Clinical Challenges: Pregnancy During and After Breast Cancer


Although rare, breast cancer can develop in pregnant women or, more commonly, breast cancer can lead to pregnancy. The good news is that with careful management of both conditions, pregnancies can usually be continued during breast cancer, and previous bouts of the disease do not appear to threaten the outcome of childbirth.

breast cancer during pregnancy

“I don’t want my patients to feel like they have to have an abortion,” said Marie C. Lee, M.D., Ph.D., of Moffitt Cancer Center in Tampa. MedPage Today“But I don’t want my patients to feel like they have to put off breast cancer treatment until the pregnancy is over. If you put off breast cancer treatment for seven to eight months because you’re waiting to give birth, you’re already late. I should have started earlier, so 8 ball.”

Studies show that 1 in 3,000 women will be diagnosed with breast cancer during pregnancy or within the first year after giving birth, but this risk has increased in recent decades as women become pregnant later in life. It may have grown over the years.

Lee said it’s not uncommon for pregnant women to seek treatment for breast cancer at her clinic. In some cases, the patient is a poor woman who only had insurance during her pregnancy thanks to a program in Florida that offers Medicaid coverage. Prior to pregnancy, these women were sometimes undiagnosed because they did not have insurance, she said.

Pregnant women with breast cancer are often younger and have more aggressive disease, she said. According to a 2018 report, “Pregnant women with breast cancer are more likely to have larger tumors, lymph node involvement, metastasis, and vascular invasion.”

As Lee explained, “There are many papers, publications, and theories about why premenopausal women have poor breast cancer symptoms. There are probably many biological underpinnings that we don’t yet understand.” I guess.”

Regarding diagnosis and treatment, one common screening test, an MRI, is not performed on pregnant women for several reasons, Lee said. The lack of contrast media during pregnancy and the large abdomen during the scan can lead to poor images. , and there are theoretical concerns about how the heat generated during the scan affects the fetus.

An axillary ultrasound is often done instead of an MRI for surgical planning, she added. The authors of the 2018 report also noted the benefits of ultrasound, stating, “Due to the high radiation density of the breast during pregnancy or lactation, ultrasound is the preferred imaging modality. It may also be useful in assessing response to neoadjuvant chemotherapy.” .”

As for prognosis, it is very rare that breast cancer actually threatens a woman’s life during pregnancy, Lee said. was not possible.

Chemotherapy can be started during pregnancy, she noted, but only after 12 weeks’ gestation. Told. fetus. “

However, radiation is not recommended. “Adjuvant radiation therapy is usually postponed until after delivery because exposure to radiation can endanger the fetus,” said a 2018 report. A 2010 report notes that “radiation therapy can be delayed until postpartum because surgery and initiation of systemic therapy are often completed before initiation of radiation therapy.”

As for surgery, Lee warned that lumpectomy may not be an ideal strategy for women in their first trimester who require follow-up radiation therapy within four to six months.

She noted that the effects of dealing with both pregnancy and breast cancer may not affect women until after giving birth. but many women suffer from anxiety, stress and post-traumatic disorder for six months, a year or a year and a half,” she said. tend to lag behind. [earlier] To get through treatment and pregnancy safely. It is not in their treatment that there is a struggle. ”

pregnancy after breast cancer

Is pregnancy after breast cancer dangerous? According to research, the answer is no. In a recent study, researchers followed 553 California women ages 18 to 45 who were diagnosed with stage I to III breast cancer between 2000 and 2012 and became pregnant after at least one year (at birth). median age of 36 years, 50.6% Caucasian, 23.9% Hispanic), 6.0% Black, 83.2% privately insured).

Compared to a matched control group of 1,659 women without breast cancer, adjusted analyzes showed a statistically significant excess of negative maternal outcomes such as preterm birth, other negative neonatal outcomes, or severe morbidity. No risk was seen. A small number of infants died, but the figures of 1 in the breast cancer group and 5 in the control group were too small to be analyzed.

“The lesson of our study is that, apart from a slightly higher risk of caesarean section, we did not see any worsening of obstetric or neonatal risks in women with a history of breast cancer,” said the study authors. Kirsten Jorgensen, M.D., Gynecologic Oncology, Fellow at the University of Texas MD Anderson Cancer Center in Houston, said: MedPage Today.

Caesarean section was common in both groups, occurring in 45.6% of the breast cancer cohort and 40.1% of the control cohort (OR 1.25, 95% CI 1.03-1.53​). The findings “could be confounded by variables that we were unable to explain,” Jorgensen said.

Overall, “We find our findings encouraging and provide reassurance to patients and their physicians regarding pregnancy in the post-breast cancer survival period.”

  • Randy Dotinga is a San Diego-based freelance medical and science journalist.

Disclosure

Lee and Jorgensen have no disclosures.



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