Total Body PET/MRI as a Gold Standard for Staging Breast Cancer During Pregnancy in a Case Report

Cancer, fertility and pregnancy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

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.

Whole body MRI for systemic staging of breast cancer in pregnant women

Breast cancer and pregnancy is rare. It is defined by the discovery of breast cancer during pregnancy or within one year after delivery. Throughout this study, we analyzed the characteristics of this entity with review of the literature. We report through a retrospective study of breast cancer in pregnant women, a series of 11 cases collected at the oncology department in Sfax between 1994 and 2012. The average age of our patients at diagnosis was 35 years. The average term of pregnancy was 22 weeks. Nine cases were diagnosed during pregnancy. The pregnancy outcome was well with babies in a good health, in 10 cases. The prognosis was excellent with complete remission after a mean follow of 39 months in 7 cases (2years-9years). The diagnosis of breast cancer in pregnant women is often delayed because of physiological changes of pregnancy and the young age which explain the poor prognosis of this entity. The prognosis was excellent in our series compared to the literature.

Introduction: The triple negative breast cancer (TNBC) is an aggressive tumor that associated a high grade of spread and worse prognosis. The treatment differs with clinical stage and patients with BRCA mutation could be beneficiated of treatment with platinium chemotherapy based and PARP inhibitors. We described a challenging clinical case of a BRCA mutated young pregnant patient with TNBC. Case Report: In a December 2021, a 28-year-old female patient, mutated BRCA1, felt a nodule in the right breast. The ultrasound showed a single 2.3cm x 1,8 cm nodule without involvement of the axillary lymph node. A core biopsy showed invasive carcinoma No Special Type (NST), grade II, negatives hormonal receptor, HER2 0 with Ki67 60%. We realized complete staging exams, including central nervous system resonance, which did not reveal distant disease. We did neoadjuvant chemotherapy with Carboplatin and Paclitaxel for 12 weeks because de patient was 17 weeks pregnant. She completed 11 weeks of chemotherapy due to oligohydramnios and we stopped for 3 weeks to monitory pregnancy. Chemotherapy with dose-dense anthracycline and doxorubicin (ddAC) was restarted. After first cycle we paused treatment for childbirth and completed more 3 cycles of ddAC. After 1 month of finalized chemotherapy, she was submitted to mastectomy and linfadenectomy. The pathology revealed an ypT1miypN1a tumor although it was not possible to start adjuvant Olaparib due to healthcare provider issues. This patient lost follow up and returned in April/2023 with Thorax CT showed multiple bilateral nodules in the lung that was biopsied and confirmed as recurrence of triple negative breast cancer. The case was discussed on the tumor board and systemic treatment with chemotherapy and immunotherapy was proposed. PDL1 for CPS was 14. We started Carboplatin, Gemcitabine and Pembrolizumab each 21 days. After 4 cicle we switched carboplatin for cisplatin due grade 3 adverse reaction to infusion. After six cycle of treatment PET-scan showed complete response. Patient presented persistent grade 2 of nauseas a despite of clinical management with antiemetics. We stopped cisplatin after cycle 7 and continue Gemcitabine 1000mg/m2 D1,D8 and Pembrolizumab D1 each 21 days. In this moment, after 12 cycles patient maintain complete response with excellent tolerance to treatment. Citation Format: Leonardo Gil-Santana, Daniela de Almeida Carvalho, Monique Celeste Tavares. Triple negative breast cancer in pregnant women with mutated BRCA [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-08-26.

INTRODUCTION. Breast cancer during pregnancy (BCGA) is a complex condition that requires careful therapeutic approaches to ensure the safety of both mother and fetus. The treatment of BCGA involves ethical and practical dilemmas, since modalities such as chemotherapy, radiotherapy, and hormonal therapy can pose risks to fetal development, especially when administered at certain times of pregnancy. In addition, physiological changes during pregnancy – such as increased mammary vascularization and hormonal changes – can make early diagnosis difficult, resulting in tumors often being identified at more advanced stages. Given this scenario, it is essential to review the available scientific evidence on therapeutic approaches, considering their efficacy, safety, and impact on maternal-fetal outcomes. OBJECTIVES. The main objective of this study is to critically analyze the therapeutic approaches available for the treatment of breast cancer during pregnancy, in light of the current scientific literature. Specifically, the aim is to: describe the epidemiology and risk factors of breast cancer diagnosed during pregnancy; identify the main diagnostic challenges of breast cancer in pregnant women, considering the clinical, radiological and histopathological aspects; review the available therapeutic options (surgery, chemotherapy, radiotherapy, hormonal therapy) and their safety during the different trimesters of pregnancy; analyze the impact of therapeutic interventions on maternal and fetal health, considering risks and benefits; explore international guidelines and consensus on the multidisciplinary management of gestational breast cancer; and evaluate the prognosis and maternal-fetal outcomes associated with the different therapeutic strategies. BACKGROUND. Breast cancer is the most common neoplasm among women of reproductive age and represents approximately 20% of cancer cases diagnosed during pregnancy, the so-called gestational breast cancer (GBC) [Amant et al., 2012]. Although rare, with an estimated incidence of 1 in 3,000 to 10,000 pregnancies, the diagnosis of breast cancer during pregnancy poses significant clinical, ethical, and therapeutic challenges, requiring a delicate balance between maternal oncological treatment and preservation of fetal health [Loibl et al., 2012; Cardonick & Iacobucci, 2004]. Pregnancy modifies breast physiology, which can mask early signs of the disease and delay diagnosis, contributing to detection at more advanced stages [Azim et al., 2010]. In addition, therapeutic management requires complex decisions regarding the type and timing of treatment—such as surgery, chemotherapy, or radiotherapy—considering gestational age and associated teratogenic risks. Despite advances in international guidelines, there are still gaps in knowledge and variations in clinical practice, especially in countries with less access to oncology referral centers. Therefore, critically reviewing therapeutic approaches to breast cancer during pregnancy is essential to contribute to evidence-based medical practice, favor multidisciplinary decision-making and, above all, ensure safer outcomes for mother and fetus. Therefore, this work is justified by the clinical, academic, social and scientific relevance of the topic, while aiming to offer updated subsidies for the ethical and therapeutic management of breast cancer, promoting comprehensive care for pregnant women with cancer. MATERIALS AND METHODS. This is a narrative literature review with a descriptive and qualitative approach, without systematization of the results. For this purpose, national and international online databases were used: Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SCIELO), U.S. National Library of Medicine (PubMed), and Google Scholar. The main objective of the research is to critically analyze the therapeutic approaches available for the treatment of breast cancer during pregnancy, in light of the current scientific literature. RESULTS/DISCUSSION. It is expected that this literature review will identify and systematize the safest and most effective therapeutic approaches for the treatment of breast cancer during pregnancy, considering the different trimesters and stages of the disease. Based on the analysis of the available data, the following trends and conclusions are likely to be observed: Late diagnosis: Most cases of gestational breast cancer tend to be diagnosed at more advanced stages, due to physiological changes in the breast during pregnancy that make early detection difficult; Safety of oncological treatment during pregnancy: The literature should demonstrate that certain treatments, such as surgery and chemotherapy (mainly with anthracyclines), can be performed with relative safety from the second trimester onwards, while radiotherapy and hormonal therapies are usually postponed until the postpartum period; Individualized and multidisciplinary approach: The studies reviewed will probably reinforce the importance of individualized management, carried out by a multidisciplinary team, including an oncologist, obstetrician, neonatologist, psychologist and social worker. With these findings, the research should contribute to the improvement of medical knowledge on the subject, in addition to serving as a basis for medical education, the formulation of clinical protocols and the improvement of the quality of care for pregnant women with cancer. CONCLUSION. Breast cancer during pregnancy, although rare, represents a significant clinical challenge that requires an individualized and multidisciplinary approach. The review showed that treatments such as surgery and chemotherapy with anthracyclines can be safe during pregnancy, especially after the first trimester, while radiotherapy and hormonal therapy should be postponed. The scarcity of national protocols reinforces the need for more studies and guidelines adapted to the Brazilian reality. It is concluded that appropriate management allows for good maternal-fetal outcomes, as long as it is combined with emotional and ethical support for the pregnant woman.

Mammary glands undergo significant physiologic changes during pregnancy and lactation in response to the increase in circulating hormone levels. Ultrasound is the first-line test for palpable breast masses in pregnant or breastfeeding patients. US images of normal breasts may vary depending on terms of pregnancy and duration of lactation. In the first trimester, the breast structure in a pregnant woman may be similar to the nonpregnant state: glandular tissue prevails, with clear granularity and narrow lactiferous ducts. In the second trimester, glandular tissue becomes more thick achieving 25–30 mm, the structure of parenchyma becomes more granular and diffusely hypoechoic due to increase of fat-free fibroglandular component, lactiferous ducts are about 3 mm wide, and vascularization of the parenchyma may be enhanced. At term, a diffuse duct ectasia of various degrees can be noted. During the entire lactation period, parenchyma is hyperechoic with significantly dilated (>3 mm) lactiferous ducts in grayscale images. Hypervascularized parenchyma shows in color imaging. During pregnancy and lactation, the mammary gland is subject to a number of specific changes, which can lead to the appearance of certain disorders, including benign changes that are associated with physiological changes in the body during pregnancy/lactation: inflammatory and infectious changes, juvenile papillomatosis, benign tumors, and malignant tumors. Specific features of breast cancer associated with pregnancy are usually aggressive in course, late diagnosis, and poor prognosis. The primary diagnosis, clinical stage, and extent of breast cancer in pregnant women in 85% are based on US findings.

Objective: Breast cancer (BC) is the most frequent cancer disease in women. An increasing number of women are delaying childbearing and diagnosis of BC during pregnancy is more and more frequent. We analyzed clinical and fetal outcome of BC treatment during pregnancy.

We analyzed the clinicopathologic characteristics and prognosis of pregnancy-associated breast cancer (PABC) according to clinical subtypes to better understand the characteristics of PABC. A total of 83,792 female patients between the ages of 20 and 49 were enrolled in the Korean Breast Cancer Society Registry database from January 1, 1996 to December 31, 2015. 'PABC' is defined as breast cancer diagnosed during pregnancy or within 1year after delivery. Other patients were defined as 'non-PABC' patients. In non-PABC patients, luminal A subtype was the most common (50.2%). In PABC patients, TNBC was the most common (40.4%) subtype, while luminal A comprised 21.2% and HER2 subtype comprised 17.3%. There was a significant difference in overall survival (OS). In non-PABC patients, TNBC had the highest HR (HR 2.3, 95% CI 2.1-2.6). In PABC patients, the luminal B subtype (HR+ HER2-high Ki67) had the highest HR at 7.0 (95% CI 1.7-29.1). In multivariate analysis of OS by subtypes, PABC patients had significantly higher HR than non-PABC patients in the HER2 subtype (HR 2.0, 95% CI 1.1-3.7) and luminal B subtype (HR+ HER2-high Ki67) (HR 4.4, 95% CI 1.6-12.3). PABC showed different biologic features than non-PABC. PABC had a particularly poor prognosis in the luminal B (HR+ HER2-highKi67) and HER2 subtypes. To improve the prognosis of PABC, treatment should be considered according to subtype. Development of drugs that can be used during pregnancy is needed.

Breast cancer is rare in young women, with an increase in incidence in the fourth and fifth decades. A trend is to defer childbearing to later in life. The issues...

BACKGROUND Pregnancy-associated breast cancer (PABC), although most commonly defined as breast cancer diagnosed during pregnancy or within one year following delivery, knows a variety of definitions, likely related to the diversity of reported clinicopathological features and prognosis. More insight into the different breast cancer subgroups during pregnancy, the time after delivery and the postpartum period is therefore warranted. METHODS Patients with breast cancer diagnosed during pregnancy or within six months after delivery between January 1, 1988 and July 1, 2019, were included. Pregnant patients were subdivided according to gestational trimester, and postpartum patients according to lactational status. To investigate the influence of pregnancy and lactation on the histopathologic profile, these subgroups were compared to non-PABC patients matched for age at diagnosis, year at diagnosis, grade and ER status. Pearson Chi-square tests were used to compare clinicopathologic characteristics, while Kaplan-Meier/logrank/Cox regression methods were used to perform overall survival (OS) analysis. RESULTS Overall, 662 PABC patients were included, of which 73.6% were diagnosed during pregnancy. Median age at diagnosis was 34 years, with a median follow-up of 6.5 years. Overall, PABC patients as a group showed an advanced stage at diagnosis and an inferior OS at 5-years (75.4% vs. 83.2%, p = 0.000) compared to 1,392 non-PABC patients. In subgroup analysis, PABC patients within their first trimester showed a significantly lower tumor size and stage as compared to other trimesters. Patients diagnosed during the first trimester and postpartum non-lactating patients had a relatively good OS (81.3% and 77.9%, respectively) versus patients diagnosed during the second and third trimesters and during lactation (OS 60.0%, 64.9% and 65.6%, respectively, p = 0.003). In multivariate Cox regression, trimester of diagnosis, year of diagnosis, PR status, stage at diagnosis and surgery-or-not were significant contributors to OS. CONCLUSION In this large PABC cohort, uniquely specified by gestational trimester, an inferior outcome was found for patients diagnosed within the second and third gestational trimesters and during postpartum lactation, compared to first trimester and non-lactating postpartum patients. These findings indicate that PABC is clinically a heterogeneous group of breast cancer patients that should be redefined based on trimester of diagnosis and postpartum lactational status. Citation Format: Britt BM Suelmann, Carsten FJ Bakhuis, Carmen van Dooijeweert, Janneke Verloop, Ronald P Zweemer, Sabine C Linn, Elsken van der Wall, Paul J van Diest. Prognosis of pregnancy-associated breast cancer: Inferior outcome in patients diagnosed during second and third gestational trimesters and lactation [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-06.

Background: Pregnancy-associated breast cancer (PABC) poses a unique challenge as hormonal changes occurring in pregnancy potentially interact with breast cancer outcomes. However, reports on prognosis of PABC have been rare and inconsistent, and most of these studies were from Western countries with only few from Asia. We investigated the outcome of PABC linking a large hospital-based database and the nationwide claims database of Korea. Patients and methods: We retrospectively studied a cohort of 3687 female patients of reproductive age (<50 years old) who had undergone surgery for breast cancer at Seoul National University Hospital from 2008 to 2015. Data on stage distribution and tumor characteristics were reviewed from the institutional database, and history of delivery or abortion from the nationwide claims database of Korea for comprehensive identification. Breast cancer during pregnancy was defined as delivery within 9 months of the diagnosis of breast cancer, and postpartum breast cancer as breast cancer diagnosis within 12 months of delivery, with both being counted as PABC. Results: Among 3687 patients, 18 and 45 patients were classified as having breast cancer during pregnancy and postpartum breast cancer, respectively, comprising 63 cases of PABC. Patients with PABC were significantly more likely to have advanced stage and/or hormone receptor negative tumor, and be younger than 35 years old at diagnosis of breast cancer than those without it (P value for T stage, .0001; N stage, .0011; ER negativity, <.0001; PR negativity, <.0001; age at breast cancer diagnosis <35, <.0001). Similar distribution pattern of clinical characteristics was observed with postpartum breast cancer compared to their counterparts (P value for T stage, <.0001; N stage, .0001; M stage, .0421; ER negativity, <.0001; PR negativity, <.0001; age at breast cancer diagnosis <35, <.0001), whereas these characteristics were comparable between patients with and without breast cancer during pregnancy. PABC and postpartum breast cancer were seemingly associated with worse survival with univariate hazard ratio (HR) of 4.53 (95% confidence interval, CI, 2.53-8.13; P value <.0001) and 5.34 (95% CI, 2.91-9.82; P value <.0001), multivariate HR of 1.52 (95% CI, .82-2.83; P value .1841) and 1.57 (95% CI, .82-2.99; P value .1708), respectively. Breast cancer during pregnancy was not associated with worse survival. Conclusions: PABC and postpartum breast cancer tended to be associated with higher stage, hormone receptor negativity, and thus worse survival, but breast cancer during pregnancy had no adverse effect on survival in patients with breast cancer. Note: This abstract was not presented at the meeting. Citation Format: Mihong Choi, Jiyeon Han, Bo Ram Yang, Myoung-jin Jang, Miso Kim, Tae-Yong Kim, Seock-Ah Im, Han-Byoel Lee, Hyeong-Gon Moon, Wonshik Han, Dong-Young Noh, Kyung-Hun Lee. Pregnancy and breast cancer outcomes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4914.

Objective: This study aimed to understand the therapeutic approaches recommended for pregnant women with breast cancer (BC). Methodology: This narrative review used PubMed, Scielo, and Virtual Health Library as databases, with the descriptors: “breast cancer,” “Pregnant woman at risk,” and “Therapeutic indication.” Results: BC is considered a risk factor during pregnancy when the diagnosis occurs during or after 1 year of pregnancy. At this stage, there is greater vascularization and density of the breast parenchyma, intensified during the lactation period. These physiological changes in the pregnancy cycle make early diagnosis by mammography difficult and, consequently, lead to a higher frequency of cases of breast CA in advanced stages. Infiltrating ductal carcinoma corresponds to the majority of BCs in pregnant women; for this, the most indicated treatment, in most cases, is surgery. However, radiotherapy is contraindicated, as chemotherapy is only used in the second and third trimesters of pregnancy. The survival of pregnant women with breast CA and non-pregnant women presents little difference, but the clinical control of the patient must be multidisciplinary with an obstetrician, oncologist, nutritionist, and psychologist to confirm both the state and the gestational time, which are necessary for safe therapeutic decisions for mother and fetus. Conclusion: Therapeutic strategies bring several benefits in the treatment of BC in pregnant women, especially infants. Furthermore, it is important to highlight the importance of the multidisciplinary team in the treatment of BC, taking into account the benefits and risks presented for each patient; therefore, the assessment must be analyzed and individualized for each patient and the specificity of BC, all with the aim of the best treatment of the mother, ensuring the benefits of her relationship with her child and ensuring a healthy and safe motherhood.

Background. Gestational breast cancer (GBC) is also known as pregnancy-associated breast cancer and it comprises all the breast cancers (BCs) which are diagnosed either during pregnancy or in the first year after delivery or during the lactation period. At present it has been confirmed that the breast malignancies are the most common forms of cancer in pregnant women with a constant increase in its incidence because of the continuous postpone in childbearing especially in women older than 40 years. However, when diagnosed during the pregnancy, the treatment modalities of the BC are complex and difficult to establish as it must be considered the impact of the treatment both on the child and the course of pregnancy. Purpose. Using an online search on Pubmed, our aim was to make a review of the treatment possibilities of a pregnant woman presenting a breast malignant tumor. We have concentrated our paper on the surgical treatment and the possibility of an oncoplastic reconstruction types, the facts of radiotherapy during pregnancy and the prognosis of the GBC particularly in women who opt to continue the pregnancy. A resume of the epidemiology of GBG is also presented. Method. The following key words have been on Pubmed introduced: ,,breast cancer’’, ,,pregnancy’’, ,,staging”, ,,chemotherapy” and ,,radiotherapy”. As mentioned above, we have tried to select the BC cases diagnosed and treated during pregnancy for which the decision of the patient was to continue the pregnancy in spite of the diagnosis. We further aimed to present the prognosis of the pregnancy-associated BC, namely the pregnancy and fetal outcome, and to investigate if the decision to terminate the pregnancy is associated with a survival benefit. Conclusion. The surgical treatment of pregnancy-associated BC does not differ from that of non-pregnancy BC. Axillary LN-dissection is permitted while the data on the safety of sentinel-LN are still poor. Elective termination of the pregnancy has no impact on the overall survival of the patient.

Pregnancy-associated breast cancer (PABC) is a rare cancer. This study aimed to determine the survival probabilities and prognostic factors in patients with PABC. A retrospective cohort study was conducted in two tertiary care hospitals in Kota Bharu. We included all patients with breast cancer who were diagnosed by histopathology while pregnant or within 2 years post-partum from 2001 through 2020. We matched patients with PABC to non-pregnant patients with breast cancer by age and year of diagnosis. The data were analyzed using Cox proportional hazard regression. A total of 35 cases of PABC and 70 non-PABC controls were recruited. The 3-year, 5-year, and 10-year survival probabilities for patients with PABC were 58.6%, 47.54%, and 38.03%, respectively. The patients with PABC had a non-significant difference in survival probabilities compared with non-PABC patients. The significant prognostic factors of PABC were age (adjusted hazard ratio [aHR], 0.91; 95% confidence interval [CI], 0.86-0.96; P=0.001), advanced stage of cancer (aHR, 9.97; 95% CI, 3.96-25.2; P<0.001), and no surgery (aHR, 3.16; 95% CI, 1.01-9.85; P=0.047). Pregnancy was not found to be an independent factor in the prognosis of PABC (aHR, 0.72; 95% CI, 0.39-1.28; P=0.266). Women diagnosed with PABC had similar survival probabilities compared with non-PABC patients. Pregnancy was not an independent prognostic factor for breast cancer. This information can be useful when women with breast cancer are counseled and supported with the option of beginning treatment with pregnancy continuation.