Pregnancy-associated Breast Cancer Research Articles

Breast diseases and breast cancer screening in pregnant and puerperals in şanlıurfa province

Objective: Pregnancy-associated breast cancer is breast cancer that occurs during pregnancy or within 1 year after birth. It occurs in one out of 3000-10000 pregnancies and is the most common cancer occurring during pregnancy and the postpartum period. It was aimed to reveal the incidence of pregnancy-associated breast cancer in pregnant and lactating patients in a city with high fertility rates.
 Methods; Patients who presented with breast pain and palpable mass in the breast in the first year of pregnancy and lactation between December 2018 and November 2020 were prospectively recorded. 314 patients were included in the study.
 Results; The mean age of the patients was 28.7 ± 6.1 years. 258 (82.1%) of the patients were Turkish and 56 (17.8%) were Syrian nationals. The most common complaints were pain in the breast, palpable mass, redness, and breast swelling. A palpable mass in the breast was detected in 39 (12.4%) patients. As a result of the examinations and tests performed in both patients, a diagnosis of malignancy was made.
 Conclusion; Breast cancer risk increases in pregnant and breastfeeding patients. To reduce the incidence of breast cancer, it is important to perform a breast examination by a physician before or at the beginning of pregnancy and breast self-examination. From the moment of diagnosis, general surgery, obstetrics and oncology clinics should be followed with a multidisciplinary approach

Radiologic and Pathologic Correlation for Lactating Adenomas.

Lactating adenomas are benign breast lesions that occur in pregnant, lactating, and postpartum women. These lesions have no associated malignant potential; their origin is disputed with no consensus on whether they represent hyperplastic or neoplastic processes. On ultrasound, lactating adenomas are classically described as solid, circumscribed, parallel masses with iso/hypoechoic internal echotexture and posterior enhancement. Histologically, lactating adenomas appear as circumscribed nodules of tightly packed lobular acini with extensive lactational change during pregnancy or the postpartum period. Masses in pregnant and lactating women with probably benign imaging characteristics-oval, circumscribed, parallel, iso/hypoechoic-can be managed with short interval follow-up (BI-RADS 3) rather than biopsy. However, lactating adenomas can also demonstrate characteristics that overlap with pregnancy-associated breast cancer, such as margins that are not circumscribed, prompting biopsy to exclude pregnancy-associated carcinoma. Breast imaging radiologists must be aware of the variable appearances of lactating adenomas to appropriately manage pregnant and lactating women presenting with palpable lumps.

Formulation effects on paclitaxel transfer and uptake in the human placenta

Diagnosis and treatment of breast cancer in pregnancy can result in morbidity and mortality for the mother and fetus. Many new paclitaxel nanoformulations commercially available worldwide for breast cancer treatment are being adopted due to favorable dosing regimens and side effect profiles, but their transplacental transport and resultant fetal exposure remain unknown. Here, we examine three formulations: Taxol (paclitaxel dissolved in Kolliphor EL and ethanol); Abraxane (albumin nanoparticle); and Genexol-PM (polymeric micelle). In the ex vivo dually perfused human placental cotyledon, placental accumulation of Genexol-PM is higher than Taxol, and both nanoformulations have lower maternal concentrations of paclitaxel over time. In vitro studies of these formulations and fluorescent nanoparticle analogs demonstrate that Genexol-PM allows paclitaxel to overcome P-glycoprotein efflux, but Abraxane behaves as a free drug formulation. We anticipate that these findings will impact future development of rational and safe treatment strategies for pregnancy-associated breast cancer and other diseases.

Pregnancy Associated Breast Cancer: An Institutional Review from a Dedicated Cancer Hospital of Pakistan

Introduction Breast cancer during pregnancy or diagnosed during lactation or 1 year after delivery comes under Pregnancy associated breast cancer (PABC). PABC are diagnosed in age ranging from 32-38 years. It has been noted that PABC is associated with larger tumors and higher incidence of lymph nodes metastases at presentation. Methodology It is a retrospective analysis of PABC patients presented at our hospital in year 2020. All patients with PABC are included while Non-PABC and male breast cancer are excluded. Calculations were performed with Statistical Package for the Social Sciences (SPSS Ver20) for Windows. The study is in compliance with the SKMCH&RC guidelines on research involving human subjects. Results A total of 899 patients presented with breast cancer at SKMCH in the year 2020. Of these patients, 41 patients (4.56%) had PABC. Mean age at presentation was 33.76 (range 24-41). Except for one patient, all the patients presented with palpable lump in breast. Seven patients (17%) had metastases at the time of presentation. Triple negative disease was observed in 16 patients (39%). We identified only one histological subtype among all patients i.e. invasive ductal carcinoma (IDC), however, five patients (12.2%) had a component of ductal carcinoma in situ along with IDC. More than half of the patient had advanced T stage i.e. 56.1%. Neo-adjuvant chemotherapy was offered in 31 patients (75.6%). 18 patients underwent breast conservation surgery, and 14 patients had mastectomy for the management of disease. Conclusion PABC is not very common tumor but it is an aggressive one with unfavorable histological and immunophenotypic characteristics. If any abnormality is noted for more than 2 months, patient should consult a specialist breast surgeon.

Long-term Outcomes of Pregnancy-Associated Breast Cancer: A Single Institution Experience

Background: The incidence of pregnancy-associated breast cancer (PABC) is increasing, especially in the developed countries. Herein, we report the long-term outcomes of PABC from a single institution in an Arab country. Methods: Consecutive patients diagnosed to have PABC between 2005 and 2012 at a tertiary referral hospital from a Gulf cooperation council country were the subjects of the study. Long-term outcomes are reported, with a minimum follow-up of 8 years. Results: A total of 16 patients were evaluable for long-term survival analysis. The median age at the time of diagnosis was 31.5 (26-40) years. Nine (56%) patients were multiparous (> 5 previous pregnancies). The mean gestational age at diagnosis was 19.7±7.4 weeks. Immunohistochemistry revealed the following phenotypes: Luminal A 3 (18.8%); HER-2 enriched 8 (50%); triple-negative 5 (31.2%). Three patients underwent modified radical mastectomy as the initial treatment, of which 2 received adjuvant chemotherapy during pregnancy. For patients who received neoadjuvant or palliative chemotherapy, the response rate was 75% (pCR 2; CR 1; PR 6). After a median follow-up of 60 months, median progression-free survival was 36 months (95%CI 24.2 to 47.8), while the overall survival was 59 months (95%CI 31.6 – 86.4). Age, marker status, Ki-67 score, clinical stage and differentiation grade did not affect the PFS or OS on univariate analysis. Conclusions: Fifty percent of the patient with PABC expressed HER-2/neu protein, and 1/3rd had triple-negative disease. The rate of response to chemotherapy, and long-term survival may help to set a benchmark for studies from the region. Larger cohort studies may help to draw firm conclusions.

Breast cancer and pregnancy: about 15 cases collected at the maternity center Monastir, Tunisia

Le but de cette étude était de décrire les caractéristiques cliniques, radiologiques, histologiques et thérapeutiques du cancer du sein diagnostiqué au cours de la grossesse. Nous avons effectué la revue de tous les cancers du sein diagnostiqués au cours de la grossesse dans le centre Maternité et de Néonatologie de Monastir -Tunisie, sur une période allant de 2004 à 2019. Nous avons ainsi colligé 15 cas. L'âge moyen des patientes était de 34 ans. La plupart des cancers du sein associés à la grossesse (CSAG) était diagnostiquée en post-partum. Le carcinome canalaire infiltrant était le type histologique majeur (93% de cas), un cas rare de carcinome sécrétoire a été observé. Le stade clinique était dominé par les formes T2 et T4. Les récepteurs hormonaux étaient négatifs dans 40% des cas, le récepteur HER2 était positif dans 26,6% des cas. Le traitement incluait la chirurgie, radiothérapie, chimiothérapie et palliative. La moyenne de survie est de 32,2 mois. Le cancer du sein associé à la grossesse est une entité rare. Son pronostic est globalement mauvais en raison de l'âge jeune de survenue et d´un diagnostic souvent tardif. La décision thérapeutique constitue une contrainte difficile, par nécessité, multidisciplinaire à laquelle participera la patiente. La thérapie ciblée reste le grand espoir des nouvelles thérapies.

Ductal Carcinoma In Situ in Pregnant Women.

Breast cancer is the second most common malignancy affecting pregnant women. Ductal carcinoma in situ (DCIS) during pregnancy has not been well described with limited literature addressing the optimal treatment options. This is important topic as the incidence of pregnancy-associated breast cancer (PABC) has been increasing. In the United States, 1 in 3000 pregnancies are complicated by breast cancer diagnosis. Most DCIS are screen detected as most patients are asymptomatic. Since routine screening mammogram is not recommended during pregnancy, diagnosis of DCIS without invasive disease is uncommon diagnosis. Although PABC is reported to account for 0.2-3.8% of all newly diagnosed breast cancer, it has not been defined between the diagnosis of DCIS or invasive breast cancer making true incidence of DCIS in pregnancy difficult to report. This review summarizes multidisciplinary recommendations for optimal treatment for DCIS diagnosed during pregnancy.

Pregnancy Associated Breast Cancer with Preferential Lactation to the Affected Breast

Pregnancy Associated Breast Cancer with Preferential Lactation to the Affected Breast

Pregnancy-associated breast cancer after fertility treatment

The incidence of pregnancy-associated cancer is on the rise. A 36-year-old lady married for three years underwent IVF for mild male factor infertility following the failure of conception with six cycles of ovulation induction and three cycles of IUI. She conceived spontaneously two months after the frozen embryo transfer cycle. She was diagnosed to have breast cancer at 32 weeks of pregnancy. Her records did not show findings of breast examination during the antenatal visits. She was advised to take chemotherapy, but she refused because of the fear of effects on the fetus and underwent LSCS at 35 weeks. An alive female baby with a weight of 2.5 kg was born. Postoperatively, she was managed with neoadjuvant chemotherapy and was referred for mastectomy. Counseling for chemotherapy should involve treating obstetrician in addition to the oncologists.

Is It Possible to Personalize the Diagnosis and Treatment of Breast Cancer during Pregnancy?

The main goal of precision medicine in patients with breast cancer is to tailor the treatment according to the particular genetic makeup and the genetic changes in the cancer cells. Breast cancer occurring during pregnancy (BCP) is a complex and difficult clinical problem. Although it is not very common, both maternal and fetal outcome must be always considered when planning treatment. Pregnancy represents a significant barrier to the implementation of personalized treatment for breast cancer. Tailoring therapy mainly takes into account the stage of pregnancy, the subtype of cancer, the stage of cancer, and the patient’s preference. Results of the treatment of breast cancer in pregnancy are as yet not very satisfactory because of often delayed diagnosis, and it usually has an unfavorable outcome. Treatment of patients with pregnancy-associated breast cancer should be centralized. Centralization may result in increased experience in diagnosis and treatment and accumulated data may help us to optimize the treatment approaches, modify general treatment recommendations, and improve the survival and quality of life of the patients.

Lactating Adenoma Co-Existing with High Grade Invasive Ductal Carcinoma; Collision Tumour or Mere Co-Incidence

Background: Lactating adenoma are benign lesions that can presents as a solitary or multiple freely movable breast mass during pregnancy or puerperium. The lesion is actually a localized focus of hyperplasia in the lactating breast, which may also develop in ectopic locations such as the axilla, chest wall, or vulva. Breast cancer developing during pregnancy or puerperium is known as pregnancy associated breast cancer. We report a case of lactating adenoma co-existing with high grade invasive ductal carcinoma in young patient in puerperium with a positive family history of breast cancer. We present a 19-year-old female with a palpable mass on her right upper outer quadrant of her right breast measuring 5x4x2cm with ipsilateral supraclavicular lymph node enlargement. Cytomorphology of the lesion showed tumour cells arranged in nests and solid sheets with abundant fibromyxoid stroma. Also seen are abnormal mitosis and areas of lymphovascular invasion. Proliferating glands are seen lined by cuboidal cells with cytoplasmic vacuolations. Immunohistochemical stain show tumour cells were triple negative (negative for progesterone receptor (PR), estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) and strongly positive for EMA in both tumours. Conclusion: This study indicated that lactating adenoma can co-exist with high grade invasive ductal carcinoma in a young patient in puerperium. The fact that this patient has a positive family history of breast cancer in first degree relative may explain the presentation at a very young age. It may be very difficult to ascertain whether this is a collision tumour or a mere co-incidence of lactating adenoma with breast cancer in this patient.

Prognosis of HER2-positive pregnancy-associated breast cancer: Analysis from the French CALG (Cancer Associé à La Grossesse) network

IntroductionThe prevalence of pregnancy-associated breast cancer is increasing. HER2-positive breast cancers typically have a poor prognosis. The objective of our study was to compare the prognosis of patients with HER2-positive breast cancer diagnosed during pregnancy (HER2-positive BCP) to young women diagnosed with HER2-positive breast cancer outside of pregnancy (HER2 non-BCP). MethodsData of patients managed for invasive breast carcinoma between January 2005 and 2020 were retrospectively collected from the database of Tenon University Hospital (Paris, France), part of the “Cancer lié à la Grossesse” network. ResultsFifty-one patients with HER2-positive BCP were matched on age at diagnosis with 51 HER2-positive non-BCP patients. Locally advanced disease with axillary lymph node involvement were frequent. Tumors were frequently aggressive with high grade (p = 0.57) and high Ki67 (p = 0.15). Among the HER2-positive BCP patients, the mean term at diagnosis was 19.3 week of gestation (WG). Eighty-four percent of the patients continued their pregnancy with a mean term at delivery of 34.2WG. Chemotherapy modalities differed between the two groups: neoadjuvant chemotherapy was more frequent in the HER2-positive BCP group (p = 0.03) and adjuvant chemotherapy more frequent in the HER2 non-BCP group (p = 0.009). The recurrence rate was 10% (n = 5) and 18% (n = 9) in the HER2-positive BCP and HER2 non-BCP groups, respectively, p = 0.25. Breast cancer-free survival was poorer in the HER2-positive BCP group with earlier recurrence, p = 0.008. No difference in type of recurrence was found between the groups (p = 0.58). ConclusionThis matched case-control study implies that patients with HER2-positive BCP still have a poorer prognosis than non-pregnant HER-positive patients.

Real-World Data Analysis of Pregnancy-Associated Breast Cancer at a Tertiary-Level Hospital in Romania

Background and objectives: Breast cancer is among the most common cancer types encountered during pregnancy. Here, we aimed to describe the characteristics, management, and outcomes of women with pregnancy-associated breast cancer at a tertiary-level hospital in Romania. Material and Methods: We retrospectively and prospectively collected demographic, oncological, and obstetrical data for women diagnosed with cancer during pregnancy, and who elected to continue their pregnancy, between June 2012 and June 2020. Complete data were obtained regarding family and personal medical history and risks factors, cancer diagnosis and staging, clinical and pathological features (including histology and immunohistochemistry), multimodal cancer treatment, pregnancy management (fetal ultrasounds, childbirth, and postpartum data), and infant development and clinical evolution up to 2020. Cancer therapy was administered following national guidelines and institutional protocols and regimens developed for non-pregnant patients, including surgery and chemotherapy, while avoiding radiotherapy during pregnancy. Results: At diagnosis, 16.67% of patients were in an advanced/metastatic stage, while 75% were in early operable stages. However, the latter patients underwent neoadjuvant chemotherapy rather than up-front surgery due to aggressive tumor biology (triple negative, multifocal, or HER2+). No patient achieved complete pathological remission, but only one patient relapsed. No recurrence was recorded within 12 months among early-stage patients. Conclusions: In this contemporary assessment of real-world treatment patterns and outcomes among patients with pregnancy-associated breast cancer, our findings were generally consistent with globally observed treatment outcomes, underscoring the need for a multidisciplinary team and reference centers.

Pregnancy-associated breast cancer

Pregnancy-associated breast cancer

Investigation of the Knowledge and Behaviors of Breast Cancer Early Diagnosis Methods and Risk factors in Pregnant Women

Objective: To investigate the knowledge and behaviors of breast cancer early diagnosis methods and risk factors in pregnant women Material and methods: The study has a descriptive, cross-sectional design. Data collection was performed by using a questionnaire created by the researcher in light of the literature. Data were collected in State Hospital between October and December in 2018. The study population included all pregnant women presenting to hospital and experiencing their second and third trimesters at the time of data collection. The study sample involved 194 pregnant women accepting to participate in the study. Results: Age at the first pregnancy was 30 years or older in 4.5% of the women, 13.6% of the women had not given birth before and 8.8% of the women had a familial history of breast cancer. Thirty-two point five percent of the women heard about breast self-examination before pregnancy and 61.3% of the women did not perform breast self-examination before pregnancy. During pregnancy, 74.7% women did not perform breast self-examination and 95.9% of the patients did not have clinical breast examinations. Conclusion: Evaluation of risk factors, performing clinical breast examination and ultrasound in the first prenatal follow-up visit will help early diagnosis of breast cancer. Informing pregnant women about breast self-examination to raise their awareness about pregnancy associated breast cancer.

Pregnancy-Associated Breast Cancer: What Radiologists Must Know.

Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy, in the first year postpartum, or during breastfeeding. Imaging techniques play a significant role in the diagnosis of PABC. It is a challenging diagnosis since physiological changes seen in pregnancy and breastfeeding may limit clinical suspicion and imaging utility. The patient's well-being and the fetus must be taken into consideration for diagnosis and treatment.

252P Survival outcomes of BRCA carriers with pregnancy-associated breast cancer (PABC)

252P Survival outcomes of BRCA carriers with pregnancy-associated breast cancer (PABC)

Pregnancy-associated Breast Cancer and Other Breast Disease: A Radiologic Review

Pregnancy-associated Breast Cancer and Other Breast Disease: A Radiologic Review

216P The impact of pregnancy-associated breast cancer (PABC) according to immunohistochemical (IHC) subtype: A matched case-control study

216P The impact of pregnancy-associated breast cancer (PABC) according to immunohistochemical (IHC) subtype: A matched case-control study

243P UK experience of the management of pregnancy associated breast cancer: A national retrospective review of practice

243P UK experience of the management of pregnancy associated breast cancer: A national retrospective review of practice