Importance of a Multidisciplinary Approach to Breast Cancer Treatment in Pregnancy: Case Report of New Diagnosis of Pregnancy-Associated Breast Cancer

Grant J,Woessner Hoyson J,Dicarlo C

doi:10.4172/2157-2518.1000279

Abstract

Pregnancy-Associated Breast Cancer (PABC) is a rare diagnosis and includes new diagnoses of cancer both during pregnancy as well as within the first year post-delivery. Due to its rarity, there is of yet no gold standard treatment nor is there a standardized regimen of treatment during pregnancy according to the American College of Obstetrics and Gynecology (ACOG). We report a case involving a 35-year-old gravida 2 para 1-0-0-1 who was diagnosed with clinical stage II (T2 N1) breast cancer in the early third trimester of pregnancy after physical examination revealed a palpable mass. Ultrasound-guided biopsy revealed poorly differentiated infiltrating ductal carcinoma, nuclear grade 3, with micropapillary features, estrogen receptor (ER 90%), progesterone receptor (PR 25%) positive, HER2 positive 3+ with Ki67 index 75%. After extensive counseling and discussion between Obstetrics, Maternal Fetal Medicine, Breast Surgery, Neonatal ICU, and Oncology, a decision was made to initiate neoadjuvant chemotherapy (NAC) with adriamycin and cyclophosphamide. Our patient completed 4 total NAC treatments prior to delivery followed by a regimen of weekly taxol plus herceptin and perjeta postpartum. This patient strongly desired to carry the pregnancy to term and began treatment prior to delivery, making this case unique in comparison to other publications in which treatment was delayed until after delivery, or the pregnancy was terminated prior to beginning treatment. Our case highlights the importance of a multi-disciplinary approach to counseling patients in this unique situation to allow them the autonomy to choose the treatment best for them and their baby.

Highlights

Breast cancer is the second most common malignancy diagnosed during pregnancy after cervical cancer, comprising approximately 0.2%-2.6% of all breast cancers [1,2]
It is imperative that a gold standard of care be adapted by all sub-divisions of the medical community, including Obstetrics and Gynecology given that in the cohort in question, initial diagnosis and work up will be performed by the obstetrician
As of yet there are no definitive regimens of care in the obstetrical guidelines for this growing cohort of patients, and recommendations at this time appear to be to treat each case uniquely taking into account all aspects including gestational age, aggression of disease, patient preference

Summary

Introduction

Breast cancer is the second most common malignancy diagnosed during pregnancy after cervical cancer, comprising approximately 0.2%-2.6% of all breast cancers [1,2]. The diagnosis of breast cancer is a difficult one to discern due to physiologic changes of the breast that occur in pregnancy including hypertrophy, engorgement, nodularity, and discharge. This can result in pregnant women being diagnosed in advanced stages and having poorer prognoses upon diagnosis in comparison to non-pregnant women due to a delay in diagnosis. History was pertinent for early breast cancer in her paternal grandmother She underwent a breast sonogram which revealed a 2.5 × 1.2 × 2.9 cm mass at 9 o’clock position with a 2nd hypoechoic mass located at the 8 o’clock position measuring 1.3 × 1.1 × 1.2 cm. This patient is being evaluated for the possible use of adjuvant radiation therapy prior to starting Lupron and arimidex therapy

Discussion

Conclusion