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Breast Cancer During Pregnancy

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Breast Cancer in Young Women

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Abstract

Allied to the current tendency to postpone childbearing to the later reproductive years, the incidence rate of pregnancy-associated breast cancer is increasing. Delayed diagnosis and suboptimal therapy worsen prognosis. General concepts concerning local and systemic treatment and staging workup should adhere as much as possible to those of young nonpregnant female patients. Clinicopathological tumor characteristics determine the appropriate treatment. Most diagnostic methods and treatments options including imaging, surgery, and chemotherapy are feasible during pregnancy depending on the gestational stage at diagnosis. However, the selection and timing of local and systemic therapies must be adapted to ensure safety of both the fetus and the mother. Treatment strategies should be established in a multidisciplinary team and the pregnant woman and the family should be clearly informed and involved in the decision-making progress. Premature delivery should be avoided, whenever possible. Radiotherapy, endocrine and anti-HER2 therapies as well as new breast cancer treatments are contraindicated during pregnancy and lactation. Since randomized studies are not feasible in patients with breast cancer during pregnancy, register studies need to be supported and international collaborations to be continued.

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References

  1. Pavlidis NA. Coexistence of pregnancy and malignancy. Oncologist. 2002;7(4):279–87.

    Article  PubMed  Google Scholar 

  2. Stensheim H, Moller B, van Dijk T, et al. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol. 2009;27(1):45–51.

    Article  PubMed  Google Scholar 

  3. Lee YY, Robets CL, Dobbins T, et al. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994–2008: a population-based linkage study. BJOG. 2012;119(13):1572–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Haas JF. Pregnancy in association with newly diagnosed cancer: a population-based epidemiologic assessment. Int J Cancer. 1984;34(2):229–35.

    Article  CAS  PubMed  Google Scholar 

  5. Abenhaim HA, Azoulay L, Holcroft CA, et al. Incidence, risk factors, and obstetrical outcomes of women with breast cancer in pregnancy. Breast J. 2012;18(6):564–8.

    Article  PubMed  Google Scholar 

  6. Sobotka T. United Nations Department of economic and social affairs. Pathways to low fertility: European perspectives. Expert Paper No 2013/08.

    Google Scholar 

  7. Andersson TM, Johansson AL, Hsieh CC, et al. Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol. 2009;114(3):568–72.

    Article  PubMed  Google Scholar 

  8. Koch-Institut R. (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg). Krebs in Deutschland 2011/2012. 10. Ausgabe. Berlin, 2015.

    Google Scholar 

  9. Amant F, Loibl S, Neven P, et al. Breast cancer in pregnancy. Lancet. 2012;379(9815):570–9.

    Article  PubMed  Google Scholar 

  10. Loibl S, Han SN, von Minckwitz G, Bontenbal M, et al. Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol. 2012;13(9):887–96.

    Article  CAS  PubMed  Google Scholar 

  11. Amant F, von Minckwitz G, Han SN, et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol. 2013;31(20):2532–9.

    Article  PubMed  Google Scholar 

  12. Azim HA Jr, Santoro L, Russell-Edu W, et al. Prognosis of pregnancy-associated breast cancer: a meta-analysis of 30 studies. Cancer Treat Rev. 2012;38:834–42.

    Article  PubMed  Google Scholar 

  13. Callihan EB, Gao D, Jindal S, et al. Postpartum diagnosis demonstrates a high risk for metastasis and merits an expanded definition of pregnancy-associated breast cancer. Breast Cancer Res Treat. 2013;138(2):549–59.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Woo JC, Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Arch Surg. 2003;138(1):91–8.

    Article  PubMed  Google Scholar 

  15. Nettleton J, Long J, Kuban D, et al. Breast cancer during pregnancy: quantifying the risk of treatment delay. Obstet Gynecol. 1996;87:414–8.

    Article  CAS  PubMed  Google Scholar 

  16. Amant F, Deckers S, Van Calsteren K, et al. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer. 2010;46(18):3158–68.

    Article  PubMed  Google Scholar 

  17. American College of Radiology. ACR–SPR practice parameter for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. In: Resolution, vol. 39. Reston, VA: ACR; 2014. https://www.acr.org/Search-Results#q=pregnant%20patients. Accessed 12 Mar 2018.

    Google Scholar 

  18. Robbins J, Jeffries D, Roubidoux M, Helvie M. Accuracy of diagnostic mammography and breast ultrasound during pregnancy and lactation. AJR Am J Roentgenol. 2011;196(3):716–22.

    Article  PubMed  Google Scholar 

  19. Vashi R, Hooley R, Butler R, et al. Breast imaging of the pregnant and lactating patient: imaging modalities and pregnancy associated breast cancer. AJR Am J Roentgenol. 2013;200(2):321–8.

    Article  PubMed  Google Scholar 

  20. Nguyen CP, Goodman LH. Fetal risk in diagnostic radiology. Semin Ultrasound CT MR. 2012;33(1):4–10.

    Article  PubMed  Google Scholar 

  21. Ray JG, Vermeulen MJ, Bharatha A, et al. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316(9):952–61.

    Article  PubMed  Google Scholar 

  22. Patenaude Y, Pugash D, Lim K, et al. Diagnostic imaging committee; Society of Obstetricians and Gynaecologists of Canada. The use of magnetic resonance imaging in the obstetric patient. J Obstet Gynaecol Can. 2014;36(4):349–63.

    Article  PubMed  Google Scholar 

  23. Pavlidis N, Pentheroudakis G. Metastatic involvement of placenta and foetus in pregnant women with cancer. Recent Results Cancer Res. 2008;178:183–94.

    Article  CAS  PubMed  Google Scholar 

  24. Berry DL, Theriault RL, Holmes FA, et al. Management of breast cancer during pregnancy using a standardized protocol. J Clin Oncol. 1999;17(3):855–61.

    Article  CAS  PubMed  Google Scholar 

  25. Toesca A, Gentilini O, Peccatori F, et al. Locoregional treatment of breast cancer during pregnancy. Gynecol Surg. 2014;11(4):279–84.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Huang J, Barbera L, Brouwers M, et al. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol. 2003;21(3):555–63.

    Article  PubMed  Google Scholar 

  27. Lohsiriwat V, Peccatori FA, Martella S, et al. Immediate breast reconstruction with expander in pregnant breast cancer patients. Breast. 2013;22(5):657–60.

    Article  PubMed  Google Scholar 

  28. Gentilini O, Cremonesi M, Toesca A, et al. Sentinel lymph node biopsy in pregnant patients with breast cancer. Eur J Nucl Med Mol Imaging. 2010;37(1):78–83.2.

    Article  PubMed  Google Scholar 

  29. Khera SY, Kiluk JV, Hasson DM, et al. Pregnancy-associated breast cancer patients can safely undergo lymphatic mapping. Breast J. 2008;14:250–4. 3

    Article  PubMed  Google Scholar 

  30. Gropper AB, Calvillo KZ, Dominici L, et al. Sentinel lymph node biopsy in pregnant women with breast cancer. Ann Surg Oncol. 2014;21:2506–11.

    Article  PubMed  Google Scholar 

  31. Pandit-Taskar N, Dauer LT, Montgomery L, St Germain J, Zanzonico PB, Divgi CR. Organ and fetal absorbed dose estimates from 99mTc-sulfur colloid lymphoscintigraphy and sentinel node localization in breast cancer patients. J Nucl Med. 2006;47:1202–8.

    CAS  PubMed  Google Scholar 

  32. Otake M, Schull WJ, Lee S. Threshold for radiation-related severe mental retardation in prenatally exposed A-bomb survivors: a re-analysis. Int J Radiat Biol. 1996;70(6):755–63.

    Article  CAS  PubMed  Google Scholar 

  33. Kal HB, Struikmans H. Radiotherapy during pregnancy: fact and fiction. Lancet Oncol. 2005;6(5):328–33.

    Article  PubMed  Google Scholar 

  34. National Toxicology Program. NTP monograph: developmental effects and pregnancy outcomes associated with cancer chemotherapy use during pregnancy. NTP Monogr. 2013;2:i–214.

    Google Scholar 

  35. de Haan J, Verheecke M, Van Calsteren K, et al. International Network on Cancer and Infertility Pregnancy (INCIP). Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol. 2018;19(3):337–46.

    Article  PubMed  Google Scholar 

  36. Queisser-Luft A, Stolz G, Wiesel A, et al. Malformations in newborn: results based on 30,940 infants and fetuses from the Mainz congenital birth defect monitoring system (1990–1998). Arch Gynecol Obstet. 2002;266:163–7.

    Article  CAS  PubMed  Google Scholar 

  37. Loibl S, Schmidt A, Gentilini O, et al. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA Oncol. 2015;1(8):1145–53.

    Article  PubMed  Google Scholar 

  38. Bines J, Earl H, Buzaid AC, Saad ED. Anthracyclines and taxanes in the neo/adjuvant treatment of breast cancer: does the sequence matter? Ann Oncol. 2014;25(6):1079–85.

    Article  CAS  PubMed  Google Scholar 

  39. von Minckwitz G, Schneeweiss A, Loibl S, et al. Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial. Lancet Oncol. 2014;15(7):747–56.

    Article  CAS  Google Scholar 

  40. Loibl S, O'Shaughnessy J, Untch M, et al. Addition of the PARP inhibitor veliparib plus carboplatin or carboplatin alone to standard neoadjuvant chemotherapy in triple-negative breast cancer (BrighTNess): a randomised, phase 3 trial. Lancet Oncol. 2018;19(4):497–509. https://doi.org/10.1016/S1470-2045(18)30111-6.

    Article  CAS  PubMed  Google Scholar 

  41. Sikov WM, Berry DA, Perou CM, et al. Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (Alliance). J Clin Oncol. 2015;33(1):13–21.

    Article  CAS  PubMed  Google Scholar 

  42. Köhler C, Oppelt P, Favero G, et al. How much platinum passes the placental barrier? Analysis of platinum applications in 21 patients with cervical cancer during pregnancy. Am J Obstet Gynecol. 2015;213(2):206.e1–5.

    Article  CAS  Google Scholar 

  43. Gray R, Bradley R, Braybrooke J, et al. Increasing the dose density of adjuvant chemotherapy by shortening intervals between courses or by sequential drug administration significantly reduces both disease recurrence and breast cancer mortality: An EBCTCG meta-analysis of 21,000 women in 16 randomised trials [abstract]. San Antonio Breast Cancer Symposium 2017. Cancer Res. 2018;78(4 Suppl):GS1-01.

    Google Scholar 

  44. Moebus V, Jackisch C, Lueck HJ, et al. Intense dose-dense sequential chemotherapy with epirubicin, paclitaxel, and cyclophosphamide compared with conventionally scheduled chemotherapy in high-risk primary breast cancer: mature results of an AGO phase III study. J Clin Oncol. 2010;28(17):2874–80.

    Article  CAS  PubMed  Google Scholar 

  45. Cardonick E, Gilmandyar D, Somer RA. Maternal and neonatal outcomes of dose-dense chemotherapy for breast cancer in pregnancy. Obstet Gynecol. 2012;120(6):1267–72.

    Article  CAS  PubMed  Google Scholar 

  46. van Hasselt JG, van Calsteren K, Heyns L, et al. Optimizing anticancer drug treatment in pregnant cancer patients: pharmacokinetic analysis of gestation-induced changes for doxorubicin, epirubicin, docetaxel and paclitaxel. Ann Oncol. 2014;25(10):2059–65.

    Article  PubMed  Google Scholar 

  47. Gottschalk I, Berg C, Harbeck N, et al. Fetal renal insufficiency following trastuzumab treatment for breast cancer in pregnancy: case report and review of the current literature. Breast Care (Basel). 2011;6:475–8.

    Article  Google Scholar 

  48. Zagouri F, Sergentanis TN, Chrysikos D, et al. Trastuzumab administration during pregnancy: a systematic review and meta-analysis. Breast Cancer Res Treat. 2013;137(2):349–57.

    Article  CAS  PubMed  Google Scholar 

  49. Barthelmes L, Davidson LA, Gaffney C, Gateley CA. Tamoxifen and pregnancy. Breast. 2004;13(6):446–51.

    Article  CAS  PubMed  Google Scholar 

  50. Isaacs RJ, Hunter W, Clark K. Tamoxifen as systemic treatment of advanced breast cancer during pregnancy—case report and literature review. Gynecol Oncol. 2001;80:405–8.

    Article  CAS  PubMed  Google Scholar 

  51. Tewari K, Bonebrake RG, Asrat T, et al. Ambiguous genitalia in infant exposed to tamoxifen in utero. Lancet. 1997;350:183.

    Article  CAS  PubMed  Google Scholar 

  52. Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics. 2004;114(2):372–6.

    Article  PubMed  Google Scholar 

  53. Avilés A, Neri N. Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2001;2(3):173–7.

    Article  PubMed  Google Scholar 

  54. Nulman I, Laslo D, Fried S, et al. Neurodevelopment of children exposed in utero to treatment of maternal malignancy. Br J Cancer. 2001;85(11):1611–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Amant F, Vandenbroucke T, Verheecke M, et al. Pediatric outcome after maternal Cancer diagnosed during pregnancy. International network on Cancer, infertility, and pregnancy (INCIP). N Engl J Med. 2015;373(19):1824–34.

    Article  CAS  PubMed  Google Scholar 

  56. Cardonick E, Dougherty R, Grana G, et al. Breast cancer during pregnancy: maternal and fetal outcomes. Cancer J. 2010;16:76–82.

    Article  PubMed  Google Scholar 

  57. Pistilli B, Bellettini G, Giovannetti E, et al. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013;39(3):207–11.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. German Breast Group, Neu-Isenburg, Germany

    Sibylle Loibl & Sabine Seiler

  2. Centrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Germany

    Sibylle Loibl

Authors
  1. Sibylle Loibl
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  2. Sabine Seiler
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Correspondence to Sibylle Loibl .

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Editors and Affiliations

  1. Breast Unit, San Raffaele University and Research Hospital, Milan, Italy

    Oreste Gentilini

  2. Dana–Farber Cancer Institute Department of Medical Oncology, Harvard Medical School, Boston, MA, USA

    Ann H. Partridge

  3. Geneva University Hospitals Swiss Group for Clinical Cancer Research (SAKK), Institute of Oncology of Southern Switzerland, Bellinzona, Switzerland

    Olivia Pagani

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Loibl, S., Seiler, S. (2020). Breast Cancer During Pregnancy. In: Gentilini, O., Partridge, A.H., Pagani, O. (eds) Breast Cancer in Young Women. Springer, Cham. https://doi.org/10.1007/978-3-030-24762-1_13

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  • DOI: https://doi.org/10.1007/978-3-030-24762-1_13

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