnancy were independent factors that significantly modified disease prognosis. CONCLUSIONS Pregnancy was an independent prognostic factor. The overall survival of PABC patients was shorter than that of non-pregnant patients.
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Affiliation(s)
- Wagner Brant Moreira
- Clinical Oncology Service at Hospital da Santa Casa de Misericórdia, Belo Horizonte, Minas Gerais, Brazil.
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Amant F, Brepoels L, Halaska MJ, Gziri MM, Van Calsteren K. Gynaecologic cancer complicating pregnancy: An overview. Best Pract Res Clin Obstet Gynaecol 2010; 24:61-79. [DOI: 10.1016/j.bpobgyn.2009.08.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 08/05/2009] [Indexed: 11/26/2022]
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Ulery M, Carter L, McFarlin BL, Giurgescu C. Pregnancy-associated breast cancer: significance of early detection. J Midwifery Womens Health 2009; 54:357-363. [PMID: 19720336 DOI: 10.1016/j.jmwh.2008.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 12/17/2008] [Accepted: 12/17/2008] [Indexed: 11/27/2022]
Abstract
Pregnancy-associated breast cancer (PABC) is defined as cancer of the breast diagnosed during pregnancy and up to 1 year postpartum. Delays in diagnosis are frequently associated with increased morbidity and mortality. The aim of this article is to determine the significance of early detection of PABC and to alert health care providers to include PABC in the differential diagnosis when evaluating a breast mass in the perinatal period. This integrative literature review evaluated 15 research studies by using the hypothetical deductive model of clinical reasoning to determine factors related to diagnosis of PABC. As women delay childbearing, the incidence of PABC increases with age. In the reviewed studies, breast cancer was diagnosed with greater frequency in the postpartum period than during any trimester in pregnancy. Delay in diagnosis is complicated by axillary lymph node metastasis, high-grade tumors at diagnosis, and poor outcomes. Early detection is a significant predictor of improved outcomes. Diagnostic modalities such as ultrasound, mammography, and biopsy can be safely used for diagnostic purposes in the evaluation of potential cases of PABC during pregnancy.
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Affiliation(s)
- MaryAnn Ulery
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
| | - Linnette Carter
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
| | - Barbara L McFarlin
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
| | - Carmen Giurgescu
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
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Halaska MJ, Pentheroudakis G, Strnad P, Stankusova H, Chod J, Robova H, Petruzelka L, Rob L, Pavlidis N. Presentation, Management and Outcome of 32 Patients with Pregnancy-Associated Breast Cancer: A Matched Controlled Study. Breast J 2009; 15:461-7. [DOI: 10.1111/j.1524-4741.2009.00760.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Amant F, Van Calsteren K, Halaska MJ, Beijnen J, Lagae L, Hanssens M, Heyns L, Lannoo L, Ottevanger NP, Vanden Bogaert W, Ungar L, Vergote I, du Bois A. Gynecologic Cancers in Pregnancy. Int J Gynecol Cancer 2009; 19 Suppl 1:S1-12. [DOI: 10.1111/igc.0b013e3181a1d0ec] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pereg D, Koren G, Lishner M. Cancer in pregnancy: Gaps, challenges and solutions. Cancer Treat Rev 2008; 34:302-12. [PMID: 18291591 DOI: 10.1016/j.ctrv.2008.01.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 01/07/2008] [Accepted: 01/08/2008] [Indexed: 11/17/2022]
Affiliation(s)
- David Pereg
- Department of Internal Medicine A, Meir Medical Center, Kfar Sava, Israel
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Affiliation(s)
- S Aebi
- University Hospital Bern, Inselspital, Breast and Gynecologic Cancer Center, Switzerland
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Epstein RJ. Adjuvant breast cancer chemotherapy during late-trimester pregnancy: not quite a standard of care. BMC Cancer 2007; 7:92. [PMID: 17537241 PMCID: PMC1894980 DOI: 10.1186/1471-2407-7-92] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 05/30/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosis of breast cancer during pregnancy was formerly considered an indication for abortion. The pendulum has since swung to the other extreme, with most reviews now rejecting termination while endorsing immediate anthracycline-based therapy for any pregnant patient beyond the first trimester. To assess the evidence for this radical change in thinking, a review of relevant studies in the fields of breast cancer chemotherapy, pregnancy, and drug safety was conducted. DISCUSSION Accumulating evidence for the short-term safety of anthracycline-based chemotherapy during late-trimester pregnancy represents a clear advance over the traditional norm of therapeutic abortion. Nonetheless, the emerging orthodoxy favoring routine chemotherapy during gestation should continue to be questioned on several grounds: (1) the assumed difference in maternal survival accruing from chemotherapy administered earlier--i.e., during pregnancy, rather than after delivery--has not been quantified; (2) the added survival benefit of adjuvant cytotoxic therapy prescribed within the hormone-rich milieu of pregnancy remains presumptive, particularly for ER-positive disease; (3) the maternal survival benefit associated with modified adjuvant regimens (e.g., weekly schedules, omission of taxanes, etc.) has not been proven equivalent to standard (e.g., post-delivery) regimens; and (4) the long-term transplacental and transgenerational hazards of late-trimester chemotherapy are unknown. SUMMARY Although an incrementally increased risk of cancer-specific mortality is impossible to exclude, mothers who place a high priority on the lifelong well-being of their progeny may be informed that deferring optimal chemotherapy until after delivery is still an option to consider, especially in ER-positive, node-negative and/or last-trimester disease.
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Affiliation(s)
- Richard J Epstein
- Division of Haematology/Oncology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
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Anderson WF, Schairer C, Chen BE, Hance KW, Levine PH. Epidemiology of inflammatory breast cancer (IBC). Breast Dis 2006; 22:9-23. [PMID: 16735783 PMCID: PMC2852616 DOI: 10.3233/bd-2006-22103] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer with unknown etiology and generally poor outcome. It is characterized by diffuse edema (peau d'orange) and redness (erythema), although either the disease itself or case definitions have varied over time and place, confounding temporal trends and geographic variations. In this review, we discuss case definitions for IBC and its clinical characteristics; describe its geographic variation, age and racial distribution, incidence and survival patterns, and summarize the very limited information on its epidemiologic risk factors. We also incorporate emerging data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) Program.
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Abstract
Breast cancer during pregnancy is generally defined as cancer occurring during pregnancy or within 1 year of delivery, although treatment options are the most complicated when the disease is diagnosed during gestation. The challenges of treatment during gestation are discussed in this article. In general, a pregnant woman with breast cancer should be treated similarly to the nonpregnant patient, with specific recommendations tailored to gestational age at diagnosis, stage of the tumor, and the personal preferences of the patient. Despite the increasing literature focusing on treatment decisions, there are little prospective data regarding treatment or long-term outcome information to provide toxicity data that can be used to advise patients and guide decisions. Most of the retrospective and anecdotal data are based on the possibility of fetal loss or demise with specific treatment or treatment administered at specific times during pregnancy. Therefore, it is impossible to accurately quantify risks to the fetus or the mother, and decisions should be made after careful discussion between the patient, her family, and the medical team. The physician must have a clear understanding of the pharmacology and teratogenic potential of individual agents, thus limiting risks.
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Affiliation(s)
- Hope S Rugo
- Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero Avenue, Second Floor, Box 1710, San Francisco, CA 94115, USA.
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Johnson RM, Barney LM, King JC. Vaginal delivery of monozygotic twins after bilateral pedicle TRAM breast reconstruction. Plast Reconstr Surg 2002; 109:1653-4. [PMID: 11932611 DOI: 10.1097/00006534-200204150-00025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R Michael Johnson
- Division of Plastic Surgery, Department of Surgery, Miami Valley Hospital, Wright State University, Dayton, OH 45409, USA.
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Abstract
Breast cancer in pregnancy is likely to become more common because more women have been waiting to bear children until they are in their 40s. This article presents an overview of pregnancy-associated breast cancer and a review of surgical, chemotherapeutical, and radiation principles as they pertain to pregnancy.
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Affiliation(s)
- Stephen S Falkenberry
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island 02905, USA
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