Breast cancer in pregnancy: Diagnosis and Treatment

Abstract

The aim of the study is to evaluate diagnosis and treatment of breast cancer in pregnant women, since pregnancy can potentially generate delay in disease approach and consequently worst prognosis than in non-pregnant women. There is also a low index of suspicion of the disease in this period and reluctance of patients and physicians to perform radiographic tests and invasive procedures. Breast cancer is the most common female malignancy. Its incidence in pregnancy is low, ranging from 1:3000 to 1:10,000 pregnancies, usually presenting at an advanced stage during pregnancy. The disease management often generates difficulties and distress for the mother, her family and health professionals involved, depending on the dilemma created between the ideal therapy for the mother and fetus welfare. Diagnostic approach is based on triple test consisting of clinical, imaging and biopsy examination to evaluate disease extension in breast and lymph nodes, identify possible multiple outbreaks or bilateral tumors, and prevent systemic metastasis and manage local disease. Therapy delay in order to protect fetus can compromise maternal health. Modified radical mastectomy and classic radical mastectomy can be safely used. Axillary dissection should be performed, since metastases are commonly found in pregnancy and lymph node involvement defines chemotherapy. Evidence suggests safety and efficacy of 5-fluorouracil, doxorubicin (or epirubicin) and cyclophosphamide during the second and third trimester of pregnancy. Radiotherapy should be postponed whenever possible after delivery. This study also aims to encourage breast examination during routine gynecologic evaluation and prenatal care, making patient and health team aware of its importance during pregnancy and childbirth.