Breast Cancer During Pregnancy

Abstract

Pregnancy-associated breast cancer is uncommon and presents unique challenges for the treating physician. Ultrasound should be performed for the evaluation of a breast mass discovered during pregnancy, although mammography can be obtained with proper fetal shielding. Biopsy of suspicious lesions should be performed. Surgery is safe during any stage of pregnancy and can consist of either mastectomy or breast-conservation therapy. Axillary staging is generally performed with axillary lymph node dissection, although sentinel lymph node biopsy can be performed without the use of blue dye, which is contraindicated in pregnancy. However, the accuracy of sentinel lymph node biopsy during pregnancy is not well established. Radiation therapy should be delayed until after delivery due to risk of fetal exposure. Chemotherapy is contraindicated during the first trimester of pregnancy. In addition, some chemotherapeutic agents are contraindicated during any stage of pregnancy. Neoadjuvant chemotherapy can be given to allow for breast-conservation therapy to be performed and also to allow for radiation to be delayed until after delivery.