Breast cancer diagnosed during pregnancy

Souayeh Nesrine, Dab Safa, Bettaieb Hajer, Rouis Hadhami, Hsayaoui Najeh, Mbarki Chaouki

Objective:  Breast cancer is the second most common cancer in pregnant women. Pregnancy-associated breast cancer (PABC) is defined as breast cancer that occurs during pregnancy or within one year of delivery. The aim of this study was to describe clinical and therapeutic aspects of PABC.

Design: A retrospective descriptive longitudinal study lead in Gynecology and obstetric department of Ben Arous hospital over a period of 10 years, including women with PABC.

Method: We performed a review of all medical records of patients with breast cancer diagnosed during pregnancy.

Results:  Four cases of PABC were diagnosed among 301 women treated for breast cancer during the same period (frequency=1.32%). The median age at diagnosis was 33.75 years (30-35 years). Term of pregnancy at disease discovery was between 20 and 32 Gestational weeks (GW). The most common discovery mode was auto-alpation of a breast bulk. The mean tumor size at diagnosis was 3 cm. Lymph node involvement was found in 2 patients, both classified as N1. No patient was metastatic at diagnosis.  Breast ultrasonography was performed in all patients as well as  mammography except for one who was pregnant at 20 GW. Infiltrating ductal carcinoma (CCI) was the most common histological type (in 3 patients) and one patient had intraductal carcinoma (CIS). High-grade SBR forms (SBRII and III) were found in 75% of cases and two patients had vascular emboli. Mastectomy associated with axillar lymphadenectomy was performed in two patients while conservative surgery was indicated for the two others. The surgery was performed after neoadjuvant chemotherapy in 2 cases and three of our patients had chemotherapy during pregnancy. Adjuvant chemotherapy was used in one patient. No premature delivery was induced and mean gestational age at delivery was 36.25 GW. Three patients had normal delivery. The median overall survival was 76.5 months.

Conclusion: Breast cancer should be treated during pregnancy following the general guidelines for young nonpregnant patients as closely as possible. Therefore, pregnancy does not seem to influence breast cancer prognosis.