Treatment Of Pregnancy-associated Breast Cancer Research Articles

Outcome of Patients with Pregnancy-Associated Breast Cancer Who Have Subsequent Pregnancies

BackgroundAfter treatment of pregnancy-associated breast cancer (PABC), some women desire future pregnancy. While safety of pregnancy after breast cancer has been demonstrated, the same cannot be said about women with PABC.ObjectiveThe aim of this study was to describe the incidence and outcomes of patients with PABC with subsequent pregnancies compared with those without another pregnancy.MethodsA retrospective chart review identified patients diagnosed with breast cancer during pregnancy or within 5 years postpartum between 2011 and 2023. Patients were then screened for further pregnancy. Clinicopathologic variables, oncologic outcomes, and pregnancy outcomes were recorded. The Chi-square test and t-test were used to compare patients with subsequent pregnancy with those without. Kaplan–Meier method and log-rank test were used to estimate 5-year disease-free survival (DFS).ResultsOverall, 75 patients with PABC were identified, 58 of whom had PABC and no further pregnancies (NSP-PABC) and 17 with subsequent pregnancy (SP-PABC). Compared with patients with NSP-PABC, patients with SP-PABC were significantly younger (p = 0.015) and less likely to have prior pregnancies (p < 0.001). Overall median follow-up was 4.3 years. Calculated 5-year DFS rates were 86.2% and 89.0% for the SP-PABC and NSP-PABC groups, respectively (p = 0.76). Calculated 5-year overall survival was 100% and 90.7% for the SP-PABC and NSP-PABC groups, respectively (p = 0.22). Within the SP-PABC group, 14/17 patients had successful deliveries.ConclusionsThis study provides the first descriptions of patients with PABC and subsequent pregnancy. Additional investigation, likely with pooled analysis from multiple institutions, is necessary to determine the oncologic and obstetric safety of pregnancy following PABC.

Exclusion of pregnant and lactating persons from breast cancer clinical trials: a review of active trials registered on ClinicalTrials.gov.

Treatment of pregnancy-associated breast cancer is complex, as providers try to balance risks to the pregnant person and the developing fetus. Given increased case fatality and increasing incidence, there is a pressing need understand the efficacy and safety of different treatment regimens in this population; however, pregnant and lactating people have traditionally been excluded from participating in randomized controlled trials (RCTs). Given recent efforts to expand the inclusion criteria for oncology RCTs, this study aimed to review the inclusion/exclusion criteria of current breast cancer RCTs to assess what proportion of trials permitted enrollment of pregnant and lactating persons. We conducted a comprehensive search of ClinicalTrials.gov in January 2022 to identify interventional studies of breast cancer in adults that were actively recruiting. The primary outcomes were the exclusion of pregnant and lactating people. The search identified 1706 studies, of which 1451 met eligibility criteria. Overall, 69.4% and 54.8% of studies excluded pregnant and lactating people, respectively. The exclusion of pregnant and lactating persons differed by study characteristics but extended across all trial designs, locations, phases and interventions. Exclusion of pregnant and lactating persons was most common in trials where the intervention was biological (86.3%), drug (83.5%) or radiation (81.5%). The exclusion of pregnant and lactating people from clinical trials contributes to evidence gaps in how to treat this population. A paradigm shift is needed that focuses on how research can be used to protect pregnant people from future harms, instead of protecting pregnant people from research-related risks.

Experience of personalized management of patients with breast cancer associated with pregnancy

The clinical case of a patient with pregnancy-associated breast cancer observed in Sverdlovsk Regional Oncological Dispensary was analyzed. The information obtained from the electronic map of obstetric database and the medical history of oncological dispensary regarding the results of clinical examination as well as the data of instrumental and laboratory research were used. The tactics of managing this patient was discussed at the Regional Obstetric and Interdisciplinary Consultation with the participation of oncologists; a compromise concept was chosen, which implies surgical treatment of malignant neoplasms followed by chemotherapy during pregnancy and early delivery at the term when a child is viable 34 weeks of pregnancy. At present, preference is given to personalized tactics of pregnancy management and treatment of pregnancy-associated breast cancer using an interdisciplinary approach with the participation of medical specialists: obstetrician-gynecologist, oncologist-surgeon, oncologist-chemotherapist, radiotherapist, anesthesiologist-resuscitator, neonatologist, pathologist. The described clinical case demonstrates successful implementation of this approach, as evidenced by the favourable outcome of childbirth as well as the absence of recurrence and progression of the tumor process in dynamics.

Treatment of Pregnancy-Associated Breast Cancer

Pregnancy-associated breast cancer (PABC) is the most common malignancy diagnosed in women of childbearing age and is increasing in frequency as the average age of pregnancy rises. Outcomes for PABC are similar to age- and stage-matched controls. In this review, we discuss current treatment recommendations for PABC. Treatment of PABC involves complex coordination by a multi-disciplinary team of providers including surgical, radiation, and medical specialists. The timing and administration of these therapies must be tailored to account for the pregnancy in order to keep both woman and fetus safe. Additional data is needed on the safety of newer breast cancer therapies during pregnancy. With close oversight, breast cancer therapy can be delivered effectively for the patient and safely for the developing fetus.

Pregnancy-associated breast cancer - diagnosis, treatment and outcomes for women and their offspring

Introduction: Pregnancy-associated breast cancer (PABC) is the most common malignancy in pregnant women with an incidence of 1 in 3-10 thousand pregnancies. It is mostly defined as breast cancer diagnosed during pregnancy or within 1 year postpartum. The number of PABCs is going to raise due to the trend of delaying childbearing. Purpose: This review summarizes data on the occurrence and characteristics of PABC. The analysis comprises diagnosis and proper treatment of BC during pregnancy. Prognosis of women and their offspring are emphasized. Material and methods: The review is based on publications mainly from 2010 to 2019 and 5 articles from 1994-2008 collected on the PubMed. Results: The sensitivity of breast ultrasonography (USG) in pregnancy is 70-100% and it is considered as safe for the fetus. Staging evaluation in pregnant women consists of chest x-ray, liver USG and non-contrast bone MRI. 71-88% of PABCs are invasive ductal carcinomas. Treatment consists of breast surgery regardless of time and optionally, chemotherapy from the 2nd trimester. Radiotherapy, tamoxifen and trastuzumab are contraindicated in PABC. Therapeutic abortion does not improve oncological outcome. Overall prognosis is similar for both pregnant and non-pregnant patients with similar type and stage of BC. The rate of congenital malformations is 1,3% for both children of PABC patients treated with chemotherapy and born from women without chemotherapeutic treatment. The most frequent obstetrical complication of PABC treatment is preterm delivery. Conclusions: Pregnancy does not impact oncologic outcome, if the treatment is appropriate. PABC patients have survival rates consistent with the stage of disease. Proper treatment of PABC does not increase the risk of congenital malformations and is relatively safe for the fetus.

Treatment of Pregnancy-Associated Breast Cancer.

KS is a 33-year-old Caucasian married woman who works full time as an accountant and has one daughter who is 2 years old. She enjoys reading and exercising in her spare time. She initially presented in July 2015 at the age of 31 years with a 1-cm breast mass in the left inner breast, which prompted a mammogram to be obtained. The mammogram revealed diffuse and occasionally grouped left breast calcifications. Additionally, there was focal edema at the site of the mass.A follow-up mammogram was recommended to document stability in 6 months, which demonstrated an interval increase in number and size of segmental pleomorphic calcifications in the lower inner breast spanning 6 cm in size. A stereotactic core needle biopsy was completed and revealed high-grade ductal carcinoma in situ (DCIS) that was estrogen receptor (ER) and progesterone receptor (PR) positive.Surgical TreatmentKS underwent genetic testing due to her young age at diagnosis of noninvasive breast cancer. She was tested with the breast/ovarian cancer panel, which was negative for mutation.She preceded to bilateral nipple-sparing mastectomy with left sentinel node biopsy and immediate implant reconstruction in February 2016. The operative pathology revealed 3.3 cm of high-grade DCIS. The surgical margins were negative (less than 1 mm posteriorly and less than 2 mm anteriorly). There was 1 sentinel node and 2 nonsentinel nodes negative for malignancy. The right breast was negative for cancer and both retro areolar margins were negative.KS did well during the ensuing routine follow-up every 6 to 12 months in surgical oncology at an academic medical center. She was not recommended to take adjuvant endocrine therapy given the benefit of bilateral mastectomy.In 2017, at a routine oncology follow-up visit, she expressed a desire to have more children. After a negative clinical exam, she and her husband were advised that future contraception may be pursued.Pregnancy-Associated Breast Cancer DiagnosisKS was in her usual state of good health when she noticed a left breast mass in the inferior reconstructed breast in June 2017. She presented to the nurse practitioner (NP) in the surgical oncology clinic for evaluation. At that time, she was 17 weeks pregnant and being seen in the same facility for high-risk obstetrics and gynecology care. KS had no other concerning symptoms for recurrent cancer, and her pregnancy had been progressing smoothly.The surgical oncology NP noted a 1-cm firm superficial mass in the breast at 6 o’clock. She had no other bilateral breast findings or adenopathy. Upon review of systems, she denied new persistent headache, shortness of breath, abdominal pain, weight loss, night sweats, or fatigue.Due to her pregnancy and the superficial presentation of the breast mass, a left breast ultrasound was ordered. It revealed an 8-mm irregular hypoechoic mass 7 cm from the nipple at the 6 o’clock position in the reconstructed breast.A diagnostic workup ensued with a left breast ultrasound-guided core needle biopsy. KS was given a diagnosis of clinical stage T1b, N0, grade 2 invasive micropapillary carcinoma: ER positive (Allred 6), PR positive (Allred 8), HER2/neu, immunohistochemistry 3+, and fluorescence in situ hybridization amplified.After discussion of this recurrent cancer diagnosis, her team opted for a bilateral diagnostic mammogram (with abdominal shielding) and bilateral axillary and breast ultrasound to evaluate the contralateral breast and lymph nodes. There was no adenopathy, a small amount of accessory breast tissue in the right axillary tail region, and a biopsy clip was noted in the left inferior breast at 6 o’clock. The new cancer was not seen on mammogram, likely due to the proximity to the implant.

Diagnosis and Management of Metastatic Breast Cancer During Pregnancy by a Multidisciplinary Team: A Case Report

Background: When breast cancer is diagnosed during pregnancy or within the first year after delivery, the condition is named as pregnancy-associated breast cancer (PABC). Breast cancer during pregnancy is a devastating situation for the patient, her family, and the medical team. Providing guidance for diagnosis and treatment of PABC, we report a case along with review of the literature.Case presentation: Here we present a 31-year-old pregnant woman with low back pain who was referred to the gynecology ward. She was at 25 weeks and 6 days pregnancy. After workup, it was discovered that she had a lytic lesion in her spine. Further workup revealed that she had metastatic breast cancer with the pathology of invasive ductal carcinoma. After consultation with a multidisciplinary team (a gynecologist, an oncologist, a radiotherapist, a hematologist-oncologist, and a neurosurgeon), we terminated the pregnancy and put her on radiotherapy for the spine metastasis and systemic therapy. Also, we reviewed 36 pregnant patients with primary or recurrent breast cancer who were managed with outpatient chemotherapy, surgery, or surgery plus radiation therapy. Care was provided by medical oncologists, breast surgeons, and perinatal obstetricians. Conclusion: Since there are no sufficient data in the literature to guide the development of standard protocols for management of PABC patients (specially in metastatic disease), pregnant women must be followed up by a multidisciplinary team, and each case should be managed considering the gestational age and the stage of cancer.

A One-center Study of Sixteen Patients with Pregnancy-associated Breast Cancer: Clinicopathological Characteristics and Survival

Aim: Cancer treatment is of special importance during pregnancy, concerning the health of both mother and baby. Treatment of pregnancy-associated breast cancer (PABC) has become even more important today because women tend to delay pregnancy to later ages and because of women who desire to conceive while under treatment for breast cancer. This retrospective study is aimed at investigating the clinical, radiological and histopathological characteristics and PABC treatment outcomes of patients who had long-term follow-up.Materials and Methods: Sixteen women diagnosed with PABC were included in this study. We evaluated the clinicopathological characteristics, gestational history, and survival outcomes of the patients who had been treated and followed up for breast cancer during pregnancy and the first postnatal year at Istanbul University Institute of Oncology in 2010–2017.Results: The median patient age was 32 (21–41) years. The median gestational week of diagnosis in pregnant patients was 26 (11–35) weeks while the mean time elapsed after delivery until diagnosis in postpartum patients was 9.3 (±3.6) months. The median follow-up time was 47.5 (5–99) months. The mean disease-free survival (DFS) and overall survival (OS) were calculated because the median DFS and OS could not be computed. The mean OS and DFS values were 87.8±7.3 and 77.6±8.5 months,respectively.Discussion and Conclusion: Breast cancer in pregnancy is a special health condition that should be treated and followed up by a multidisciplinary team. Primary surgical intervention should not be delayed. While chemotherapy could be administered safely in the first and second trimesters, radiotherapy and targeted and endocrine treatments should be postponed until after delivery. Reporting and long-term follow-up of cases of pregnancy and cancer concurrence is essential for increasing the relevant knowledge.

Pregnancy-associated breast cancer: An institutional experience

Introduction: Breast cancer is the second most common malignancy in pregnant women. Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy and the first postpartum year. PABC is associated with difficulty in detection, diagnosis, and definitive management. Management of these patients is centered on the wellbeing of both the fetus and the mother. We report the epidemiology, pathology, treatment, and outcome of patients with PABC managed at our institution. Patients and Methods: Twelve patients were managed for PABC by the Division of General Surgery from January 2012 to December 2017. Their records were retrieved and relevant information extracted. Results: Nine patients were diagnosed during pregnancy and three while lactating. All patients presented with stage III and IV disease, with all stage IV patients dying within 6 months of presentation. None of the children born to patients who had neoadjuvant chemotherapy had any obvious congenital anomaly at birth. Conclusion: The late stage at presentation of our patients means that antenatal screening of pregnant women for PABC should be strongly encouraged. Treatment of PABC in our setting should be aggressive and similar to that of nonpregnant patients. The use of taxane-based chemotherapy may improve outcome.

Treatment of the Pregnant Patient with Breast Cancer.

Pregnancy-associated breast cancer is defined as invasive breast cancer diagnosed during gestation, within 1 year postpartum, or during lactation. Of particular interest is the treatment of invasive breast cancer during gestation; standard treatment protocols must take into account the health of the fetus. This article reviews the literature and emerging data regarding the treatment of pregnancy-associated breast cancer. Existing staging and treatment practices need slight modification in the setting of pregnancy. The timing of surgery and the administration of cytotoxic chemotherapy must take into account age of gestation, but these modalities are safe in pregnancy.

Contemporary multidisciplinary treatment of pregnancy-associated breast cancer

Breast cancer diagnosed during pregnancy poses unique challenges. Application of standard treatment algorithms is limited by lack of level I evidence from randomized trials. This study describes contemporary multidisciplinary treatment of pregnancy-associated breast cancer (PABC) in an academic setting and explores early maternal and fetal outcomes. A search of the Dana-Farber/Harvard Cancer Center clinical databases was performed to identify PABC cases. Sociodemographic, disease, pregnancy, and treatment information, as well as data on short-term maternal and fetal outcomes, were collected through retrospective chart review. 74 patients were identified, the majority with early-stage breast cancer. Most (73.5%) underwent surgical resection during pregnancy, including 40% with sentinel lymph node biopsy and 32% with immediate reconstruction. A total of 36 patients received anthracycline-based chemotherapy during pregnancy; of those, almost 20% were on a dose-dense schedule and 8.3% also received paclitaxel. 68 patients delivered liveborn infants; over half were delivered preterm (< 37 weeks), most scheduled to allow further maternal cancer therapy. For the infants with available data, all had normal Apgar scores and over 90% had birth weight >10th percentile. The rate of fetal malformations (4.4%) was not different than expected population rate. Within a multidisciplinary academic setting, PABC treatment followed contemporary algorithms without apparent increase in maternal or fetal adverse outcomes. A considerable number of preterm deliveries were observed, the majority planned to facilitate cancer therapy. Continued attention to maternal and fetal outcomes after PABC is required to determine the benefit of this delivery strategy.

P2-19-02: Multidisciplinary Treatment of Pregnancy-Associated Breast Cancer.

Abstract Background: Breast cancer complicates pregnancy in a significant minority of younger breast cancer (BC) patients (pts). Application of standard treatment algorithms is limited by the lack of randomized data to support safety and efficacy. A multidisciplinary approach attempts to maximize treatment efficacy for a pt while minimizing fetal toxicity. We sought to describe contemporary multidisciplinary BC treatment in an academic setting and explore early maternal and fetal outcomes. Methods: A search of the Dana-Farber/Harvard Cancer Center clinical database was performed to find BC pts self-identified as pregnant at presentation with &amp;gt;2 visits at our institution. Information available within the database along with complementary chart review provided sociodemographic, disease, staging, pregnancy and treatment information as well as short-term maternal and fetal outcomes. Results: 55 pts diagnosed between 1996–2011 were identified. The median age at diagnosis was 34 years. 25.5% were stage I, 49.1% stage II, 20% stage III, and 5.4% stage IV. 63.6% had hormone receptor positive disease, 36.3% HER2 positive, and 18.1% triple negative. 71% underwent testing for germline BRCA1/2 mutations, with 9% of all pts testing positive. 29% were diagnosed in the first trimester (T1), 29% in T2, and 42% in T3. 89% underwent ultrasound imaging for staging, 49% X-ray imaging, 16.3% MRI, and 0% CT. 67% underwent surgery during pregnancy: 43.2% mastectomy, 48.6% lumpectomy, and 8.1% lumpectomy with subsequent mastectomy during pregnancy. 18.9% underwent surgery in T1, 45.9% in T2, and 37.8% in T3. 27.2% underwent sentinel lymph node biopsy. 51% received chemotherapy (C) during pregnancy: of those, 100% received anthracycline/cyclophosphamide (2-4 cycles), 11% paclitaxel, and 0% trastuzumab. 28.5% received C on a dose-dense schedule, with 25% supported by growth factors (14.2% filgrastim, 10.8% pegfilgrastim). 28.5% received neoadjuvant C. C was initiated during T1 for 0%, T2 for 64.3%, and T3 for 35.7%. Two pts terminated pregnancy in T1, one spontaneously miscarried at 12 weeks (wks), and two are currently in the third trimester of pregnancy; therefore, a total of 50 pts had delivered at the time of this analysis. The median time of delivery was 36 wks. 50% delivered prior to 37 wks and were considered preterm; of those, 76% were inductions or Caesarian sections planned to facilitate cancer therapy. Only 12% delivered prior to 34 wks. For the 25 infants for whom Apgar scores were available, 76% had scores of ≥ 8 at delivery, and 100% had scores of ≥ 8 at 5 minutes. For the 25 infants for whom birth weights were available, the median birth weight was 6lbs 1oz. Only 4 were less than 5lbs at the time of delivery. A total of 4 fetal abnormalities were noted: cleft palate (2), club foot (1), and ventricular septal defect (1). Conclusions: Within a multidisciplinary academic center, treatment of pregnancy-associated BC using contemporary treatment algorithms, including taxane chemotherapy, growth factor support, and sentinel lymph node biopsy, has been pursued without significant adverse effect on fetal outcomes when compared to other published series. A considerable number of preterm deliveries have been observed. Further data collection is ongoing for confirmation of initial observations. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-19-02.

Treatment of pregnancy-associated breast cancer

Background: In primary breast cancer three therapeutic components-cytotoxic, endocrine and targeted antibody therapy-have led to a significant reduction in breast cancer mortality. In pregnancy associated breast cancer the right therapeutic choice is still under discussion while incidence is increasing. With an incidence of 1/3,000 to 1/10,000 pregnancies, pregnancy-associated breast cancer is the most common solid tumor in pregnancy after cervical carcinoma. Objective: This article reviews the evidence base for the use of various treatment modalities in patients with pregnancy-associated breast cancer. Methods: Medline review, searching for articles including years 2000 through 2008 was performed. Search was conducted for the terms “pregnancy” and “breast cancer”. Cross references up to the second level were taken into account if of interest for this review. Results: Loco-regional therapy of pregnancy-associated breast cancer follows the general guidelines for breast cancer therapy in principle. Radiation of the breast and/or chest wall is usually not performed during pregnancy. Chemotherapy is indicated for the majority of patients with pregnancy-associated breast cancer. After the first trimester, anthracycline-based chemotherapy is regarded as the treatment standard in pregnancy. Folate antagonists such as methotrexate are strictly contraindicated as they are the main cause of fetal malformations. Adjuvant endocrine therapy with anti-estrogens during pregnancy is contraindicated. Data on targeted biological treatment, particularly for HER2/neu positive tumors during pregnancy are scarce and this treatment should be postponed until after delivery. Conclusion: This article summarizes the special features of the diagnosis and primary therapy of pregnancy-associated breast cancer with particular emphasis on cytotoxic therapy.

Breast Cancer Treatment During Pregnancy

The diagnosis of breast cancer during pregnancy, athough uncommon, can be a devastating and confusing diagnosis for many women. Many clinicians are unaware of the treatment options available for the pregnant patient and are unable to counsel their patients. The treatment of pregnancy-associated breast cancer is determined by the age of gestation and the stage of cancer at presentation. A multidisciplinary approach involving a medical oncologist, surgical oncologist, radiation oncologist and high-risk obstetrician will lead to an optimal outcome for the mother and child. This article will discuss the management of a pregnant patient with breast cancer.

Pregnancy-associated breast cancer; A management dilemma in Nigeria

Pregnancy-associated breast cancer (PABC) is uncommon. Its management is sometimes controversial and may present ethical problems. This paper presents cases treated in the University of Port Harcourt Teaching Hospital from 1990 to 2002. The case records of patients treated for pregnancy-associated breast cancer were retrieved, studied and are presented with a limited review of the literature on the current management of the disease. There were 5 nulliparous young women aged between 26 and 32 years with breast cancer involved in 6 pregnancies. One patient had sequential bilateral mastectomy for carcinoma of the breast in pregnancy at two pregnancies, three had the cancer affecting one breast in pregnancy and one had the mastectomy but while on chemotherapy became pregnant and delivered successfully. One patient with advanced disease, refused biopsy and treatment. The diagnosis in 5 instances was intraductal carcinoma. The disease is uncommon but evokes significant emotion in patients and their doctors. The prognosis appears similar to that in non-pregnant women. The treatment of PABC is similar to that in non-pregnant women except that radiotherapy and chemotherapy may be contraindicated at certain trimesters. KEY WORDS: Breast cancer, Pregnancy, Management dilemma. Sahel Medical Journal Vol.7(2) 2004: 69-72

Conservative surgery and chemotherapy for breast carcinoma during pregnancy

Surgery 2002;131:108-10.