Breast cancer in pregnancy: a literature review

S Deckers, F Amant, S Deckers, F Amant

Abstract

Breast cancer is the most common cancer diagnosed during pregnancy. The incidence of breast cancer in pregnancy (BCP) is expected to increase since women tend to postpone childbearing until later in life and since the incidence of breast cancer increases with age. The management of this co-incidence is a clinical and ethical multidisciplinary challenge for all involved medical care workers since two lives are at risk. Breast cancer treatment is possible during pregnancy. Still, little prospective research data are available on this condition. In this review, we present an overview of the current knowledge about the safety of diagnostic imaging, staging methods and treatment options of BCP. We also discuss the prognosis, neonatal outcome and recommendations concerning prenatal care.

Keywords: Pregnancy; breast; cancer; management; neonatal.

References

    1. Aghajafari F, Murphy K, Matthews S, Ohlsson A, Amankwah K, Hannah M. Repeated doses of antenatal corticosteroids in animals: a systematic review. Am J Obstet Gynecol. 2002;186:843–849.
    1. Alexander A, Samlowski WE, Grossman D, Bruggers C, Harris R, Zone J, Noyes D, Bowen G, Leachman S. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol. 2003;21:2179–2186.
    1. Amant F, Van Calsteren K, Vergote I, Ottevanger N. Gynecologic oncology in pregnancy. Critical Reviews in Oncology/Hematology. 2008;67:187–195.
    1. National Institutes of Health. Antenatal corticosteroids revisited: repeat courses – National Institutes of Health Consensus Development Conference Statement, August 17-18,. 2000. Obstet Gynecol. 2001;98:144–150.
    1. Antypas C, Sandilos P, Kouvaris J, Balafouta E, Karinou E, Kollaros N, Vlahos L. Fetal dose evaluation during breast cancer radiotherapy. Int J Radiat Oncol Biol Phys. 1998;40:995–999.
    1. Arceci RJ, Croop JM, Horwitz SB, Housman D. The gene encoding multidrug resistance is induced and expressed at high levels during pregnancy in the secretory epithelium of the uterus. Proc Natl Acad Sci USA. 1988;85:4350–4354.
    1. Aviles A, Neri N, Nambo MJ. Long-term evaluation of cardiac function in children who received anthracyclines during pregnancy. Ann Oncol. 2006;17:286–288.
    1. Aviles A, Neri N. Hematologic malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2001;2:173–177.
    1. Bader AA, Schlembach D, Tamussino KF, Pristauz G, Petru PE. Anhydramnios associated with administration of trastuzumab and paclitaxel for metastatic breast cancer during pregnancy. Lancet Oncol. 2007;8:79–81.
    1. Baker J, Ali A, Groch M, Fordham E, Economou S. Bone scanning in patients with breast carcinoma. Clin Nucl Med. 1987;12:519–524.
    1. Barber HR. Fetal and neonatal effects of cytotoxic agents. Obstet Gyncol. 1981;58:41–47.
    1. Berger JC, Clericuzio CL. Clinical report: Pierre Robin sequence associated with first trimester fetal tamoxifen exposure. Am J Med Genet. 2008;146(Part A):2141–2144.
    1. Blanford AT, Murphy BE. In vitro metabolism of prednisolone, dexamethasone, betamethasone, and cortisol by the human placenta. Am J Obstet Gynecol. 1977;127:264–267.
    1. Blatt J, Mulvihill JJ, Ziegler JL, Young RC, Poplack DG. Am J Med. 1980;69:828–832.
    1. Byrd BF, Bayer DS, Robertson JC, Stepheson SE., Jr Treatment of breast tumors associated with pregnancy and lactation. Ann Surg. 1962;155:940–947.
    1. Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5:283–291.
    1. Chen MM, Coackley FV, Kaimal A, Laros RK. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol. 2008;112:333–340.
    1. Clark S. Prophylactic tamoxifen. Lancet. 1993;342:168.
    1. Crowther CA, Doyle LW, Haslam RR, Hiller JE, Harding JE, Robinson JS. Outcomes at 2 years of age after repeat doses of antenatal corticosteroids. N Engl J Med. 2007;357:1179–1189.
    1. Cullins SL, Pridjian G, Sutherland CM. Goldenhar’s syndrome associated with tamoxifen given to the mother during gestation. JAMA. 1994;271:1905–1906.
    1. Cunha GR, Taguchi O, Namikawa R, Nishizuka Y, Robboy SJ. Teratogenic effects of clomiphene, tamoxifen, and diethylstilbestrol on the developing human female genital tract. Hum Pathol. 1987;18:1132–1143.
    1. De Santis M, Lucchese A, De Carolis S, Ferrazani S, Caruso A. Metastatic breast cancer in pregnancy: first case of chemotherapy with docetaxel. Eur J Cancer Care. 2000;9:235–237.
    1. de Vries A, Holmes MC, Heijnis A, Seier J, Heerden J, Louw J, Coote S, Meaney M, Levitt N, Seckl J. Prenatal dexamethasone exposure induces changes in nonhuman primate offspring cardiometabolic and hypothalamic-pituitary-adrenal axis function. J Clin Invest. 2007;117:1058–1067.
    1. Doll DC, Ringenberg QS, Yarbo JW. Antineoplastic agents and pregnancy. Semin Onc. 1989;16:337–345.
    1. Duncan PG, Pope WD, Cohen MM, Greer N. Fetal risk of anesthesia and surgery during pregnancy. 1986;64:790–794.
    1. Dunn JS, Jr, Anderson CD, Brost BC. Breast carcinoma metastatic to the placenta. Obstet Gynecol. 1999;94:846.
    1. Eedarapalli P, Jain S. Breast cancer in pregnancy. J Obstet Gynaecol. 2006;26:1–4.
    1. Fanale MA, Uyei AR, Theriault RL, Adam K, Thompson RA. Treatment of metastatic breast cancer with trastuzumab and vinorelbine during pregnancy. Clin Breast Cancer. 2005;6:354–356.
    1. Gadducci A, Cosio S, Fanucchi A, Nardini V, Roncella M, Conte PF, Genazzani AR. Chemotherapy with epirubicin and paclitaxel for breast cancer during pregnancy: case report and review of the literature. Anticancer Res. 2003;23:5225–5229.
    1. Gainford MC, Clemons M. Breast cancer in pregnancy: are taxanes safe? Clin Oncol. 2006;18:159.
    1. Garcia-Manero M, Royo MP, Espinos J, Pina L, Alcazar JL, Lopez G. Pregnancy associated breast cancer. Eur J Surg Oncol. 2008:1–4.
    1. Gedeon C, Koren G. Designing pregnancy centered medications: drugs which do not cross the human placenta. Placenta. 2006;27:861–868.
    1. Gentilini O, Cremonesi M, Trifiro G, Ferrari M, Baio SM, Caracciolo M, Rossi A, Smeets A, Galimberti V, Luini A, et al. Safety of sentinel node biopsy in pregnant patients with breast cancer. Ann Oncol. 2004;15:1348–1351.
    1. Gonzalez-Angulo AM, Walters RS, Carpenter RJ, Jr, Ross MI, Perkins GH, Gwyn K, Theriault RL. Paclitaxel chemotherapy in a pregnant patient with bilateral breast cancer. Clin Breast Cancer. 2004;5:317–319.
    1. Gralla RJ, Osoba D, Kris MG, Kirkbridge P, Hesketh P, Chinnery L, Snow R, Gill D, Groshen S, Grunberg S, et al. Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol. 1999;17:2971–2994.
    1. Greskovich JF, Jr, Macklis RM. Radiation therapy in pregnancy: risk calculation and risk minimization. Semin Oncol. 2000;27:633–645.
    1. Gwyn K, Theriault R. Breast cancer during pregnancy. Oncology (Huntingt) 2001;15:39–46.
    1. Gwyn K. Children exposed to chemotherapy in utero. J Natl Cancer Inst Monogr. 2005;34:69–71.
    1. Hahn KM, Johnson PH, Gordon N, Kuerer H, Middleton L, Ramirez M, Yang W, Perkins G, Hortobagyi GN, Theriault RL. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer. 2006;107:1219–1226.
    1. Hall EJ. Scientific view of low-level radiation risks. Radiographics. 1991;1:509–518.
    1. Hogge JP, De Paredes ES, Magnant CM, Lage J. Imaging and management of breast masses during pregnancy and lactation. Breast J. 1999;5:272–283.
    1. Hubalek M, Schinderwig C, Zeimet AG, Sergi C, Brezinka C, Holzner E, Marth C. Chemotherapeutic treatment of a pregnant patient with ovarian dysgerminoma. Arch Gynecol Obstet. 2007;276:179–183.
    1. International Commission on Radiological Protection. Biological effects after prenatal irradiation (embryo and fetus) Ann ICRP. 2003;33:205–206.
    1. Jones AL. Management of pregnancy-associated breast cancer. The breast. 2006;15:47–52.
    1. Kal HB, Struikmans H. Radiotherapy during pregnancy: fact and fiction. Lancet Oncol. 2005;6:328–333.
    1. Keleher A, Wendt R, Delpassand E, Stachowiak AM, Kuerer HM. The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulphur colloid. The Breast Journal. 2004;10:492–495.
    1. Khera SY, Kiluk JV, Hasson DM, Meade TL, Meyers MP, Dupont EL, Berman CG, Cox CE. Pregnancy-associated breast cancer patients can safely undergo lymphatic mapping. The Breast Journal. 2008;14:250–254.
    1. King RM, Welch JS, Martin JK, Jr, Coulam CB. Carcinoma of the breast associated with pregnancy. Surg Gynecol Obstet. 1985;160:228–232.
    1. Lee KF, Simon H, Chen H, Bates B, Hung MC, Hauser C. Requirement for neuroregulin receptor erbB2 in neural and cardiac development. Nature. 1995;378:394–398.
    1. Lenhard MS, Bauerfeind I, Untch M. Breast cancer and pregnancy: challenges of chemotherapy. Critical Reviews in Oncology/Hematology. 2008;67:196–203.
    1. Loibl S, Von Minckwitz G, Gwyn K, Ellis P, Blohmer JU, Schlegelberger B, Keller M, Harder S, Theriault RL, Crivellari D, et al. Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer. 2006;106:237–246.
    1. Lycette JL, Dul CL, Munar M, Belle D, Chui SY, Koop DR, Nichols CR. Effect of pregnancy on the pharmacokinetics of paclitaxel: a case report. Clin Breast Cancer. 2006;7:342–344.
    1. Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal re-hospitalization. JAMA. 2000;283:2411–2416.
    1. Maghfoor I, Doll DC. Perry MC, editor. The chemotherapy source book. Philadelphia: Lippincott Williams & Wilkins; 2001. Chemotherapy in pregnancy; pp. 537–546.
    1. Mantovani G, Gramignano G, Mais V, Melis GB, Parodo G, Carucciu GM. Use of chemotherapy for ovarian cancer during human pregnancy: case report and literature review. Eur J Obstet Gynecol Reprod Biol. 2007;131:238–239.
    1. Mazonakis M, Varveris H, Damilakis J, Theoharopoulos N, Gourtsoyiannis N. Radiation dose to conceptus resulting from tangential breast irradiation. Int J Radiation Oncology Biol Phys. 2003;55:386–391.
    1. Mendez LE, Mueller A, Salom E, Quintero VH. Paclitaxel and carboplatin chemotherapy administered during pregnancy for advanced epithelial ovarian cancer. Obstet Gynecol. 2003;102:1200–1202.
    1. Meyer-Wittkopf M, Barth H, Emons G, Schmidt S. Fetal cardiac effects of doxorubicin therapy for carcinoma of the breast during pregnancy: case report and review of the literature. Ultrasound Obstet Gynecol. 2001;18:62–66.
    1. Mir O, Berveiller P, Ropert S, Goffinet F, Pons G, Treluyer , Goldwasser F. Emerging therapeutic options for breast cancer chemotherapy during pregnancy. Ann Oncol. 2008;19:607–613.
    1. Gilani M, Karimi-Zarchi M, Behtash N, Ghaemmaghami F, Mousavi AS, Behnamfar F. Preservation of pregnancy in a patient with advanced ovarian cancer at 20 weeks of gestation: case report and literature review. Int J Gynecol Cancer. 2007;17:1140–1143.
    1. Molckovsky A, Madarnas Y. Breast cancer in pregnancy: a literature review. Breast Cancer Res Treat. 2008;108:333–338.
    1. Mondi MM, Cuenca RE, Ollila DW, Stewart JH, Levine EA. Sentinel lymph node biopsy during pregnancy: initial clinical experience. Ann Surg Oncol. 2006;14:218–221.
    1. Muireachtaigh RN, Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth. 2006;18:60–66.
    1. Navrozoglou I, Vrekoussis T, Kontostolis E, Dousias V, Zervoudis S, Stathopoulos EN, Zoras O, Paraskevaidis E. Breast cancer during pregnancy: a mini-review. Eur J Surg Oncol. 2008;34:837–843.
    1. Nettleton J, Long J, Kuban D, Wu R, Shaeffer J, El-Mahdi A. Breast cancer during pregnancy: quantifying the risk of treatment delay. Obstet Gynecol. 1996;87:414–418.
    1. Ngu SL, Duval P, Collins C. Foetal radiation dose in radiotherapy for breast cancer. Australas Radiol. 1992;36:321–322.
    1. Nieto Y, Santisteban M, Aramendia JM, Fernandez-Hidalgo O, Manero M, Lopez G. Docetaxel administered during pregnancy for inflammatory breast carcinoma. Clin Breast Cancer. 2006;6:533–534.
    1. Novotny DB, Maygarden SJ, Shermer RW, Frable WJ. Fine needle aspiration of benign and malignant breast masses associated with pregnancy. Acta Cytol. 1991;35:676–686.
    1. Osei EK, Faulkner K. Fetal doses from radiological examinations. Br J Radiol. 1999;72:773–780.
    1. Otake M, Schull WJ, Lee S. Threshold for radiation-related severe mental retardation in prenatally exposed A-bomb survivors: a re-analysis. Int J Radiat Biol. 1996;70:755–763.
    1. Oto A, Ernst R, Jesse MK, Chaljub G, Saade G. Magnetic resonance imaging of the chest, abdomen and pelvis in the evaluation of pregnant patients with neoplasms. Am J Perinatol. 2007;24:243–250.
    1. Ozer H, Armitage JO, Bennett CL, Crawford J, Demetri GD, Pizzo PA, Schiffer CA, Smith TJ, Somlo G, Wade JC, et 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. J Clin Oncol. 2000;18:3558–3585.
    1. Parente JT, Amsel M, Lerner R, Chinea F. Breast cancer associated with pregnancy. Obstet Gynecol. 1988;1:861–864.
    1. Pavlidis N, Pentheroudakis G. The pregnant mother with breast cancer: diagnostic and therapeutic management. Cancer Treatment Reviews. 2005;31:439–447.
    1. Peccatori F, Martinelli G, Gentilini O, Goldhirsch A. Chemotherapy during pregnancy: what is really safe? Lancet Oncol. 2004;5:398.
    1. Pereg D, Koren G, Lishner M. Cancer in pregnancy: gaps, challenges and solutions. Cancer Treatment Reviews. 2008;34:302–312.
    1. Potluri V, Lewis D, Burton GV. Chemotherapy with taxanes in breast cancer during pregnancy: case report and review of the literature. Clin Breast Cancer. 2006;7:167–170.
    1. Reed W, Hannisdal G, Skovlund E, Thoresen S, Lileng P, Nesland JM. Pregnancy and breast cancer: a population-based study. Virchows Arch. 2003;443:44–50.
    1. Ring A. Breast cancer and pregnancy. The breast. 2007;16:155–158.
    1. Ring AE, Smith IE, Ellis PA. Breast cancer and pregnancy. Ann Oncol. 2005;16:1855–1860.
    1. Sekar R, Stone PR. Trastuzumab use for breast cancer in pregnancy. Obstet Gynecol. 2007;110:507–510.
    1. Sener SF, Winchester DJ, Martz CH, Feldman JL, Cavanaugh JA, Winchester MD, Weigel B, Bonnefoi K, Kirby K, Morehead C. Lymphedema after sentinel lymphadenectomy for breast carcinoma. Cancer. 2001;92:748–752.
    1. Shellock FG, Kanal E. Policies, guidelines, and recommendations for MR imaging safety and patient management. SMRI Safety Committee. J Magn Reson Imaging. 1991;1:97–101.
    1. Shrim A, Bournissen F, Maxwell C, Farine D, Koren G. Favorable pregnancy outcome following Trastuzumab (Herceptin®) use during pregnancy – Case report and updated literature review. Reprod Toxicol. 2007;23:611–613.
    1. Smit JW, Huisman MT, Van Tellingen O, Wiltshire HR, Schinkel AH. Absence or pharmacological blocking of placental P-glycoprotein profoundly increases fetal drug exposure. J Clin Invest. 1999;104:1441–1447.
    1. Sood AK, Shahin MS, Sorosky JI. Paclitaxel and platinum chemotherapy for ovarian carcinoma during pregnancy. Gynecol Oncol. 2001;83:599–600.
    1. Sorosky JI, Conner CE. Breast disease complicating pregnancy. Obstet Gynecol Clin North Am. 1998;25:353–363.
    1. Sorosky JI, Sood AK, Buekers TE. The use of chemotherapeutic agents during pregnancy. Obstet Gynecol Clin North Am. 1997;24:591–599.
    1. Steenvoorde P, Pauwels EK, Harding LK, Bourguignon M, Mariere B, Broerse JJ. Diagnostic nuclear medicine and risk for the fetus. Eur J Nucl Med. 1998;25:193–199.
    1. Stensheim H, Moller B, Van Dijk T, Fossa S. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol. 2009;27:45–51.
    1. Stovall M, Blackwell CR, Cundiff J, Novack DH, Palta JR, Wagner LK, Webster EW, Shalek RJ. Fetal dose from radiotherapy with photon beams: Report of AAPM Radiation Therapy Committee Task Group No. 36. Med Phys. 1995;22:63–82.
    1. Teran-Porcayo MA, Gomes-Del Castillo-Rangel AC, Barrera-Lopez N, Reichener-Gancz I. Cancer during pregnancy: 10-year experience at a regional cancer reference center in Mexico. Med Oncol. 2008;25:50–53.
    1. Tewari K, Bonebrake RG, Asrat T, Shanberg AM. Ambiguous genitalia in infant exposed to tamoxifen in utero. Lancet. 1997;350:183.
    1. Tobon H, Horowitz LF. Breast cancer during pregnancy. Breast Dis. 1993;6:127–134.
    1. UNSCEAR. Sources and effects of ionizing radiation. Annex J, developmental effects of irradiation in utero. New York: United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR); 1977.
    1. Uren R. Safety of lymphoscintigraphy and ⁄or blue dye for SLN biopsy in pregnancy. Presented at the 5th Biennial International Sentinel Node Society Meeting; November 1-4, 2006; Rome, Italy.
    1. Van Calsteren K, Berteloot P, Hanssens M, Vergote I, Amant F, Ganame J, Claus P, Mertens L, Lagae L, Delforge M, et al. In utero exposure to chemotherapy: effect on cardiac and neurologic outcome. J Clin Oncol. 2006;24:16–17.
    1. Van Calsteren K, Heyns L, De Smet F, Van Eycken L, Mhallem Gziri M, Van Gemert W, Halaska M, Vergote I, Ottevanger PB, Amant F. Cancer during pregnancy: an analysis of 215 patients emphasising the obstetical and the neonatal outcome. J Clin Oncol. 2009
    1. Van Calsteren K, Lagae L, Mertens L, Vergote I, Amant F. Maternale oncologische problemen tijdens de zwangerschap: neonatale en langetermijnuitkomst van kinderen. Tijdschr Geneeskd. 2007;63:595–599.
    1. Van Calsteren K, Verbesselt R, Paridaens R, Verhaeghe J, Vergote I, de Hoon J, Amant F. Pregnancy induces decreased doxorubicin plasma levels and tissue toxicity. European Society of Gynaecological Oncology Meeting. 2007, 28/10 till 1/11/2007, Berlin, Germany.
    1. Van Der Giessen PH. Measurement of the peripheral dose for the tangential breast treatment technique with Co-60 gamma radiation and high energy X-rays. Radiother Oncol. 1997;42:257–264.
    1. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Robertson C, Maisonneuve P, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546–553.
    1. Wapner RJ, Sorokin Y, Mele L, Johnson F, Dudley DJ, Spong CY, Peaceman AM, Leveno KJ, Malone F, Caritis SN, et al. Long-term outcomes after repeat doses of antenatal corticosteroids. N Engl J Med. 2007;357:1190–1198.
    1. Waterston AM, Graham J. Effect of adjuvant trastuzumab on pregnancy. J Clin Oncol. 2006;24:321–322.
    1. Watson W. Herceptin (trastuzumab) therapy during pregnancy: association with reversible anhydramnios. Obstet Gynecol. 2005;105:642–643.
    1. Webb JA, Thomsen HS, Morcos SK. The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol. 2005;15:1234–1240.
    1. White TT. Carcinoma of the breast and pregnancy; analysis of 920 cases collected from the literature and 22 new cases. Ann Surg. 1954;139:9–18.
    1. Wilson S, Amsler K, Hyink D, Li X, Lu W, Burrow CR, Wilson PD. Inhibition of HER-2/(neu/ErbB2) restores normal function and structure to polycystic kidney disease (PKD) epithelia. Biochim Biophys Acta. 2006;1762:647–655.
    1. Witzel ID, Mueller V, Harps E, Jaenicke F, Dewit M. Trastuzumab in pregnancy associated with poor fetal outcome. Ann Oncol. 2008;19:191–195.
    1. Woo JC, Taechin Y, Hurd TC. Breast cancer in pregnancy. A literature review. Arch Surg. 2003;138:91–98.
    1. Zanotti-Fregonara P, Champion Ch, Trebossen R, Maroy R, Devaux JY, Hindie E. Estimation of the ß+ dose to the embryo resulting from 18F-FDG administration during early pregnancy. J Nucl Med. 2008;49:679–682.
    1. Zemlickis D, Lishner M, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G. Fetal outcome after in utero exposure to cancer chemotherapy. Arch Intern Med. 1992;152:573–576.

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