Breast cancer in pregnancy: a literature review.
OBJECTIVE
Breast cancer in pregnancy will increase as more women postpone childbearing until later in life.


OBJECTIVE
To review the literature on diagnosis, staging, treatment, and prognosis.


METHODS
Articles were obtained from MEDLINE (1966-present) using the keywords breast, cancer, carcinoma, and pregnancy. Additional articles were sought using the references of those obtained. A total of 171 articles were found, 125 in English. More than 100 were reviewed, including 7 prospective and 40 retrospective studies, 6 case reports, and at least 47 review articles on various aspects of pregnancy and cancer. Data extraction was performed by 1 reviewer.


RESULTS
Diagnostic delays are shorter than in the past but remain common. Mammography has a high false-negative rate during pregnancy. Biopsy or needle aspiration are needed for diagnosis and cannot be postponed until after delivery. Pregnancy-associated cancers tend to occur at a later stage and be estrogen receptor-negative. However, they carry a similar prognosis to other breast cancers when matched for stage and age. Although modified radical mastectomy is the traditional treatment, breast-conserving therapy is increasingly common. Therapeutic radiation is contraindicated, but chemotherapy is relatively safe after the first trimester. Tamoxifen should be avoided in the first trimester and possibly beyond.


CONCLUSIONS
Physicians should perform a thorough breast examination at the first prenatal visit and maintain a high index of suspicion for cancer. Patients who wish to continue their pregnancies have a growing array of treatment options.
Woo
Junda C
JC
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
Yu
Taechin
T
Hurd
Thelma C
TC
D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods
D000970:Antineoplastic Agents