𝐏𝐫𝐞𝐠𝐧𝐚𝐧𝐜𝐲 𝐚𝐧𝐝 𝐁𝐫𝐞𝐚𝐬𝐭 𝐂𝐚𝐧𝐜𝐞𝐫

Pregnancy is a boon but it can be scavenged with the threat of breast cancer. Breast cancer impacts around 1 in 3000 pregnant women and is the second most common malignancy affecting women in their reproductive years (European Journal of Surgical Oncology. 2008; 34:837–843).

Pregnancy-associated breast cancer (PABC) is termed as breast cancer diagnosed during pregnancy or in the first postpartum year. (Reviews In Obstetrics & Gynecology, 2012; 5(2): 94–99).

Medical experts claim that the majority of women are delaying conception and there is a rampant increase in breast cancer rates, doctors anticipate more diagnoses of PABC.

Diagnosis of Pregnancy Associated Breast Cancer

Breast cancer during pregnancy is most likely found in the first trimester during the doctor’s visit and breast examination. Obstetricians perform a thorough breast mass examination during initial visits and also reinforce self-examination throughout pregnancy.

A palpable mass or breast thickening may arise suspicion and a breast ultrasound can help characterize the mass and identify any concerning features. More than 80% of breast masses identified in pregnancy represent benign pathologies.

Ultrasound has been noted to be 100% accurate in detecting a mass in patients with PABC (Current Oncology Reports, 2007Jan; 9(1):17-21).

Some women diagnosed with breast cancer during pregnancy can be in the advanced stages at the time of finding and a thorough evaluation of possible metastasis is prioritized. Breast cancer can metastasize to lungs, liver, and bone.

Not Recommended During Pregnancy

1. Gadolinium-enhanced magnetic resonance imaging is not recommended unless there is a specific need for it to investigate a clinical problem; there are limited data for the use of this imaging method in pregnancy, although no adverse effects of gadolinium on the fetus have been reported.
2. Tumor markers such as CA15-3, CEA, and CA125 are not used in early breast cancer and may be misleading in pregnancy, and are not recommended.
3. Bone scanning and pelvic X-ray computed tomography are not recommended because of the possible effect of irradiation on the baby in the womb.

Expected Treatment For Breast Cancer During Pregnancy

1. Surgical clearance or mastectomy can be considered.
2. Radiotherapy is contraindicated until delivery unless vital for life-saving.
3. Systemic chemotherapy is contraindicated in the first trimester but may be considered in the second trimester.

Warning: Tamoxifen and trastuzumab are contraindicated in pregnancy and should not be used.

Planning for birth delivery

It is observed that most women can go through a full term of pregnancy and have a normal or induced delivery. If the mother is on chemotherapy, delivery should be after 2-3 weeks of the last chemotherapy session.

Women intending to conceive after treatment for breast cancer should consult with their clinical oncologist, breast surgeon, and obstetrician.

It is observed that breast cancer patients on tamoxifen are advised to stop this treatment 3 months before trying to conceive because of the long half-life of the drug and to have any routine imaging before trying to conceive.

Breast Cancer Survivors

Women are reassured by experts that long-term survival after breast cancer is not adversely affected by pregnancy.

Since many breast cancers are estrogen receptor-positive and endocrine responsive, women used to be advised against pregnancy because of concerns that it would worsen prognosis.

However, the evidence from the published studies is reassuring, showing either no impact on survival or improved survival.

Also, check my article published in Indian Express:-

Breast cancer during pregnancy is usually detected in the first trimester

If you want to know about how family history influences, click Breast Cancer & Family History