Breast Cancer in Pregnancy
Breast cancer diagnosed during pregnancy is relatively rare but management of the patient is challenging to both patient and multidisciplinary team
The cancer is usually aggressive stage when detected during pregnancy or lactation.
Diagnosis and Investigation
- Breast Ultrasound
- US guided core biopsy
Note: Staging with CT scan or PET Ct scan is not recommended due to radiation, which could pose a threat to the unborn child
Treatment NCCN Gguideline
Treatment is different for each stage of pregnancy
First Trimester
- Advice/ Counsel for termination of pregnancy
- Decision to continue pregnancy and make other choices are possible depending on the stage and subtypes of breast cancer.
- Surgery : Total mastectomy and Axillary dissection preferred over lumpectomy as radiation after lumpectomy is not safe during pregnancy.
- Chemotherapy can begin in 2nd trimester if it is necessary.
- Radiation and hormone therapy if needed would be recommended after the baby is born.
Second Trimester
- Surgery wound be safe and recommended in 2nd trimester ie Total mastectomy or lumpectomy and axillary dissection
- Chemotherapy is also relatively safe in 2nd trimester
- Radiation and hormone therapy is recommended after baby is born.
Third Trimester
- Surgery can be offered in early 3rd trimester ie Total mastectomy / Lumpectomy with axillary dissection.
- Chemotherapy can also be offered in early 3rd trimester
- Radiation and Hormone therapy would be better after baby is born.
- However, if diagnosed late 3rd trimester, then most will start treatment after the baby is born.
Issues Concern during Pregnancy
- Multidisciplinary discussion between obstetrician, breast surgeon, oncologist and patient –husband is important for decision making
- Often patient would want to delay all treatment until baby is born. Patient needs to understand the risk depending on the stage and subtypes of breast cancer at time of diagnosis.
- Prognosis and survival of patient is dependent on the stage at diagnosis and subtypes of breast cancer. The prognosis of the women is not adversely affected by pregnancy
- There is no evidence to show increase in congenital malformations or stillbirth in pregnant women who had surgery or chemotherapy.
Breast-Feeding after Breast Cancer Treatment
- There is no increase risk of recurrence in women who wishes to breast-feed after completed breast cancer treatment
- Breast feeding can be offered from the unaffected breasts.