title: Treatment of pregnancy-associated breast cancer.
abstract: BACKGROUND
  In primary breast cancer three therapeutic components-cytotoxic, endocrine and targeted antibody therapy-have led to a significant reduction in breast cancer mortality. In pregnancy associated breast cancer the right therapeutic choice is still under discussion while incidence is increasing. With an incidence of 1/3,000 to 1/10,000 pregnancies, pregnancy-associated breast cancer is the most common solid tumor in pregnancy after cervical carcinoma.
  
  
  OBJECTIVE
  This article reviews the evidence base for the use of various treatment modalities in patients with pregnancy-associated breast cancer.
  
  
  METHODS
  Medline review, searching for articles including years 2000 through 2008 was performed. Search was conducted for the terms "pregnancy" and "breast cancer". Cross references up to the second level were taken into account if of interest for this review.
  
  
  RESULTS
  Loco-regional therapy of pregnancy-associated breast cancer follows the general guidelines for breast cancer therapy in principle. Radiation of the breast and/or chest wall is usually not performed during pregnancy. Chemotherapy is indicated for the majority of patients with pregnancy-associated breast cancer. After the first trimester, anthracycline-based chemotherapy is regarded as the treatment standard in pregnancy. Folate antagonists such as methotrexate are strictly contraindicated as they are the main cause of fetal malformations. Adjuvant endocrine therapy with anti-estrogens during pregnancy is contraindicated. Data on targeted biological treatment, particularly for HER2/neu positive tumors during pregnancy are scarce and this treatment should be postponed until after delivery.
  
  
  CONCLUSIONS
  This article summarizes the special features of the diagnosis and primary therapy of pregnancy-associated breast cancer with particular emphasis on cytotoxic therapy.
authors: Frauenklinik der Heinrich Heine Universität, Dusseldorf, Germany. Wolfgang.Janni@med.uni-duesseldorf.de.
authors: W
authors: W
authors: Janni
authors: P
authors: P
authors: Hepp
authors: C
authors: C
authors: Nestle-Kraemling
authors: J
authors: J
authors: Salmen
authors: B
authors: B
authors: Rack
authors: E
authors: E
authors: Genss
authors: C
authors: C
authors: Schindlbeck
authors: K
authors: K
authors: Friese
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D005260:Female; D006801:Humans; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy* / Q000401:mortality; D013534:Survival
chemical_list: D000970:Antineoplastic Agents