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Monday, October 8, 2018

BREAST CANCER IN PREGNANT WOMEN




 It is possible to have breast cancer during pregnancy, although it is rare and it is not caused by the pregnancy. Breast cancer occurs about once in every 3,000 pregnancies. It occurs most often in women aged 32 to 38 years. Because many women are choosing to delay having children, it is likely that the number of new cases of breast cancer during pregnancy will increase.

Signs of breast cancer

These and other signs may be caused by breast cancer or by other conditions. Check with your doctor if you have any of the following:

·         A lump or thickening in or near the breast or in the underarm area.

·         A change in the size or shape of the breast.

·         A dimple or puckering in the skin of the breast.

·         A nipple turned inward into the breast.

·         Fluid, other than breast milk, from the nipple, especially if it's bloody.

·         Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple).

·         Dimples in the breast that look like the skin of an orange, called peau d’orange.

 Diagnosis of breast cancer in pregnant women

The natural tenderness and engorgement of the breasts of pregnant and lactating women may hinder detection of discrete masses and early diagnosis of breast cancer. Delays in diagnosis are common, with an average reported delay of 5 to 15 months from the onset of symptoms.[1-4] Because of this delay, cancers are typically detected at a later stage than in a nonpregnant, age-matched population.[5]

The following tests and procedures may be used to diagnose breast cancer during pregnancy:

·         Breast self-examination.

·         Clinical breast examination.

·         Ultrasound.

·         Biopsy and hormone receptor assays.

·         Mammography.

To detect breast cancer, pregnant and lactating women should consider practicing self-examination and undergo a clinical breast examination as part of the routine prenatal examination by a doctor. If an abnormality is found, diagnostic approaches such as ultrasound and mammography may be used.

Because at least 25% of mammograms in pregnancy may be negative in the presence of cancer, a biopsy is essential for the diagnosis of any palpable mass. Diagnosis may be safely accomplished with a fine-needle aspiration, core biopsy, or excisional biopsy under local anesthesia.

Breast cancer pathology is similar in age-matched pregnant and nonpregnant women. Hormone receptor assays using a competitive binding assay are usually negative in pregnant breast cancer patients, but this may be the result of receptor binding by high serum estrogen levels associated with the pregnancy. Enzyme immunocytochemical receptor assays are more sensitive than competitive binding assays. A study that used both assay methods indicated similar receptor positivity between pregnant and nonpregnant women with breast cancer. The study concluded that increased estrogen levels during pregnancy could result in a higher incidence of receptor positivity detected with immunohistochemistry than is detected by radiolabeled ligand-binding assay because of competitive inhibition by high levels of endogenous estrogen.

Tests done on finding the Cancer

If cancer is found, tests are done to study the cancer cells.

Decisions about the best treatment are based on the results of these tests and the age of the unborn baby. The tests give information about:

·         How quickly the cancer may grow.

·         How likely it is that the cancer will spread to other parts of the body.

·         How well certain treatments might work.

·         How likely the cancer is to recur (come back).

Tests may include the following:

·         Estrogen and progesterone receptor test

·         Human epidermal growth factor type 2 receptor (HER2/neu) test

·         Multigene tests

Prognosis and Chance of Treatment

The prognosis (chance of recovery) and treatment options depend on the following:

·         The stage of the cancer (the size of the tumor and whether it is in the breast only or has spread to other parts of the body).

·         The type of breast cancer.

·         The age of the unborn baby.

·         Whether there are signs or symptoms.

·         The patient’s general health.

The treatment plan will depend on the size of the tumor, its location, and the term of the pregnancy. Although the cancer itself cannot spread to and harm the unborn child, sometimes the best treatment plan for the mother may put the unborn child at risk. These decisions will require the expertise and consultation between the patient’s obstetrician, surgeon, medical oncologist, and radiation oncologist. Ending a pregnancy won’t improve a woman's chances of beating breast cancer. Also, there's no evidence that the cancer harms the baby. But the treatments have risks.

 Source: National Cancer Institute