Management of pregnancy-associated breast cancer requires careful multidisciplinary care and coordination for optimal outcomes.
Pregnancy after a breast cancer diagnosis is not associated with worsened outcomes, based on retrospective data.
Male breast cancer management is largely extrapolated from data on female breast cancer; however, tamoxifen is the preferred endocrine therapy agent.
Combined hormone replacement therapy with estrogen and progesterone in postmenopausal women increases the risk of developing breast cancer, but risk is not clearly increased with estrogen-only therapy.
Adjuvant endocrine therapy with tamoxifen or an aromatase inhibitor can be considered for estrogen receptor–positive ductal carcinoma in situ.
Patients with pathogenic mutations in breast cancer susceptibility genes should be counseled regarding the risks and benefits of screening and prevention options.
BREAST CANCER DURING PREGNANCY
Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy, the 12 months after delivery, or during lactation. Breast cancer is one of the most common cancers diagnosed during pregnancy. Because many women delay pregnancy, and age is a risk factor for breast cancer, the incidence of PABC appears to be rising. A Swedish National Health Registry study showed increased incidence from 16 to 37.4 per 100,000 deliveries between 1963 and 2002.1 Factors associated with PABC included age 35 years or older, private insurance, and delivery in an urban teaching hospital.2 Pregnancy itself is associated with a transient increase in breast cancer risk, followed by a reduced risk later in life.3
PABC most commonly presents as a painless mass that is self-detected or noted on clinical examination. The duration of symptoms is often longer in patients with PABC compared with their nonpregnant counterparts. Physiologic changes in a pregnant woman's breast, especially in women older than 30 years, lack of physician familiarity with PABC, and socioeconomic and cultural factors may contribute to delays in diagnosis.4
Although the majority of breast masses during pregnancy are benign, a breast mass that does not resolve within 2 weeks requires further investigation.5 Any clinically suspicious breast mass should be biopsied for a definitive diagnosis. Although a number of small studies have demonstrated diagnostic accuracy of fine-needle aspiration, a core or excisional biopsy is necessary to identify invasion (Fig. 38–1).6
Algorithm for the evaluation and treatment of a suspicious breast mass during pregnancy. DCIS, ductal carcinoma in situ; MRI, magnetic resonance imaging.
Two large surgical series of pregnant patients who had general anesthesia for various medical problems failed to demonstrate an increased risk of congenital malformations compared with those not undergoing surgery.7,8 Ultimately, the least invasive, but most technically accurate method(s) available are recommended to determine the nature of a breast mass in a pregnant ...