Diagnosis and treatment of breast cancer during pregnancy: a review of twelve cases

Abstract

Objective To investigate the principles of diagnosis and treatment of breast cancer during pregnancy. Methods Clinical data of twelve patients with breast cancer during pregnancy admitted to Peking Union Medical College Hospital between January 1995 and October 2015 were analyzed retrospectively. Follow-up studies on the prognosis of the mothers and infants and the long-term survival were carried out, and data were analyzed with descriptive statistical analysis. Results Of these twelve patients, eleven were diagnosed with breast cancer preliminarily by ultrasound. In the remaining one who presented with paraneoplastic neurological syndrome, breast tumor was discovered by the whole-body positron emission tomography/computed tomography (PET-CT) examination after emergent cesarean section. The mean gestational age at ultrasonic diagnosis in the eleven patients was (26.3±3.0) weeks, and all of them received surgical treatment during pregnancy. The mean gestational age at surgery was (28.2±4.4) weeks. Ten patients with epithelial tumor underwent modified radical mastectomy. One patient with breast malignant phyllodes tumor received local extended lumpectomy. Postoperative pathological staging revealed one patient with stage Ⅰa, two with stage Ⅱa, one with stage Ⅱb, six with stage Ⅲa, and one with stage Ⅲb. The patient with paraneoplastic neurological syndrome was diagnosed as having stage Ⅳ breast cancer, and received chemotherapy, radiotherapy and endocrinotherapy. One patient received chemotherapy during pregnancy. None of the patients received radiotherapy during pregnancy. All twelve patients, except one with breast malignant phyllodes tumor, received postpartum adjuvant therapy. All patients were followed up regularly. Five patients were followed up for more than five years, the progression-free survival rate was 4/5 and the overall survival was 5/5. The other seven patients were followed up for less than five years, the progression-free survival rate was 6/7 and the overall survival was 7/7. Eleven of the twelve patients had live birth. Eleven cases received cesarean section at (36.5±2.8) gestational weeks, and the other one had mid-trimester induction of labor at 27 gestational weeks. Of four premature infants, three were sent to neonatal intensive care unit because of neonatal respiratory distress syndrome, and one died of intracranial hemorrhage. The prognosis of the ten survived infants was good. Conclusions Breast cancer is one of the most common malignant tumors during pregnancy, and it often presents in more advanced stages compared with that in non-pregnant women. Multidisciplinary cooperation and detailed assessment of maternal-fetal risks and benefits are necessary. Key words: Pregnancy complications, neoplastic; Breast neoplasms; Pregnancy outcome