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Bothou Α, Margioula-Siarkou C, Petousis S, Margioula-Siarkou G, Zervoudis S, Sotiriadis A, Amant F, Dinas K. Sentinel lymph node biopsy for breast cancer during pregnancy: A comprehensive update. Eur J Clin Invest 2024; 54:e14134. [PMID: 38095225 DOI: 10.1111/eci.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/27/2023] [Accepted: 11/05/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pregnant patients diagnosed with breast cancer (PrBC) may receive substantially different treatments compared to general population, considering that certain treatment options cannot be applied during pregnancy due to their potential harmful effects to the foetus. Regarding the use of sentinel lymph node biopsy (SLNB) in pregnant patients, potential concerns include foetal harm from radiation exposure, possible teratogenic effects of blue dyes and maternal anaphylaxis to isosulfan. OBJECTIVE The main objective of the present systematic review is to summarize and present current knowledge and up-to-date evidence about the safety and efficacy of SLNB in PABC. METHODS MEDLINE, Google Scholar and UpToDate databases were searched up to 22 January 2023. Articles studying the safety and effectiveness of SLNB in patients for PrBC were eligible for inclusion in the present review. RESULTS In total, 63 articles that met the inclusion criteria were included in this study. Forty-seven articles were strongly in favour of performing SLNB in PABC, 4 articles were partially in favour, 10 articles were strongly against and 2 articles were partially against performing SLNB in PABC. Sub-categorization based on type of study showed that the majority of studies in favour were of higher level of evidence than those against. Furthermore, there were overall 12 studies reporting on outcomes. There were overall 382 women with PrBC that underwent SLNB. Full data were reported for 237 cases. Overall live birth rate was 95.8%, while overall neonatal complication rate was 3.4%. No case of maternal side effects or anaphylactic reaction, maternal death, stillbirth and neonatal death was reported (0%). CONCLUSIONS Sentinel lymph node biopsy seems to be safe and effective technique for breast cancer during pregnancy.
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Affiliation(s)
- Αnastasia Bothou
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- University of West Attica, Athens, Greece
- Breast Department of Alexandra General Hospital, Athens, Greece
| | - Chrysoula Margioula-Siarkou
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Gynaecologic Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
| | - Stamatios Petousis
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Gynaecologic Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
| | - Georgia Margioula-Siarkou
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Gynaecologic Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Zervoudis
- University of West Attica, Athens, Greece
- Breast Department of REA Hospital, Athens, Greece
- Medical School, University of Montpellier-Nimes, Nimes, France
| | - Alexandros Sotiriadis
- Maternal-Fetal Medicine Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
| | - Fréderic Amant
- Division Gynecologic Oncology, UZ Leuven, Leuven, Belgium
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Konstantinos Dinas
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Gynaecologic Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Maternal-Fetal Medicine Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
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Surgical and obstetric outcomes of breast cancer surgery during pregnancy: a nationwide database study in Japan. Breast Cancer Res Treat 2022; 195:289-299. [PMID: 35917051 DOI: 10.1007/s10549-022-06659-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/13/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Although the incidence of breast cancer during pregnancy is increasing, little is known about short-term outcomes following breast cancer surgery during pregnancy. We aimed to compare the characteristics and outcomes of breast cancer surgery with and without pregnancy, and describe the obstetric outcomes following surgery. METHODS The data of 249,257 female patients aged < 60 years who underwent breast cancer surgery between July 2010 and March 2020 were analyzed using a nationwide Japanese database; we generated a 1:10 matched-pair cohort (260 and 2597 patients with and without pregnancy, respectively) matched according to age and treatment year. We conducted multivariable analyses to compare surgical procedures and outcomes, adjusting for potential confounders in the matched-pair cohort. Additionally, we described the obstetric outcomes of patients with pregnancy. RESULTS Patients with pregnancy were more likely to undergo total mastectomy [odds ratio: 1.48 (95% confidence interval: 1.13-1.94)] and axillary dissection [1.62 (1.17-2.24)], but less likely to undergo reconstruction [0.14 (0.07-0.31)], than patients without; however, postoperative complications, postoperative length of stay, and total hospitalization costs did not differ significantly with pregnancy. Additionally, some pregnant patients experienced premature delivery [n = 18 (6.9%)] and miscarriage [n = 4 (1.5%)], and 31 of 101 patients in the third trimester at breast cancer surgery underwent a cesarean section. CONCLUSION This study demonstrated significant differences regarding surgical procedures; however, there were no significant differences regarding surgical outcomes between patients who underwent breast cancer surgery with and without pregnancy. Obstetric outcomes following breast cancer surgery were also reported.
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Gochhait D, Dehuri P, Devi D. Role of fine-needle aspiration cytology in peripartum/pregnancy.associated breast malignancy . Six cases with review of literature. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2020. [DOI: 10.4103/mjmsr.mjmsr_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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De Garnier J, Boudy AS, Selleret L, Gligorov J, Chabbert-Buffet N, Bendifallah S, Darai E. [Expert centre Cancer du sein et Grossesse (CALG): Concordance between the proposed therapeutics and those finally received]. ACTA ACUST UNITED AC 2018; 47:36-43. [PMID: 30563785 DOI: 10.1016/j.gofs.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Breast cancer associated with pregnancy (CSAG) is a rare condition whose management justifies the use of expert center. The Pregnancy-Associated Cancer Network (CALG) was created in France to optimize therapeutic management. The objective of our study was to evaluate its impact on the therapeutic management of CSAGs and the discrepancy rate between the CALG proposal and the treatment performed. METHOD A retrospective study including 58 CSAGs for which the opinion of the CALG network was solicited between January 2015 and November 2017. A questionnaire was addressed to the practitioner requesting the network. These practitioners were contacted to know the treatments received by the patient to assess the discrepancy rate. RESULTS In 70% of the cases, the CALG network was solicited before any therapeutic treatment. When the opinion was requested after initiation of therapy, the discrepancy rate between the CALG proposal and the one practiced was 47%. Of the 46 physicians contacted, the response rate was 62.5% (30/46). In 90% of cases, the therapy proposed by the CALG network was the one received by the patient. CONCLUSION This study emphasizes the need to refer to an expert center before treatment of a CSAG and the need for the contribution of doctors requesting the expert center to inform them of the follow-up of patients and children.
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Affiliation(s)
- J De Garnier
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A S Boudy
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - L Selleret
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J Gligorov
- Service d'oncologie médicale, hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, faculté de médecine Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
| | - S Bendifallah
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, faculté de médecine Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
| | - E Darai
- Service de gynécologie obstétrique, centre Cancer associé à la grossesse (CALG), hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, faculté de médecine Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France
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Gomez-Hidalgo NR, Mendizabal E, Joigneau L, Pintado P, De Leon-Luis J. Breast cancer during pregnancy: results of maternal and perinatal outcomes in a single institution and systematic review of the literature. J OBSTET GYNAECOL 2018; 39:27-35. [PMID: 29912592 DOI: 10.1080/01443615.2018.1457631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
To compare the maternal and the perinatal variables of the patients with pregnancy associated breast cancer (PABC) and the pregnant patients without breast cancer (PNABC), we retrospectively included 13 PABC cases and 66.265 PNABC patients. The PABC patients presented a lower mean gestational age at their delivery and had higher induction of labour and prematurity rates. A diagnosis was performed before stage III in 77% of the cases. The overall survival was 90%; moreover, we collected 16 manuscripts when gathering data from 1581 patients with PABC. The mean follow-up time was 70 ± 8 months. The mean maternal age at diagnosis was 34 years old. Most of the patients were at their second trimester of pregnancy. The gestational age at delivery was 35 weeks. A mastectomy was the most frequently used surgical approach. PABC should be managed by a multidisciplinary team, ensuring there is a rigorous oncological treatment, with foetal well-being. IMPACT STATEMENT What is already known on this subject? The malignant breast tumours diagnosed during pregnancy, or 1 year after a delivery are increasing, there is evidence supporting the treatment during a pregnancy with maternal and foetal safety. A PABC should be managed by a multidisciplinary team in a referral centre, ensuring that there is a rigorous oncological treatment with foetal well-being. What do the results of this study add? Our results show that the PABC patients in our centre had a mean maternal age older than the PNABC women, as well as a higher percentage of the induction of labour and prematurity. 48 Cancer was usually diagnosed in early stages, and the most common type was ductal infiltrating, with positive hormonal receptors. For those patients continuing their pregnancies, a mastectomy plus a lymphadenectomy was the most frequent chemotherapy, and was usually administered in the third trimester of pregnancy. What are the implications of these findings for future clinical practice and/or further research? Moreover, the number of publications concerning PABC has grown, series are still scarce. We understand the limitations of the low number of the cases on our population, but this study is the first which compare the PABC with the PNABC patients, allowing to describe and compare the obstetrical and perinatal variables. Finally, we consider it is of a paramount importance to create an international database to register in a prospective way all of the cases of PABC to increase our knowledge in this field.
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Affiliation(s)
- Natalia R Gomez-Hidalgo
- a Department of Obstetrics and Gynecology , Hospital Gregorio Marañon Universidad Complutense de Madrid , Madrid , Spain
| | - Elsa Mendizabal
- a Department of Obstetrics and Gynecology , Hospital Gregorio Marañon Universidad Complutense de Madrid , Madrid , Spain
| | - Laura Joigneau
- a Department of Obstetrics and Gynecology , Hospital Gregorio Marañon Universidad Complutense de Madrid , Madrid , Spain
| | - Pilar Pintado
- a Department of Obstetrics and Gynecology , Hospital Gregorio Marañon Universidad Complutense de Madrid , Madrid , Spain
| | - Juan De Leon-Luis
- a Department of Obstetrics and Gynecology , Hospital Gregorio Marañon Universidad Complutense de Madrid , Madrid , Spain
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Kirkman M, Apicella C, Graham J, Hickey M, Hopper JL, Keogh L, Winship I, Fisher J. Meanings of abortion in context: accounts of abortion in the lives of women diagnosed with breast cancer. BMC Womens Health 2017; 17:26. [PMID: 28381301 PMCID: PMC5382471 DOI: 10.1186/s12905-017-0383-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 03/30/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A breast cancer diagnosis and an abortion can each be pivotal moments in a woman's life. Research on abortion and breast cancer deals predominantly with women diagnosed during pregnancy who might be advised to have an abortion. The other-discredited but persistent-association is that abortions cause breast cancer. The aim here was to understand some of the ways in which women themselves might experience the convergence of abortion and breast cancer. METHODS Among 50 women recruited from the Australian Breast Cancer Family Study and interviewed in depth about what it meant to have a breast cancer diagnosis before the age of 41, five spontaneously told of having or contemplating an abortion. The transcripts of these five women were analysed to identify what abortion meant in the context of breast cancer, studying each woman's account as an individual "case" and interpreting it within narrative theory. RESULTS It was evident that each woman understood abortion as playing a different role in her life. One reported an abortion that she did not link to her cancer, the second was relieved not to have to abort a mid-treatment pregnancy, the third represented abortion as saving her life by making her cancer identifiable, the fourth grieved an abortion that had enabled her to begin chemotherapy, and the fifth believed that her cancer was caused by an earlier abortion. CONCLUSIONS The women's accounts illustrate the different meanings of abortion in women's lives, with concomitant need for diverse support, advice, and information.
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Affiliation(s)
- Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Carmel Apicella
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jillian Graham
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
| | - Martha Hickey
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - John L. Hopper
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ingrid Winship
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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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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Locoregional treatment of breast cancer during pregnancy. ACTA ACUST UNITED AC 2014; 11:279-284. [PMID: 25419205 PMCID: PMC4237906 DOI: 10.1007/s10397-014-0860-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 09/17/2014] [Indexed: 11/01/2022]
Abstract
The management of patients with breast cancer during pregnancy is very demanding and it should be better performed in highly qualified and experienced centers. Referral to institutes and physicians trained in this special clinical scenario allows reducing the risk of both overtreating and undertreating the patients. Moreover, patients can receive appropriate information regarding safety of treatments without old-fashioned taboo. The purpose of the current paper is to discuss the main issues concerning surgical management and in general locoregional treatment of patients diagnosed with breast cancer and treated during gestation, focusing on those women who chose to continue their pregnancy. We cover the issues regarding type of breast surgery, radiation therapy, immediate reconstruction during mastectomy, and management of the axilla.
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Murawa P, Murawa D, Adamczyk B, Połom K. Breast cancer: Actual methods of treatment and future trends. Rep Pract Oncol Radiother 2014; 19:165-72. [PMID: 24936340 DOI: 10.1016/j.rpor.2013.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/04/2013] [Indexed: 01/17/2023] Open
Abstract
The recent ten to twenty years have seen a substantial progress in the diagnosis and treatment of breast cancer. A rapid development of various curative options has led to the improvement of treatment outcomes, while paying more and more attention to the aspects of quality of life and cosmetic effect. In our publication, we wish to outline certain trends in the development of modern treatment of breast cancer. Among topics discussed are new forms of molecular diagnostics, new approach to the idea of sentinel node biopsy, as well as new techniques for delivery of medical procedures, the increasing use of nomograms, progress in the techniques of breast conservative treatment, modern approach to occult breast lesions, the increasing use of neoadjuvant treatment and intraoperative radiotherapy.
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Affiliation(s)
- Paweł Murawa
- Oncological and General Surgery Department I, Greater Poland Cancer Centre, Poznań, Poland ; Cancer Pathology Department, Oncology Department, Poznań University of Medical Sciences, Poland
| | - Dawid Murawa
- Oncological and General Surgery Department I, Greater Poland Cancer Centre, Poznań, Poland
| | - Beata Adamczyk
- Oncological and General Surgery Department I, Greater Poland Cancer Centre, Poznań, Poland
| | - Karol Połom
- Oncological and General Surgery Department I, Greater Poland Cancer Centre, Poznań, Poland
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Multidisciplinary approach to breast cancer diagnosed during pregnancy: Maternal and neonatal outcomes. Breast 2013; 22:515-9. [DOI: 10.1016/j.breast.2012.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/30/2012] [Accepted: 10/07/2012] [Indexed: 11/30/2022] Open
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Lohsiriwat V, Peccatori FA, Martella S, Azim HA, Sarno MA, Galimberti V, De Lorenzi F, Intra M, Sangalli C, Rotmensz N, Pruneri G, Renne G, Schorr MC, Nevola Teixeira LF, Rietjens M, Giroda M, Gentilini O. Immediate breast reconstruction with expander in pregnant breast cancer patients. Breast 2013; 22:657-60. [PMID: 23871328 DOI: 10.1016/j.breast.2013.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/11/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Breast reconstruction after mastectomy is currently considered an essential component in managing breast cancer patients, particularly those diagnosed at a young age. However, no studies have been published on the feasibility of immediate breast reconstruction in patients diagnosed and operated during the course of gestation. METHOD We retrospectively identified all breast cancer patients who were subjected to mastectomy and immediate breast reconstruction during pregnancy at the European Institute of Oncology between 2002 and 2012. Patient demographics, gestational age at surgery, tumor stage, adjuvant treatment, details of the surgical procedures, surgical outcomes and fetal outcomes were analyzed. RESULTS A total of 78 patients with breast cancer diagnosed during pregnancy were subjected to a surgical procedure during the course of gestation. Twenty-two patients had mastectomy; of whom 13 were subjected to immediate breast reconstruction. Twelve out of 13 patients had a two-stage procedure with tissue expander insertion. Median gestational age at surgery was 16 weeks. No major surgical complications were encountered. Only one patient elected to have an abortion, otherwise, no spontaneous abortions or pregnancy complications were reported. Median gestational age at delivery was 35 weeks (range: 32-40 weeks). No major congenital malformations were reported. At a median follow-up of 32 months, all patients are alive with no long-term surgical complications. CONCLUSIONS This is the first study of immediate breast reconstruction in pregnant breast cancer patients. Tissue expander insertion appears to ensure a short operative time, and does not seem to be associated with considerable morbidity to the patient or the fetus. Hence, it could be considered in the multidisciplinary management of women diagnosed with breast cancer during pregnancy.
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Affiliation(s)
- Visnu Lohsiriwat
- Division of Plastic Surgery, European Institute of Oncology, Via Ripamonti, 435 - 20141 Milano, Italy; Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand.
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Dang C, Giuliano AE. Individualizing Axillary Management in Breast Cancer Treatment. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-013-0108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Hassiotou F, Hepworth AR, Beltran AS, Mathews MM, Stuebe AM, Hartmann PE, Filgueira L, Blancafort P. Expression of the Pluripotency Transcription Factor OCT4 in the Normal and Aberrant Mammary Gland. Front Oncol 2013; 3:79. [PMID: 23596564 PMCID: PMC3622876 DOI: 10.3389/fonc.2013.00079] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/28/2013] [Indexed: 01/20/2023] Open
Abstract
Breast cancers with lactating features, some of which are associated with pregnancy and lactation, are often poorly differentiated, lack estrogen receptor, progesterone receptor, and HER2 expression and have high mortality. Very little is known about the molecular mechanisms that drive uncontrolled cell proliferation in these tumors and confer lactating features. We have recently reported expression of OCT4 and associated embryonic stem cell self-renewal genes in the normal lactating breast and breastmilk stem cells (hBSCs). This prompted us to examine OCT4 expression in breast cancers with lactating features and compare it with that observed during normal lactation, using rare specimens of human lactating breast. In accordance with previous literature, the normal resting breast (from non-pregnant, non-lactating women) showed minimal OCT4 nuclear expression (0.9%). However, this increased in the normal lactating breast (11.4%), with further increase in lactating adenomas, lactating carcinomas, and pregnancy-associated breast cancer (30.7–48.3%). OCT4 was expressed in the epithelium and at lower levels in the stroma, and was co-localized with NANOG. Comparison of normal non-tumorigenic hBSCs with OCT4-overexpressing tumorigenic breast cell lines (OTBCs) demonstrated upregulation of OCT4, SOX2, and NANOG in both systems, but OTBCs expressed OCT4 at significantly higher levels than SOX2 and NANOG. Similar to hBSCs, OTBCs displayed multi-lineage differentiation potential, including the ability to differentiate into functional lactocytes synthesizing milk proteins both in vitro and in vivo. Based on these findings, we propose a hypothesis of normal and malignant transformation in the breast, which centers on OCT4 and its associated gene network. Although minimal expression of these embryonic genes can be seen in the breast in its resting state throughout life, a controlled program of upregulation of this gene network may be a potential regulator of the normal remodeling of the breast toward a milk-secretory organ during pregnancy and lactation. Deregulation of this gene network either within or outside pregnancy and lactation may lead to aberrant breast cell proliferation and malignant transformation, suggesting a role of these genes in both normal lactation and breast oncogenesis.
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Affiliation(s)
- Foteini Hassiotou
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia Perth, WA, Australia ; School of Anatomy, Physiology and Human Biology, Faculty of Science, The University of Western Australia Perth, WA, Australia
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Baulies S, Cusidó M, Tresserra F, Rodríguez I, Ubeda B, Ara C, Fábregas R. [Pregnancy-Associated Breast Cancer: An analytical observational study]. Med Clin (Barc) 2013; 142:200-4. [PMID: 23490493 DOI: 10.1016/j.medcli.2012.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/12/2012] [Accepted: 12/13/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum. PATIENTS AND METHOD A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared. RESULTS The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P < .05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P < .05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively. CONCLUSIONS The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade iii, as well as a delay in diagnosis with a higher rate of advanced stages.
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Affiliation(s)
- Sonia Baulies
- Unidad de Ginecología Oncológica y Mastología, Departamento de Obstetricia, Ginecología y Reproducción Humana, Institut Universitari Dexeus, Barcelona, España.
| | - Maite Cusidó
- Unidad de Ginecología Oncológica y Mastología, Departamento de Obstetricia, Ginecología y Reproducción Humana, Institut Universitari Dexeus, Barcelona, España
| | - Francisco Tresserra
- Departamento de Anatomía Patológica, Institut Universitari Dexeus, Barcelona, España
| | - Ignacio Rodríguez
- Unidad de Epidemiología y Estadística, Departamento de Obstetricia, Ginecología y Reproducción Humana, Institut Universitari Dexeus, Barcelona, España
| | - Belén Ubeda
- Unidad de Diagnóstico Ginecológico por la Imagen, Departamento de Obstetricia, Ginecología y Reproducción Humana, Institut Universitari Dexeus, Barcelona, España
| | - Carmen Ara
- Unidad de Ginecología Oncológica y Mastología, Departamento de Obstetricia, Ginecología y Reproducción Humana, Institut Universitari Dexeus, Barcelona, España
| | - Rafael Fábregas
- Unidad de Ginecología Oncológica y Mastología, Departamento de Obstetricia, Ginecología y Reproducción Humana, Institut Universitari Dexeus, Barcelona, España
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15
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Postpartum diagnosis demonstrates a high risk for metastasis and merits an expanded definition of pregnancy-associated breast cancer. Breast Cancer Res Treat 2013; 138:549-59. [PMID: 23430224 PMCID: PMC3608871 DOI: 10.1007/s10549-013-2437-x] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 01/28/2013] [Indexed: 12/19/2022]
Abstract
Previous studies report conflicting data on outcomes of pregnancy-associated breast cancer (PABC). Our aim was to examine the effect of a postpartum diagnosis on maternal prognosis in a young women's breast cancer cohort. We conducted a retrospective cohort study of women age ≤45 years, diagnosed with breast cancer (n = 619) during 1981-2011 at the University of Colorado Hospital and The Shaw Cancer Center in Edwards, CO. Breast cancer cases were grouped according to time between giving birth and diagnosis: nulliparous (n = 125), pregnant (n = 24), < 5 years postpartum (n = 136), >5-<10 postpartum (n = 130), and ≥10 years postpartum (n = 147), to examine the clinicopathologic features and the risk of distance recurrence and death. Cases diagnosed after pregnancy, but within five-years postpartum, had an approximate three fold increased risk of distant recurrence (HR 2.80, 95 % CI: 1.12-6.57) and death (HR 2.65, 95 % CI: 1.09-6.42) compared to nulliparous cases. Postpartum cases diagnosed within five years of last childbirth demonstrated a higher five-year distant recurrence probability (31.1 %) and a markedly lower five-year overall survival probability (65.8 %) compared to nulliparous cases (14.8 and 98.0 %, respectively). A diagnosis of breast cancer during the first five-years postpartum confers poorer maternal prognoses after adjustment for biologic subtype, stage, and year of diagnosis. We propose that the definition of PABC should include cases diagnosed up to at least five-years postpartum to better delineate the increased risk imparted by a postpartum diagnosis. Based on emerging preclinical and epidemiologic data, we propose that pregnant and postpartum cases be researched as distinct subsets of PABC to clarify the risk imparted by pregnancy and the events subsequent to pregnancy, such as breast involution, on breast cancer. Further, we highlight the importance of postpartum breast cancer as an area for further research to reduce the increased metastatic potential and mortality of PABC.
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16
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Juárez-Moreno K, Erices R, Beltran AS, Stolzenburg S, Cuello-Fredes M, Owen GI, Qian H, Blancafort P. Breaking through an epigenetic wall: re-activation of Oct4 by KRAB-containing designer zinc finger transcription factors. Epigenetics 2013; 8:164-76. [PMID: 23314702 DOI: 10.4161/epi.23503] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The gene Oct4 encodes a transcription factor critical for the maintenance of pluripotency and self-renewal in embryonic stem cells. In addition, improper re-activation of Oct4 contributes to oncogenic processes. Herein, we describe a novel designer zinc finger protein (ZFP) capable of upregulating the endogenous Oct4 promoter in a panel of breast and ovarian cell lines carrying a silenced gene. In some ovarian tumor lines, the ZFP triggered a strong reactivation of Oct4, with levels of expression comparable with exogenous Oct4 cDNA delivery. Surprisingly, the reactivation of Oct4 required a KRAB domain for effective upregulation of the endogenous gene. While KRAB-containing ZFPs are traditionally described as transcriptional repressors, our results suggest that these proteins could, in certain genomic contexts, function as potent activators and, thus, outline an emerging novel function of KRAB-ZFPs. In addition, we document a novel ZFP that could be used for the epigenetic reprograming of cancer cells.
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Affiliation(s)
- Karla Juárez-Moreno
- Department of Pharmacology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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17
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Kumar A, Puri R, Gadgil PV, Jatoi I. Sentinel lymph node biopsy in primary breast cancer: window to management of the axilla. World J Surg 2012; 36:1453-9. [PMID: 22555287 DOI: 10.1007/s00268-012-1635-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In patients with primary breast cancer, several large, randomized prospective trials have shown that sentinel node biopsy (SNB) substantially reduces the morbidity associated with axillary surgery compared with formal axillary lymph node dissection (ALND). Moreover, the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 trial has demonstrated that when the sentinel node reveals no evidence of metastatic disease, then no further ALND is required. Recently, the results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial have challenged the notion that all patients with metastases to the sentinel node require ALND. The results of this trial suggest that in selected sentinel node-positive patients, ALND can be potentially avoided. Yet, some concerns about the ACOSOG Z0011 trial have been raised, and these concerns may have implications in the widespread implementation of the results of this trial. Since the advent of the SNB technology, occult metastases within the sentinel node are frequently observed, and the significance of these findings remains controversial. Finally, this review considers special situations, such as pregnancy and the neoadjuvant setting, where the use of SNB should be applied judiciously. The SNB technology has dramatically improved the quality of life for women with breast cancer, and further modifications of its role in breast cancer treatment should be based on evidence obtained from randomized, controlled trials.
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Affiliation(s)
- Ashwini Kumar
- Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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18
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Autio K, Rassnick KM, Bedford-Guaus SJ. Chemotherapy during pregnancy: a review of the literature. Vet Comp Oncol 2012; 5:61-75. [PMID: 19754790 DOI: 10.1111/j.1476-5829.2006.00119.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although diagnosing cancer during pregnancy is uncommon in veterinary medicine, when it occurs, chemotherapy may represent a reasonable treatment option. A major consideration is that physiological changes associated with pregnancy affect drug pharmacokinetics and complicate correct dosing of chemotherapy agents. Additionally, most antineoplastic drugs are able to cross the placenta thus adversely affecting the foetus. However, favourable outcomes have been observed in human beings when chemotherapy has been administered after organogenesis. Conversely, chemotherapy should be avoided during the early embryonic and organogenesis periods as it might lead to foetal death and/or major malformations.
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Affiliation(s)
- K Autio
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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19
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Buré LA, Azoulay L, Benjamin A, Abenhaim HA. Pregnancy-Associated Breast Cancer: A Review for the Obstetrical Care Provider. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:330-7. [DOI: 10.1016/s1701-2163(16)34850-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Agborsangaya CB, Lehtinen T, Toriola AT, Pukkala E, Surcel HM, Tedeschi R, Lehtinen M. Association between Epstein-Barr virus infection and risk for development of pregnancy-associated breast cancer: joint effect with vitamin D? Eur J Cancer 2011; 47:116-20. [PMID: 20691583 DOI: 10.1016/j.ejca.2010.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 07/05/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have evaluated the role of the ubiquitous Epstein-Barr virus (EBV) infection, together with levels of the immunomodulator, vitamin D, in different breast cancer entities. We studied, prospectively, the association of EBV and vitamin D status with the risk of pregnancy-associated breast cancer (PABC), breast cancer diagnosed during pregnancy or 1 year post-partum, using a nested case-control study. METHODS Serum vitamin D and antibodies to EBV were measured for 108 PABC cases of the Finnish Maternity Cohort, and 208 controls matched for date of birth, date of sampling and parity. The joint effect of vitamin D and EBV on the risk of PABC was evaluated. RESULTS EBV seropositivity was generally not associated with the risk of PABC. Among individuals with sufficient (≥75 nmol/l) levels of vitamin D, we, however, found similar increased risk estimates for PABC associated with serum immunoglobulin G (IgG) antibodies to EBV early antigens [odds ratio (OR)=7.7, 95% (confidence interval) CI 1.4-42.3] and the viral reactivator protein, ZEBRA (OR=7.8, 95% CI 1.1-61.2). CONCLUSION Immunological markers of EBV reactivation status among individuals with sufficient vitamin D levels were consistently associated with increased risk of the disease. This suggests that EBV reactivation may be an indicator of the progression of breast cancer occurring soon after pregnancy, while the virus probably is not the aetiological agent.
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Pruthi S, Haakenson C, Brost BC, Bryant K, Reid JM, Singh R, Netzel B, Boughey JC, Degnim AC. Pharmacokinetics of methylene blue dye for lymphatic mapping in breast cancer—implications for use in pregnancy. Am J Surg 2011; 201:70-5. [DOI: 10.1016/j.amjsurg.2009.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 03/31/2009] [Accepted: 03/31/2009] [Indexed: 10/18/2022]
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22
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Sánchez Martínez MC, Ruiz Simón A. Breast cancer during pregnancy. Breast Cancer Res Treat 2010; 123 Suppl 1:55-8. [DOI: 10.1007/s10549-010-1059-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 07/08/2010] [Indexed: 11/29/2022]
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23
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Azim HA, Peccatori FA. Treatment of Cancer During Pregnancy: The Need for Tailored Strategies. J Clin Oncol 2010; 28:e302-3; author reply e304. [DOI: 10.1200/jco.2010.28.0628] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Abstract
Breast cancer is one of the most commonly diagnosed malignancies during pregnancy. Pregnancy-associated breast cancer (PABC) presents a challenging clinical situation. This article reviews the current evidence around the management of PABC and the safety of pregnancy after breast cancer. The trend towards later age at first childbirth has resulted in an increase in the number of breast cancer cases coexistent with pregnancy. The management of breast cancer during pregnancy requires a multidisciplinary team approach. Breast surgery can be safely performed during any trimester of pregnancy. Radiation therapy, if required, must be delayed until after delivery. The majority of patients with PABC require chemotherapy. The timing of delivery in relation to chemotherapy administration should be carefully considered. There is no evidence to date that pregnancy termination influences overall survival for the mother. To date, there is no clear evidence that subsequent pregnancy after breast cancer is associated with worse maternal survival. There is a suggestion that subsequent pregnancy may in fact be associated with an improved survival. However, the available studies are limited by potential biases.
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Affiliation(s)
- R Sasidharan
- Department of Medical Oncology, Auckland City Hospital , Auckland , New Zealand
| | - V Harvey
- Department of Medical Oncology, Auckland City Hospital , Auckland , New Zealand
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25
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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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26
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Vinatier E, Merlot B, Poncelet E, Collinet P, Vinatier D. Breast cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol 2009; 147:9-14. [PMID: 19773111 DOI: 10.1016/j.ejogrb.2009.06.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 05/28/2009] [Accepted: 06/30/2009] [Indexed: 11/19/2022]
Abstract
Breast cancer in pregnancy is an uncommon situation but poses dilemmas for patients and their physicians. There is a paucity of prospective studies regarding diagnosis and treatment of breast cancer during pregnancy. Women diagnosed with breast cancer during pregnancy have similar disease characteristics to age-matched controls. Current evidence suggests that diagnosis may be carried out with limitations regarding staging. Surgical treatment may be performed as for non-pregnant women. Radiotherapy and endocrine or antibody treatment should be postponed until after delivery. Chemotherapy is allowed after the first trimester. Physicians should be aggressive in the workup of breast symptoms in the pregnant population to expedite diagnosis and allow multidisciplinary treatment without delay.
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Affiliation(s)
- Edouard Vinatier
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandre, 59037 Lille cedex, France
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27
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Sentinel lymph node biopsy in pregnant patients with breast cancer. Eur J Nucl Med Mol Imaging 2009; 37:78-83. [DOI: 10.1007/s00259-009-1217-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
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Lyons TR, Schedin PJ, Borges VF. Pregnancy and breast cancer: when they collide. J Mammary Gland Biol Neoplasia 2009; 14:87-98. [PMID: 19381788 PMCID: PMC2693784 DOI: 10.1007/s10911-009-9119-7] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 04/03/2009] [Indexed: 12/29/2022] Open
Abstract
Women of childbearing age experience an increased breast cancer risk associated with a completed pregnancy. For younger women, this increase in breast cancer risk is transient and within a decade after parturition a cross over effect results in an ultimate protective benefit. The post-partum peak of increased risk is greater in women with advanced maternal age. Further, their lifetime risk for developing breast cancer remains elevated for many years, with the cross over to protection occurring decades later or not at all. Breast cancers diagnosed during pregnancy and within a number of years post-partum are termed pregnancy-associated or PABC. Contrary to popular belief, PABC is not a rare disease and could affect up to 40,000 women in 2009. The collision between pregnancy and breast cancer puts women in a fear-invoking paradox of their own health, their pregnancy, and the outcomes for both. We propose two distinct subtypes of PABC: breast cancer diagnosed during pregnancy and breast cancer diagnosed post-partum. This distinction is important because emerging epidemiologic data highlights worsened outcomes specific to post-partum cases. We reported that post-partum breast involution may be responsible for the increased metastatic potential of post-partum PABC. Increased awareness and detection, rationally aggressive treatment, and enhanced understanding of the mechanisms are imperative steps toward improving the prognosis for PABC. If we determine the mechanisms by which involution promotes metastasis of PABC, the post-partum period can be a window of opportunity for intervention strategies.
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Affiliation(s)
- Traci R. Lyons
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, CO USA
| | - Pepper J. Schedin
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, CO USA
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO USA
- AMC Cancer Research Center, University of Colorado Denver, Aurora, CO USA
| | - Virginia F. Borges
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, CO USA
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO USA
- Division of Medical Oncology, University of Colorado Denver, Mail Stop 8117, RC-1 S, 12801 E. 17th Avenue, UCD, Aurora, CO 80045 USA
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Vinatier E, Merlot B, Poncelet E, Collinet P, Vinatier D. Cancer du sein et grossesse. ACTA ACUST UNITED AC 2009; 37:495-503. [DOI: 10.1016/j.gyobfe.2009.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 03/05/2009] [Indexed: 10/20/2022]
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Abstract
PURPOSE In spite of the general consensus on the issue, to point to major dilemmas which appear in this matter of multidisciplinary interest, and to review current concepts on how to achieve optimal diagnostic and therapeutic outcome. RESULTS Recent literature data show that the rate of gestational breast cancer, according to most protocols, range from 0.2% to 3.8%. By definition, the clinical manifestation of this type of carcinoma is expected to occur during pregnancy or within one year after delivery. The mode of treatment and prognosis is identical to those of women with breast carcinoma beyond pregnancy, except for radiotherapy that is not indicated during pregnancy and selective use of cytostatics in polychemotherapy during the first trimester. The only exceptions to this practice are women with any advanced stage of the disease due to delayed diagnosis. Results of large studies indicate that the therapy for breast cancer has no adversarial effect on the prognosis of subsequent pregnancy. CONCLUSION The evaluation and management of women with gestational breast cancer requires a multidisciplinary approach. A chemotherapeutic regimen should be individualised to a maximum reduction of risk, if applied in the second and third trimester. Surgical therapy may include mastectomy and sparing operative procedures. Sentinel node biopsy should be considered in node negative patients. Radiotherapy should be postponed to the postpartum period.
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Galimberti V, Ciocca M, Leonardi MC, Zanagnolo V, Paola B, Manuela S, Sahium RC, Lazzari R, Gentilini O, Peccatori F, Veronesi U, Orecchia R. Is Electron Beam Intraoperative Radiotherapy (ELIOT) Safe in Pregnant Women with Early Breast Cancer? In Vivo Dosimetry to Assess Fetal Dose. Ann Surg Oncol 2009; 16:100-5. [DOI: 10.1245/s10434-008-0172-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 09/10/2008] [Accepted: 09/10/2008] [Indexed: 11/18/2022]
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Lenhard MS, Bauerfeind I, Untch M. Breast cancer and pregnancy: Challenges of chemotherapy. Crit Rev Oncol Hematol 2008; 67:196-203. [DOI: 10.1016/j.critrevonc.2008.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 02/05/2008] [Accepted: 02/21/2008] [Indexed: 11/17/2022] Open
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Azim HA, Peccatori FA. Treatment of metastatic breast cancer during pregnancy: we need to talk! Breast 2008; 17:426-8. [PMID: 18455398 DOI: 10.1016/j.breast.2008.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 02/22/2008] [Indexed: 11/26/2022] Open
Abstract
Metastatic breast cancer during pregnancy is a challenging situation. The literature yield in this topic is poor given the rarity of the disease. Management strategies should be discussed in a multidisciplinary manner and each case have to be counselled separately and informed about the pros and cons of different treatment options. Here, we report a case of metastatic breast cancer initially diagnosed during pregnancy. We discuss the clinical course and dilemmas governing the management decisions.
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Affiliation(s)
- Hatem A Azim
- Department of Medicine, Division of Haematology Oncology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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35
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Khera SY, Kiluk JV, Hasson DM, Meade TL, Meyers MP, Dupont EL, Berman CG, Cox CE. Pregnancy-Associated Breast Cancer Patients Can Safely Undergo Lymphatic Mapping. Breast J 2008; 14:250-4. [DOI: 10.1111/j.1524-4741.2008.00570.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gentilini O. Breast cancer during pregnancy: epidemiology, surgical treatment, and staging. Recent Results Cancer Res 2008; 178:39-44. [PMID: 18080441 DOI: 10.1007/978-3-540-71274-9_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- O Gentilini
- Breast Surgery, European Institute of Oncology, Milan, Italy
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37
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Martínez-Ramos D, Ferraris C, Greco M, Grosso I, Rudy Conti A. [Breast carcinoma during pregnancy]. Cir Esp 2007; 82:305-7. [PMID: 18021631 DOI: 10.1016/s0009-739x(07)71730-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pregnancy associated breast cancer includes cancers concurrent with pregnancy and those diagnosed up to 1 year after delivery. The incidence of breast carcinoma in pregnancy is estimated to be approximately 1 in 3000 pregnancies. Due to the difficulties of clinical breast examination, diagnosis is frequently delayed and made when the cancer stage has progressed. Consequently, prognosis is usually poor. Treatment options are limited by concern about harming the fetus and depend on gestational age. We present the case of a 34-year-old woman who was diagnosed with cancer of the right breast in the 28th week of gestation. The patient underwent modified radical mastectomy. This association is uncommon but is not exceptional. Knowledge of cases such as that reported herein will allow early diagnosis and improve the prognosis of these patients.
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Affiliation(s)
- David Martínez-Ramos
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón de la Plana, Castellón, España.
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Abstract
Breast cancer is one of the most commonly diagnosed cancers of pregnancy. The diagnostic and therapeutic implications in this population are special. These women typically present with more advanced disease that carries a poorer prognosis. This article highlights patient care in this population, where aggressive care must be modified to ensure fetal protection.
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Affiliation(s)
- Dawn M Barnes
- Department of Surgery, University of Michigan Health System, 1500 East Medical Center Drive, B1-380 Taubman Center/Box 0305, Ann Arbor, MI 48109, USA
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Mondi MM, Cuenca RE, Ollila DW, Stewart JH, Levine EA. Sentinel Lymph Node Biopsy During Pregnancy: Initial Clinical Experience. Ann Surg Oncol 2006; 14:218-21. [PMID: 17066225 DOI: 10.1245/s10434-006-9199-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 07/07/2006] [Accepted: 07/13/2006] [Indexed: 11/18/2022]
Abstract
The diagnosis of breast cancer or melanoma in a pregnant patient presents some unique and difficult challenges for both patients and providers. Lymphatic mapping and sentinel lymph node (SLN) biopsy has become an attractive alternative to elective lymphadenectomy procedures for patients with breast cancer and melanoma. However, there is no data on the safety or utility of sentinel node mapping in pregnant patients. Therefore, we reviewed our experience with mapping in gravid patients. Academic institutions throughout North Carolina were asked to contribute cases of mapping performed during pregnancy. A total of nine women underwent sentinel node mapping during pregnancy. All nine were Caucasian with an average age of 32. SLN were found in all cases and mapping procedures were for breast cancer (three), and melanoma (six). There were no adverse reactions to the SLN procedures and one patient developed a seroma at a biopsy site. All went on to have term deliveries without known adverse effects. This limited experience shows that SLN mapping procedures are feasible in pregnant patients. However, this is not a general endorsement of such procedures in pregnant patients. We suggest that potential risks of vital dye or radioactive tracers be clearly explained to the parents when the mother is a candidate for a mapping procedure, and be balanced against the risk of delaying therapy or omitting nodal staging.
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Affiliation(s)
- Matthew M Mondi
- Surgical Oncology Services, Wake Forest University, Winston-Salem, North Carolina, USA
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Abstract
The physiologic changes of pregnancy and risks to the fetus require attention during dermatologic surgery. Elective surgery should be performed in the second trimester or the postpartum period. Cosmetic work should occur after delivery to avoid hypertrophic or hyperpigmented scars. Skin preparatory agents and anesthetics may have fetal implications and should be chosen with care. Antibiotic selection for any infections must take into account possible maternal and fetal risks. Attention to detail and awareness of the changes in pregnancy should lead to safe surgery in the pregnant patient.
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Affiliation(s)
- Susan M Sweeney
- Division of Dermatology, University of Massachusetts Medical School, and Dermatologic Surgery, University of Massachusetts Memorial Health Care, Worcester, MA 01655, USA.
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Abstract
The status of the axilla is the single most important prognostic indicator of overall survival in patients with breast cancer. Staging is based on tumor size and on the presence of lymph node metastases. The number of lymph nodes, although prognostic, no longer impacts treatment options. Sentinel lymph node (SLN) mapping and dissection is a more sensitive and accurate technique for nodal evaluation and has been applied to staging of axillary lymph nodes in patients with breast cancer, providing prognostic information, with less surgical morbidity than with axillary lymph node dissection (ALND). When analyzed by an experienced pathologist with serial sectioning and immunohistochemical evaluation, SLN is the most accurate detection tool used in staging of breast cancer. In many centers that use these staging principles, ALND is no longer performed for histologically negative axillary SLNs. In addition, this technique may also be therapeutic because in most patients, the SLN is the only positive axillary node. SLN biopsy is justified in women with ductal carcinoma in situ who have a high risk of invasive carcinoma, such as those with large tumors, a mass, or high-grade lesions. SLN biopsy is performed in the setting of neoadjuvant chemotherapy and demonstrates accurate evaluation of the axilla in 90% of the cases. Women with locally advanced breast cancer may derive great benefit from a minimally invasive approach to the axilla because the extent of nodal involvement is unlikely to change further treatment. For clinically palpable nodes, ALND should be performed for therapeutic and local control. The use of sentinel node mapping in pregnancy is controversial. Vital blue dye is contraindicated in pregnant patients, although some have used radioactive colloid alone to map this subgroup of patients.
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Affiliation(s)
- Farin Amersi
- Northwestern University Feinberg School of Medicine, Lynn Sage Comprehensive Breast Center, Galter 13-104, 675 North St. Clair Street, Chicago, IL 60611, USA
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Abstract
This article addresses a challenging diagnostic and treatment dilemma encountered in the care of pregnant women-breast cancer. The treatment of a breast cancer is significantly affected by an ongoing pregnancy and may result in an increased risk for a poor outcome in the mother. The definition, incidence, mechanism, diagnosis, and treatment of breast cancer associated with pregnancy and the normal physiologic and endocrine changes in the breast during pregnancy that contribute to the difficulty encountered by practitioners in diagnosing and treating the disorder are reviewed. The risks associated with pregnancy after breast cancer treatment and the effect of pregnancy on lifetime risk for breast cancer in the general population and for women with mutations in BRCA1 and BRCA2 are also discussed.
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Affiliation(s)
- Kimberly K Leslie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, 2211 Lomas Boulevard NE, ACC-4, Albuquerque, NM 87131, USA
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