Cáncer de mama y embarazo

Abstract

Breast cancer is the most frequent cancer among women in developed countries. During the past two decades, the number of women who became pregnant over the age of 35 age rose to more than 35%. This means that in many occasions, patients diagnosed of a malignant neoplasm before 36 years of age had not fulfilled the desire to conceive and many women would not still even consider about getting pregnant. Furthermore, more cases of breast cancer during pregnancy are diagnosed. Octavi Córdoba, Elisa Llurba, Cristina Saura, Isabel Rubio, Queralt Ferrer, Javier Cortés, Jordi Xercavins. Multidisciplinary approach to breast cancer diagnosed during pregnancy: Maternal and neonatal outcomes. Breast 2013; 22: 515-9. On this paper we assessed maternal and neonatal outcome in women diagnosed with breast cancer during pregnancy. Patients and methods: Retrospective single-centre cohort study of 25 consecutive pregnant women (mean age 36 years) diagnosed and treated for breast cancer between 2000 and 2011. Management was individualized according to type of tumor and time of gestation at diagnosis. Results: Twelve patients were diagnosed during the second trimester. BI-RADS category <3 mammographic lesions were diagnosed in 7 patients. A suspicious area was detected by ultrasound in 20 of 21 women who underwent ultrasound studies. Nineteen patients had positive hormone receptors and 7sobreexpressed HER2. One patient was in stage 0, 8 in stage I, 8 in stage II, 3 in stage III and 5 in stage IV. Four patients decided voluntarily to legally terminate their pregnancies, one had a spontaneous miscarriage and in three patients, pregnancy was interrupted at the end of the third trimester before oncological treatment. Eleven patients were treated with chemotherapy during pregnancy after the second trimester using anthracycline-based regimens. In five patients the pregnancy was ended before 34 weeks of gestation. Nine patients had gestation-related complications, including preterm labor, pneumonia, increase in velocity of the middle cerebral artery, oligohydramnios, preeclampsia, extreme prematurity, intrauterine growth restriction, dyspnea, spontaneous miscarriage and chemotherapyrelated granulocytopenia. Betamethasone to stimulate fetal lung maturation was used in 6 patients. Conclusion: Breast cancer women diagnosed during pregnancy presented a high number of complications unrelated to antineoplastic treatment. A multidisciplinary team approach is necessary for satisfactory neonatal results. Octavi Córdoba, Meritxell Bellet, Xavier Vidal, Javier Cortés, Elisa Llurba, Isabel T Rubio, J Xercavins. Pregnancy after breast cáncer in young women does not adversily affect the prognosis. Breast 2012; 21: 272-5 On this paper ee assessed whether pregnancy after breast cancer in patients younger than 36 years of age affects the prognosis. Of 115 women with breast cancer followed for a mean of 6 years, 18 became pregnant (median time between diagnosis and the first pregnancy 44. 5 months). Voluntary interruption of pregnancy was decided by 8 (44. 4%) women. Significant differences in prognostic factors between pregnant and nonpregnant women were not observed. Pregnant women showed a lower frequency of positive estrogen receptors (41%) than non-pregnant (64%) (P ¼ 0. 06). At 5 years of follow-up, 100% of women in the pregnant group and 80% in the non-pregnant group were alive. The percentages of disease-free women were 94% and 64%, respectively (P ¼ 0. 009). Breast cancer patients presented a high number of unwanted pregnancies. Pregnancy after breast cancer not only did not adversely affect prognosis of the neoplasm but also may have a protective effect.

Date of Award	17 Dec 2013
Original language	Spanish
Supervisor	Jordi Xercavins Montosa (Director)