Breast cancer is the most common type of cancer diagnosed in women and is believed to be the second-most leading cause of death in women. It is a type of cancer in which certain cells in the breast become abnormal, grow uncontrollably, and form a mal
Breast cancer is the most common type of cancer diagnosed in women and is believed to be the second-most leading cause of death in women. It is a type of cancer in which certain cells in the breast become abnormal, grow uncontrollably, and form a malignant mass (tumor). According to research studies, the incidence of breast cancer in pregnant women is approximately 1.3 breast cancer cases per 10,000 live births. Detection of breast cancer during pregnancy can raise several diagnostic and treatment challenges. Studies have shown that breast cancers diagnosed during pregnancy, usually presents a larger tumor size and a higher incidence of metastasis to the lymph nodes. Most likely explanation of this phenomenon is that the breast cancer cells are responsive to the increased hormones during pregnancy. Studies show that the breast cancer diagnosed during a pregnancy are of higher grade, which means they are more poorly-differentiated. There also usually estrogen receptor negative, progesterone receptor negative and are occasionally, HER-2/neu positive tumors.
The presence of an enlarged breast during pregnancy can make the diagnosis of breast cancer difficult. Presence of a new breast mass in a pregnant woman is more likely to be associated with pregnancy changes. This often results in a delayed diagnosis. Diagnosing breast cancer during pregnancy causes significant challenges. Performing a mammography in a pregnant woman may be difficult because of potential radiation to the developing baby. Also, the mammograms are more difficult to interpret due to the increased breast density during pregnancy. However, ultrasonography of the breast and axillary lymph nodes may be very helpful in detecting the presence of suspicious areas. The presence of suspicious areas in the axillary lymph nodes may be used for performing a tissue biopsy. A core biopsy of the suspicious axillary or breast mass is often recommended.
Once a diagnosis of a breast cancer is confirmed on a tissue biopsy, the follow-up staging of breast cancer can also be challenging. Whole-body PET scan is often contraindicated in pregnant women with breast cancer. In such cases, undertaking an MRI scan of chest may be helpful. Treatment of breast cancer during pregnancy is challenging. It is generally recommended to avoid chemotherapy during the first trimester of pregnancy due to increased risk of fetal malformation. Chemotherapy during the second and third trimester may be given. The protocols are considered on a case-by-case basis.
Studies have shown that the incidence of fetal malformation in the second and third trimester is around 1.3% in women who received chemotherapy. This incidence is statistically not significant compared to the second and third-trimester pregnancy in women who have not received chemotherapy. The type of chemotherapy medication used is decided on a case-by-case basis. It is generally recommended that chemotherapy should not be given during week 35 of pregnancy, since this may lead to increased complications at the time of delivery. Further, radiation therapy and the use of endocrine therapy during pregnancy is contraindicated. Hence, a pregnant woman should not either receive endocrine therapy or radiation therapy. Such treatment measures should be withheld until the pregnancy is completed.
In summary, breast cancer during pregnancy can bring about diagnostic and treatment challenges. More and more studies are being reported regarding treatment of breast cancer in pregnancy. An experienced healthcare provider will be able to customize a treatment plan, based on the individual’s specific circumstances.
References:
https://www.cancer.org/cancer/breast-cancer/treatment/treating-breast-cancer-during-pregnancy.html (accessed on 9/25/2017)
http://ww5.komen.org/BreastCancer/TreatmentDuringPregnancy.html (accessed on 9/25/2017)
http://www.nationalbreastcancer.org/breast-cancer-and-pregnancy (accessed on 9/25/2017)
http://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/breast-cancer-during-pregnancy (9/25/2017)
