Full‐term delivery in a pregnant breast cancer patient

Abstract

Dear Sir, We read with great interest the article by Asgeirsson (1), who reviewed pregnancy-associated breast cancer and suggested that early management may have a similar outcome to that in non-pregnant breast cancer patients, without damage to the fetuses as well. We recently treated a 32-year-old woman, gravida 1, para 0, diagnosed by ultrasound with high-grade invasive ductal carcinoma of the breast following a core needle biopsy in her 22nd week of pregnancy. After discussion with her oncologist, general surgeon and obstetrician, she decided to receive standard treatment during pregnancy. She underwent a quadrantectomy of the breast and axillary lymph-node dissection in her second trimester. Four courses of adjuvant chemotherapy were given for her stage IIA disease. During this period, her antenatal examinations were normal. A healthy male infant was born by vaginal delivery at 39 weeks of gestation. As breast masses found during pregnancy are often thought to be normal changes, delayed diagnosis is not uncommon. Early awareness is helpful for improved outcome. Ultrasound is the first-line screening technique, although core biopsy remains the gold standard method in the diagnosis of breast cancer. For pregnant women with breast cancer, termination of the pregnancy may be their first thought before starting treatment. There is no significant increase in the survival rate among patients who elect to terminate their pregnancies before their breast cancer is treated (83%), those who experience a spontaneous abortion and those who continue their pregnancies (85%) (2). Those patients should be treated like non-pregnant breast cancer patients, in whom surgery is the first choice. The physiological changes during pregnancy make general anesthesia in pregnant women an important and complicated issue. Under careful evaluation, pregnant women have undergone breast and axillary surgery without increased surgical or obstetric complications (3). In terms of the importance of adjuvant or neoadjuvant chemotherapy, the physiological changes in pregnancy may alter the optimal dose of chemotherapy, or may increase the risk of maternal and fetal toxicity. Hahn et al. indicated that no intrauterine fetal deaths, miscarriages or perinatal deaths occurred among pregnant women who underwent 5-fluorouracil, doxorubicin and cyclophosphamide (FAC) chemotherapy during their second or third trimester (4). Neonates exposed to FAC chemotherapy in the uterus have birthweights in percentiles similar to those of the general population and no increased congenital abnormalities (2). Regardless of whether breast cancer is diagnosed in pregnant or non-pregnant women, similar survival is observed for matched stages. Precious experience and evidence encourage physicians and pregnant women to make confident decisions of optimal treatment, better prognosis and childbearing wishes.