Breast cancer in pregnancy a literature review

Breast cancer in pregnancy a literature review

Breast cancer is the most common cancer diagnosed during pregnancy. The incidence of breast cancer in pregnancy (BCP) is expected to increase since women tend to postpone childbearing until later in life and since the incidence of breast cancer increases with age. The management of this co-incidence Cited by: 3 Jan 01,  · Several studies of women who had a history of breast cancer and subsequently became pregnant have shown a "healthy mother effect": the former cancer patients who became pregnant had a better year survival rate than their matched controls. 91,93 Cooper and Butterfield 94 also found that breast cancer survivors who subsequently became pregnant Cited by: Nov 01,  · They reported that the histopathological and immunohistochemical findings of breast cancer in pregnancy are similar to those in non-pregnant subjects. They showed that pregnant women had a high rate of distant relapse (23%) within one year and 25% of patients had died after an approximately 5-year blogger.com by: 11

Pregnancy characteristics and maternal breast cancer risk: a review of the epidemiologic literature

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Breast cancer is the most common cancer diagnosed during pregnancy. The incidence of breast cancer in pregnancy BCP is expected to increase since women tend to postpone childbearing until later in life and since the incidence of breast cancer increases with age, breast cancer in pregnancy a literature review.

The management of this co-incidence is a clinical and ethical multidisciplinary challenge for all involved medical care workers since two lives are at risk. Breast cancer treatment is possible during pregnancy. Still, little prospective research data are available on this condition. In this review, we present an overview of the current knowledge about the safety of diagnostic imaging, staging methods and treatment options of BCP. We also discuss the prognosis, neonatal outcome and recommendations concerning prenatal care.

However, breast cancer in pregnancy a literature review, any suspicious or persisting mass deserves further investigation. Breast cancer is the most common malignancy occurring during pregnancy Van Calsteren et al.

The diagnosis of breast cancer in pregnancy BCP is expected to become more frequent since there is an increasing trend for women to delay childbearing. Breast cancer incidence increases with age Loibl et al. The diagnosis of cancer in a pregnant woman is a clinical challenge for the mother and the medical team Teran-Porcayo et al.

The benefit and risks of the different diagnostic and therapeutic modalities should be carefully assessed for both the mother and the fetus. Optimal treatment of the mother must be combined with minimal risk of harm to the fetus. In this review we aim to highlight the evidence supporting breast cancer treatment during pregnancy. The level of evidence is low since only case reports, small series and mainly retrospective data are available. Therefore, individualisation is mandatory.

In any case, breast cancer diagnosis, staging and treatment during pregnancy should adhere as much as possible to standard care. The diagnosis may be delayed and difficult due to physiological changes within the breast during pregnancy Garcia-Manero et al.

Small masses are difficult to detect and nodularities and densities in the breast are often overlooked or ascribed to benign proliferative changes. Therefore, pregnancy associated breast cancer is usually diagnosed in a higher stage. In contrast to many other breast cancer cases, BCP is not diagnosed during a screening examination.

BCP most often presents in a symptomatic patient. A painless mass or thickening, occasionally associated with nipple discharge, is most frequently observed Eedarapalli and Jain, The clinical examination of the breast at the first prenatal visit is a critical step in the — early — diagnosis of BCP. Although a breast examination at each prenatal visit is unrealistic, breast cancer in pregnancy a literature review, an adequate examination is strongly recommended in symptomatic women.

Mammography is diagnostic and enables to detect microcalcifications and multicentricity of masses. With adequate abdominal shielding, a mammography presents little risk to the fetus Loibl et al.

However, the increased breast vascularity and density and the physiological changes within the breast during pregnancy make the mammogram often difficult to interpret Hogge et al.

Breast ultrasound has a high sensitivity and specificity for the diagnosis of BCP Navrozoglou et al. It can distinguish between cystic and solid breast lesions Woo et al. It is considered the standard method for the evaluation of a palpable breast mass during pregnancy.

Biopsy of a suspicious mass is the golden standard for the diagnosis of breast cancer Woo et al. A fine-needle aspiration FNAC can be executed for initial evaluation for cytological investigation. However, sensitivity of cytologic examination during pregnancy is low because atypical cytomorphologic findings are breast cancer in pregnancy a literature review seen in normal breast tissue during gestation Sorosky and Scott-Conner, ; Novotny et al.

A breast cancer in pregnancy a literature review needle biopsy is preferred. It is important that the pathologist is informed about the pregnant state to avoid misdiagnosis of the hyperproliferative changes of the breast during gestation. Similar to non-pregnant women, mainly invasive ductal carcinomas are diagnosed in pregnant women Parente et al.

Since the histopathologic and immunohistochemical findings of BCP are similar to those of non-pregnant young women Loibl et al. Optimal oncological treatment necessitates adequate staging. Some exposure to medical irradiation during pregnancy is therefore unavoidable but should be limited where possible.

Ionizing radiation x-ray is composed of high-energy photons that are capable of damaging DNA and generating caustic free radicals Hall, In general, the expected radiation effects, such as mental retardation and organ malformations, probably only arise above a threshold dose of 0. The dose to the fetus resulting from most conventional radiograph examinations is breast cancer in pregnancy a literature review than 0.

Staging is therefore possible and should be executed when indicated. The risk of not staging is often greater than the potential harm to the fetus. In cases of doubt, the examination is permitted if the result would alter the immediate management Ring et al. A metastatic workup should be limited to patients with high probability of metastasis and only when their establishment may alter therapy Pereg et al.

Furthermore, the cumulative radiation dose of the required examinations should always be taken into account in the risk assessment of the fetus. The cumulative fetal exposure is calculated in consultation with radiologists and nuclearists.

Only the most relevant examinations are performed. Table I gives an overview of the threshold dose of radiation during different stages of pregnancy and the possible adverse effects when exceeding this threshold. Table II summarizes the fetal radiation dose due to exposure to several imaging techniques that are discussed below. Chest radiography with abdominal shielding can be carried out relatively safe during pregnancy, breast cancer in pregnancy a literature review. The expected exposure to the fetus ranges from 0 to 0.

Computed tomography scanning is associated with higher radiation exposure to the fetus. Computed tomography of the upper abdomen with appropriate shielding may be considered safe since it is associated with a fetal exposure of 0.

In contrast, the computed tomography scanning of the lower abdomen is less safe since fetal exposure approximately 0. Controversy continues on the use of magnetic resonance imaging MRI during pregnancy. However, since the effects of MRI exposure in the prenatal period have not been fully determined, MRI should be used with caution, especially during the first trimester Oto et al. The most important fetal concerns are the possibility of teratogenic effects and the potential risk of acoustic damage Chen et al.

The possible mechanisms of teratogenesis include the heating effect of magnetic resonance gradient changes and direct nonthermal interaction of the electromagnetic field with biological structures. This suggests cautious administration of MRI in the first trimester.

The acoustic damage due to the breast cancer in pregnancy a literature review noise produced by the MRI scanner breast cancer in pregnancy a literature review, appears to be rather a theoretical than a real concern. Despite the above mentioned concerns, MRI is widely applied during pregnancy, also for non-oncological indications.

MRI is of good value for the detection of brain and bone metastases, if clinically indicated Molckovsky and Madarnas, Contrast media are used during radiologic imaging in order to increase diagnostic sensitivity. The intravenous presence of these agents questions fetal safety. After administration of gadolinium or iodinated contrast media during pregnancy, no mutagenic or teratogenic effects have been described Webb et al.

The most important potential harmful effect of iodinated contrast media within the fetus is the depression of thyroid function.

Therefore, it is necessary to check the neonatal thyroid function after delivery. No adverse effects in the fetus have been documented after gadolinium administration during pregnancy.

Table III gives an overview of the guidelines for the use of iodinated and gadolinium contrast media during pregnancy. In recent years, 18 fluorodeoxyglucose positron emission tomography FDG PET has become an essential component of cancer management Zanotti-Fregonara et al.

Limited data on the safety during pregnancy are however available. Also the combined use with computed tomography gains more importance. Zanotti-Fregonara et al. She was found to be pregnant at the time of the examination embryo age, 8 weeks. They calculated that the radionuclide dose to the embryo was This dose remains within the range of safe levels Steenvoorde et al.

Although these data are promising, no conclusions can be made about the safety of FDG-PET during pregnancy based on one case. Further investigations are required. The low dose bone scan exposes the fetus to 0. A bladder catheter is inserted to avoid accumulation in the bladder in the proximity of the pregnancy. This examination can therefore be used as an alternative for MRI for the detection of bone metastases of the thoracic or lumbosacral spine Gwyn and Theriault, Sentinel lymph node biopsy SLNB has become a valid alternative for standard axillary lymph node dissection in patients with small breast carcinoma and a clinically negative axilla Veronesi et al.

This procedure is associated with far less serious morbidity than the standard axillary node dissection Sener et al. The use of lymphoscintigraphy and SLNB during pregnancy has been considered unsafe for a long time Gentilini et al.

The sentinel lymph node technique relies on an injection of a radioactive colloid, a vital dye or both in the proximity of the primary lesion Mondi et al, breast cancer in pregnancy a literature review.

There are justifiable concerns regarding the use of any of these agents during pregnancy and the subsequent implications to the developing fetus. However, inGentilini et al. described that the injected 99m TC sulphur colloid is concentrated only in the injection site and in the lymph nodes with negligible irradiation to other tissues and organs Gentilini et al. Keleher et al, breast cancer in pregnancy a literature review.

found that the maximum absorbed dose to the fetus in pregnant women undergoing breast lymphoscintigraphy with This is well below the minimum dose reported to be associated with adverse fetal effects. The use of isosulfan blue for lymphatic mapping has a possible risk of an allergic or anaphylactic maternal reaction, which can be harmful for the fetus Khera et al.

Also the maternal life is put into danger since treatment of an anaphylactic reaction during pregnancy is hazardous.

Managing breast cancer during pregnancy

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Breast cancer in pregnancy: a literature review. - Abstract - Europe PMC

Breast cancer, along with cervical cancer, is one of the most commonly diagnosed cancers of pregnancy. Most would define gestational breast can-cer as breast cancer that is diagnosed during pregnancy, lactation, and up to 12 months post-partum. The diagnostic and therapeutic implications in this clinical setting are special Jan 01,  · Breast cancer is the most common cancer diagnosed during pregnancy. The incidence of breast cancer in pregnancy (BCP) is expected to increase since women tend to postpone childbearing until later in life and since the incidence of breast cancer Cited by: 3 The short- and long-term effects of pregnancy on breast cancer risk are well documented. Insight into potential biological mechanisms for these associations may be gained by studying breast cancer risk and pregnancy characteristics (e.g., preeclampsia, twining), which may reflect hormone levels during blogger.com by: 82