Breast cancer and pregnancy

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Actuality. Today, the urgency of the problem of breast cancer (breast cancer) can not be said much. The steady increase in the incidence among the female population around the world and the figures are self-evident. In particular, in Ukraine more than 15 thousand new cases of breast cancer are recorded annually. The percentage of breast cancer in pregnant women ranges from 8 to 15% of cases in different countries of Europe.Diagnosis of breast cancer in pregnant women has a number of difficulties in terms of visualization. First of all, it is connected with morphological and structural changes in the breast tissue during pregnancy and lactation. A number of changes in palpation in pregnant and lactating women can be mistakenly regarded by clinicians as tumor formations and, more dangerously, it can happen the other way around when a woman complains of a clear compaction with specific symptoms, and the clinician neglects it and recommends observation without sending it to additional research. Safe and most informative methods of examination are ultrasound of the mammary glands in combination with a biopsy.Treatment of breast cancer in pregnant and lactating women is a rather complex and not fully understood issue.There are three main tactical concepts for the treatment of breast cancer in pregnant women:1) the concept of fetal preservation – is aimed at eliminating any risks to the fetus, treatment of breast cancer is postponed until the natural end of pregnancy;2) the concept of saving the mother – the immediate termination of pregnancy (abortion, cesarean section, removal of the uterus with appendages) and the beginning of breast cancer treatment;3) compromise concept – breast cancer is treated without interruption of pregnancy, as well as in its absence, with the exception of chemotherapy (not performed in the I trimester of pregnancy), radiation therapy , endocrine and targeted therapy (excluded throughout pregnancy).The most justified and taking into account the interests of all parties to date is a compromise concept, on the basis of which it can be said that the presence of breast cancer in the first trimester of pregnancy in the early stages of the disease can be accompanied by a surgical stage of treatment, and the planning of chemotherapy should be transferred to II and III trimesters. If the patient is diagnosed with stage III–IV disease, premature termination of pregnancy with subsequent complex treatment of breast cancer according to generally accepted standards will be optimal. Treatment of pregnant women in the II and III trimesters can be accompanied by both radical surgery and chemotherapy. Conduction of radiation therapy is not recommended at any term of pregnancy and is recommended in the postpartum period.