Prognosis Of Pregnancy-associated Breast Cancer Research Articles

Survival probabilities and prognostic factors of pregnancy-associated breast cancer in Malaysian women.

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.

Pregnancy-associated breast malignancy mostly presents with an aggressive type of breast cancer

Published reports on the prognosis of pregnancy-associated breast cancer are controversial. This study aims to determine the histopathological features of pregnancy-associated breast carcinoma (PABC) and the outcomes of patients with breast cancer during pregnancy and lactation among Turkish women. The study retrospectively analyzed 29 patients diagnosed with pregnancy-associated breast malignancies who underwent surgery between January 1989 and March 2021. Demographic and pathological data were obtained to evaluate the clinicopathological and prognostic characteristics of the patients. The median age was 36 years (range: 26–42 years). Of the 29 patients with breast cancer, 13 (44.8%) were diagnosed during pregnancy, and the remaining 16 (55.2%) were diagnosed during lactation. Most patients had clinical tumor stage (cT) cT2–3 (n = 20, 69%) disease, and 15 patients had clinically node (cN)-positive disease (N1 and N2, 51.7%). The majority (n = 19, 65.5%) had invasive ductal carcinoma with high Ki-67 scores (&gt;20%). Patients with lactation-associated breast cancer were more likely to have a family history of breast cancer (44% vs. 8%, p = 0.04) than those with pregnancy-associated breast cancer. Notably, symptom duration ≥6 months and presenting with cT3–4 or cN(+) disease were associated with poor disease-free and disease-specific survival. However, no difference could be found in outcome among patients with pregnancy- and lactation-associated breast cancer. PABC mostly presents with aggressive tumor molecular subtypes with high Ki-67 scores and more advanced stages associated with poor outcome, possibly due to delayed diagnosis. Therefore, prompt early diagnosis and awareness of this disease might improve survival.

Clinicopathologic features, treatment, and prognosis of pregnancy-associated breast cancer.

To identify the clinicopathological features, treatment, and prognosis of patients with breast cancer, who were diagnosed during and after pregnancy. We searched for patients with pregnancy-associated breast cancer (PABC) using the big data query and analysis system of Peking Union Medical College Hospital from between January 1, 2013, and December 31, 2021, and matched each patient with two non-PABC patients by age at diagnosis, year at diagnosis, and tumor stage. The clinicopathologic features, treatment, and outcomes of breast cancer during pregnancy (BC-P) and breast cancer during the first-year post-partum (BC-PP) were examined retrospectively in two case-control studies. Eighteen BC-P cases, 36 controls for BC-P cases, 62 BC-PP cases, and 124 controls for BC-PP cases were enrolled in our study. The expression of HER-2 and Ki-67 was higher in BC-PP cases than in its controls (P=0.01, 0.018, respectively). Patients with BC-PP were more likely to choose mastectomy than breast-conserving surgery (P=0.001). There were no significant differences in event-free survival (EFS) between patients with BC-P and BC-PP and their controls. BC-P and BC-PP patients displayed adverse clinicopathological features in our population. However, when matched by age at diagnosis, year of diagnosis, and tumor stage, BC-P and BC-PP patients did not show inferior outcomes to controls, probably due to aggressive multimodality therapy.

Survival of women with pregnancy-associated breast cancer according to clinical characteristics: A propensity score matching study.

In recent years, postponing childbearing has increased the prevalence of pregnancy-associated breast cancer (PABC). PABC has a poorer prognosis than breast cancer not associated with pregnancy (non-PABC) due to delayed diagnosis and aggressive subtype. Additionally, pregnancy itself predicts a poor prognosis; but, this is a subject of debate. Thus, we analyzed the effects of known prognostic factors and pregnancy on the prognosis of PABC. We retrospectively analyzed women aged 20 to 49 years who were diagnosed with breast cancer (BC) between 1989 and 2014. Patients were distributed into PABC and non-PABC groups, and 1:4 propensity score matching was performed to adjust for baseline characteristics. Primary endpoints were overall survival (OS) and BC-specific survival (BCSS). Secondary endpoint was the difference in prognosis according to BC subtype. Of the 34,970 recruited patients with BC, 410 (1.2%) had PABC. Patients with PABC were younger and tended to have triple-negative BC (TNBC) subtype than non-PABC patients. The 1640 matched non-PABC patients showed a significantly worse mean survival rate than the unmatched non-PABC patients. Patients with PABC had a significantly worse OS and BCSS than those with non-PABC. In multivariate analyses, patients with PABC of luminal B (Ki-67 ≥14.0%) and TNBC subtypes had worse OS and BCSS than patients with non-PABC. Patients with PABC had poorer prognosis than non-PABC patients after adjusting for several prognostic factors. This difference was particularly significant in patients with the luminal B and TNBC subtypes.

Distinctive gene expression patterns in pregnancy-associated breast cancer.

Pregnancy-associated breast cancer (PABC) is diagnosed during pregnancy or within 1 year postpartum, but the unique aspects of its etiology and pathogenesis have not been fully elucidated. This study aimed to ascertain the molecular mechanisms of PABC to facilitate diagnosis and therapeutic development. The Limma package was used to characterize the differentially expressed genes in PABC as compared to non-pregnancy-associated breast cancer (NPABC) and normal breast tissue. A total of 871 dysregulated genes were identified in the PABC versus NPABC groups and 917 in the PABC versus normal groups, with notable differences in the expression of MAGE and CXCL family genes. The dysregulated genes between the PABC and normal groups were mainly associated with signal transduction and immune response, while Kyoto Encyclopedia of Genes and Genomes analysis revealed that the dysregulated genes were enriched in immune-related pathways, including the major histocompatibility complex (MHC) class II protein complex, the type I interferon signaling pathway, regulation of α-β T-cell proliferation, and the T-cell apoptotic process. Through protein-protein interaction network construction, CD44 and BRCA1 were identified as prominent hub genes with differential expression in PABC versus NPABC. Furthermore, a cluster with eleven hub genes was identified in PABC versus normal adjacent tissues, of which the expression of EGFR, IGF1, PTGS2, FGF1, CAV1, and PLCB1 were verified to be differentially expressed in an independent cohort of PABC patients. Notably, IGF1, PTGS2, and FGF1 were demonstrated to be significantly related to patient prognosis. Our study reveals a distinctive gene expression pattern in PABC and suggests that IGF1, PTGS2, and FGF1 might serve as biomarkers for diagnosis and prognosis of PABC.

Abstract P3-12-06: Prognosis of pregnancy-associated breast cancer: Inferior outcome in patients diagnosed during second and third gestational trimesters and lactation

Abstract 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.

Prognosis of pregnancy-associated breast cancer: inferior outcome in patients diagnosed during second and third gestational trimesters and lactation.

Pregnancy-associated breast cancer, although most commonly defined as breast cancer diagnosed during pregnancy or ≤1year 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, time after delivery and the postpartum period is therefore warranted. Patients with breast cancer diagnosed during pregnancy or ≤6months postdelivery were included, and subdivided according to gestational trimester, and postpartum patients according to lactational status. Subgroups were compared to matched non-PABC patients, to investigate the influence of pregnancy and lactation on clinical course and outcome. Overall, 662 PABC patients were included (median age 34years, median follow-up 6.5years). PABC patients showed an advanced stage at diagnosis and an inferior 5-years-OS (75.4% vs. 83.2%, p = 0.000) compared to 1392 matched non-PABC patients. In subgroup analysis, first trimester PABC patients 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 this large (uniquely specified) PABC cohort, an inferior outcome was found for patients diagnosed within the second and third gestational trimesters and during lactation. These findings indicate that PABC is clinically a heterogeneous group of breast cancer patients that should be redefined based on trimester of diagnosis and lactational status.

Clinicopathological features and prognosis of patients with pregnancy-associated breast cancer: A matched case control study.

AimWe aimed to clarify tumor features and prognosis of pregnancy‐associated breast cancer (PABC) among Chinese women.MethodsPABC was defined as breast cancer diagnosed during pregnancy or within a year after delivery. Patients with PABC were selected from breast cancer cases of women ≤45 years treated at our institution between December 2012 and December 2017, and one non‐PABC control was matched for stage, age, and year of diagnosis for each case.ResultsForty‐one women with PABC were identified (22 diagnosed during pregnancy and 19 within 1 year of delivery). There were significantly more progesterone receptor (PR)‐ and triple‐negative tumors in the PABC (56.1% and 24.4%, respectively) than in the non‐PABC group (31.7% and 4.9%, respectively) (P = .045 and .026, respectively). Human epidermal growth factor receptor 2 positivity was the same in both groups (31.7%). Median disease‐free survival (DFS) was 29.0 months (95% confidence interval [CI], 6.5‐51.5 months) in the PABC and 40.9 months (95% CI, 22.8‐58.8 months) in the non‐PABC group (P = .167). Median overall survival (OS) was 82.8 months in the PABC (95% CI, 39.3‐126.5 months) versus 80.1 months (95% CI, 56.7‐103.6 months) in the non‐PABC group (P = .131).ConclusionHistological features were similar in both groups, except that PR‐ and triple‐negative tumors were more frequent in the PABC group. Survival analyses show similar OS for patients with PABC and non‐PABC. DFS tended to be shorter in the PABC group; however, this difference was not statistically significant.

Prognosis of pregnancy-associated breast cancer: a meta-analysis

BackgroundPregnancy-associated breast cancer (PABC) is defined as breast cancer that is diagnosed during pregnancy and/or the postpartum period. Definitions of the duration of the postpartum period have been controversial, and this variability may lead to diverse results regarding prognosis. Moreover, evidence on the dose-response association between the time from the last pregnancy to breast cancer diagnosis and overall mortality has not been synthesized.MethodsWe systematically searched PubMed, Embase, and the Cochrane Library for observational studies on the prognosis of PABC published up to June 1, 2019. We estimated summary-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs). Subgroup analyses based on diagnosis time, PABC definition, geographic region, year of publication and estimation procedure for HR were performed. Additionally, dose-response analysis was conducted by using the variance weighted least-squares regression (VWLS) trend estimation.ResultsA total of 54 articles (76 studies) were included in our study. PABC was associated with poor prognosis for overall survival (OS), disease-free survival (DFS) and cause-specific survival (CSS), and the pooled HRs with 95% CIs were 1.45 (1.30–1.63), 1.39 (1.25–1.54) and 1.40 (1.17–1.68), respectively. The corresponding reference category was non-PABC patients. According to subgroup analyses, the varied definition of PABC led to diverse results. The dose-response analysis indicated a nonlinear association between the time from the last delivery to breast cancer diagnosis and the HR of overall mortality (P < 0.001). Compared to nulliparous women, the mortality was almost 60% higher in women with PABC diagnosed at 12 months after the last delivery (HR = 1.59, 95% CI 1.30–1.82), and the mortality was not significantly different at 70 months after the last delivery (HR = 1.14, 95% CI 0.99–1.25). This finding suggests that the definition of PABC should be extended to include patients diagnosed up to approximately 6 years postpartum (70 months after the last delivery) to capture the increased risk.ConclusionThis meta-analysis suggests that PABC is associated with poor prognosis, and the definition of PABC should be extended to include patients diagnosed up to approximately 6 years postpartum.

Clinical Presentation, Diagnosis and Prognosis of Pregnancy-Associated Breast Cancer.

Breast cancer in pregnancy is a rare entity generally presenting as a persistent breast mass, but is often a delayed finding due to the expected physiologic changes in the breast related to pregnancy and lactation. The preferred diagnostic workup of a persistent breast mass involves a combination of mammographic and ultrasonographic evaluation in addition to tissue diagnosis via core biopsy ; breast MRI is not recommended. Surgical excision should be reserved for definitive treatment in order to minimize fetal exposure to anesthesia. Evaluation for distant metastatic spread can be performed using radiographs and ultrasound to limit fetal radiation exposure . Similar to the non-pregnant patient, prognosis is primarily driven by tumor biology, however, there is limited and conflicting data regarding the impact of pregnancy on breast cancer outcomes with a distinct difference in survival among patients with breast cancer during pregnancy compared to those diagnosed postpartum.

Abstract 4914: Pregnancy and breast cancer outcomes

Abstract 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 (&amp;lt;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, &amp;lt;.0001; PR negativity, &amp;lt;.0001; age at breast cancer diagnosis &amp;lt;35, &amp;lt;.0001). Similar distribution pattern of clinical characteristics was observed with postpartum breast cancer compared to their counterparts (P value for T stage, &amp;lt;.0001; N stage, .0001; M stage, .0421; ER negativity, &amp;lt;.0001; PR negativity, &amp;lt;.0001; age at breast cancer diagnosis &amp;lt;35, &amp;lt;.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 &amp;lt;.0001) and 5.34 (95% CI, 2.91-9.82; P value &amp;lt;.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.

Identification of core genes and clinical roles in pregnancy-associated breast cancer based on integrated analysis of different microarray profile datasets

More women are delaying child-birth. Thus, the diagnosis of pregnancy-associated breast cancer (PABC) will continue to increase. The aim of this study was to identify core candidate genes of PABC, and the relevance of the genes on the prognosis of PABC. GSE31192 and GSE53031 microarray profile datasets were downloaded from the Gene Expression Omnibus database and differentially expressed genes were analyzed using the R package and GEO2R tool. Then, Gene Ontology and Kyoto Encyclopedia of Gene and Genome pathway enrichment analyses were performed using the Database for Annotation, Visualization, and Integrated Discovery. Moreover, the Search Tool for the Retrieval of Interacting Genes and the Molecular Complex Detection Cytoscape software plug-in were utilized to visualize protein–protein interactions and to screen candidate genes. A total of 239 DEGs were identified in PABC, including 101 up-regulated genes mainly enriched in fatty acid activation and the fibroblast growth factor signaling pathway, while 138 down-regulated genes particularly involved in activation of DNA fragmentation factor and apoptosis-induced DNA fragmentation. Fourteen hub genes with a high degree of connectivity were selected, including CREB1, ARF3, UBA5, SIAH1, KLHL3, HECTD1, MMP9, TRIM69, MEX3C, ASB6, UBE2Q2, FBXO22, EIF4A3, and PXN. Overall survival (OS) analysis of core candidate genes was performed using the Gene Expression Profiling Interactive Analysis and UALCAN websites. High ASB6 expression was associated with worse OS of PABC patients. Molecular subtypes and menopause status were also associated with worse OS for PABC patients. In conclusion, ASB6 could be a potential predictor and therapeutic target in patient with PABC.

Incidence and prognosis of pregnancy-associated breast cancer: time-trends study from the nationwide Korean breast cancer registry database

Purpose: Pregnancy-associated breast cancer (PABC) is rare, and its cause and prognosis are not well known. In addition, treatment is limited in relation to the risk to the fetus. The purpose of this study was to investigate the incidence and characteristics of PABC and the changes of survival rate according to treatment.

Clinical subtypes and prognosis of pregnancy-associated breast cancer: results from the Korean Breast Cancer Society Registry database.

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.

Clinical Characteristics and Prognosis of Pregnancy-Associated Breast Cancer: Poor Survival of Luminal B Subtype

Background: Pregnancy-associated breast cancer (PABC) is rare and is generally defined as breast cancer diagnosed during pregnancy or within 1 year of delivery. The average ages of marriage and childbearing are increasing, and PABC is expected to also increase. This study is intended to increase understanding of the characteristics of PABC. Methods: A database of 2,810 patients with breast cancer diagnosed when they were less than 40 years of age was reviewed. The clinicopathological factors and survival of PABC (40 patients) were compared to those of patients with young breast cancer (YBC, non-pregnant or over 12 months after delivery; 2,770 patients). Results: PABC had significantly lower estrogen receptor (ER) and progesterone receptor (PR) expression (ER-positive 50.0%, PR-positive 45.0%) and higher HER2 overexpression (38.5%) than YBC. The most common subtype of PABC was triple-negative breast cancer (TNBC; 35.9%), and luminal A subtype represented only 7.7% of cases. In univariate analysis, PABC had significantly worse disease-free survival (DFS) and breast cancer-specific survival (BCSS) compared to YBC. In multivariate analysis, PABC was associated with worse BCSS (HR 4.0, 95% CI 1.2–12.9, p = 0.019) and survival, but there was no difference in DFS between PABC and YBC. In subgroup analysis by subtype, luminal B subtype of PABC showed worse DFS (HR 3.5; 95% CI 1.1–11.2, p = 0.039) and BCSS (HR 10.2, 95% CI 1.2–87.1, p = 0.035), especially with high Ki67. However, no differences were demonstrated in other subtypes. Conclusion: In this study, PABC showed lower expression of ER/PR, higher overexpression of HER2, fewer luminal A subtype, and more TNBC subtype compared to YBC. PABC had worse BCSS, especially luminal B subtype, compared to YBC.

Breast cancer and Fertility Part 2- Pregnancy Associated Breast Cancer

Pregnancy-associated breast cancer (PABC) refers to breast cancer (BC) diagnosed during pregnancy or within the first postpartum year. The increasing incidence follows the increase in age at first childbirth. Diagnostic delay due to physiological breast changes of pregnancy leads to the tumor being diagnosed at a more advanced stage. Since the termination of pregnancy does not alter the course of disease, patients can be offered BC management during pregnancy with a good outcome. Chemotherapy (CT) can be given safely during the second and third trimester of pregnancy. In the first trimester, the option of surgery is available while during puerperium, radiotherapy can be safely administered in addition to CT. Prognosis is related to the stage and grade of the tumor. Neonatal outcomes are reassuring. This article gives an overview of the diagnosis, management, and prognosis of PABC.

Neoadjuvant Chemotherapy and Prognosis of Pregnancy-Associated Breast Cancer: A Time-Trends Study of the Korean Breast Cancer Registry Database.

PurposePregnancy-associated breast cancer (PABC) is rare, and its cause and prognosis are not well known. Additionally, treatment is limited with respect to the risk to the fetus. The purpose of this study was to investigate the characteristics and treatment trends of PABC and the survival rate according to the treatment.MethodsIn the Korean Breast Cancer Society Registry database, women younger than 50 years and who were diagnosed with breast cancer from 1996 to 2015 were included. PABC was defined as breast cancer diagnosed during pregnancy or within 1 year after delivery.ResultsWe examined 411 patients with PABC and 83,381 patients with non-PABC. Over time, the proportions of patients undergoing breast-conserving surgery and sentinel lymph node biopsy increased, and neoadjuvant chemotherapy and radiation therapy administration rates also increased. In the past, the overall survival of patients with PABC was poorer than that of patients with non-PABC, but there was no difference in overall survival rates in more recent years. There was no difference in overall survival rates between patients who received neoadjuvant chemotherapy (hazard ratio [HR], 1.28; 95% confidence interval [CI], 0.66–2.49; p=0.459), but PABC conferred poorer prognosis than non-PABC in patients receiving adjuvant chemotherapy (HR, 1.63; 95% CI, 1.27–2.08; p<0.001).ConclusionThere was no difference in the prognosis between patients with PABC and those with non-PABC receiving neoadjuvant chemotherapy. The increase in neoadjuvant chemotherapy according to current treatment guidelines is expected to improve the survival rate of patients with PABC.

Prognosis of pregnancy-associated breast cancer.

Conventionally, breast cancer diagnosed during pregnancy and within the years following have been referred to collectively as pregnancy-associated breast cancer. However, increasing evidence suggests that breast cancer diagnosed during pregnancy is a different entity from that diagnosed postpartum, both in terms of prognosis and biology. Given the increasing number of women who find themselves diagnosed with breast cancer during or following a pregnancy, future research and discussion should separate these two into distinct groups: breast cancer diagnosed during pregnancy and breast cancer diagnosed postpartum in an effort to enhance our understanding to inform and improve clinical management and counseling.

Pregnancy-associated Breast Cancer.

Breast cancer is one of the most common malignancies affecting pregnancy. Pregnancy-associated breast cancer refers to breast cancer that is diagnosed during pregnancy or within the first postpartum year. The incidence is increasing as more women delay childbearing. Breast cancer can be safely diagnosed, staged, and treated during pregnancy while protecting the fetus and mother with excellent outcomes for both. Avoiding diagnostic delays is vital to prognosis. This article provides an overview of the diagnosis, staging, management, and prognosis of pregnancy-associated breast cancer. Relevant current literature is reviewed.

Cancers du sein associés à la grossesse

The occurrence of pregnancy-associated breast cancer (PABC) is rare but increasing. Its management is challenging: to treat the patient without compromising fetal prognosis. Usually, PABC is diagnosed at a more advanced stage compared to non-pregnant patients of the same age. The diagnostic approach should fit with the recommendations for nonpregnant women except CT scan or isotopic exploration, which are performed only if absolutely necessary. Similarly, the therapeutic management should be close to guidelines: surgical treatment and sentinel lymph node procedure (without blue patent), chemotherapy beyond the first trimester, and radiotherapy during the 1st and 2nd trimesters. Targeted therapy and hormonal therapy are not recommended during pregnancy. After this treatment, the prognosis of PABC is comparable to nonpregnant patients with similar clinical, histological, and radiological characteristics.