Breast cancer in pregnancy

Abstract

Breast cancer in pregnancy presents a challenging clinical situation that places the welfare of the mother in conflict with that of her fetus. It is difficult to detect, to stage and to treat breast cancer in pregnancy due to the physiological changes in the breast that accompany pregnancy and lactation, as well as the desire to limit radiation exposure and chemotherapy. Prospective studies of women who are pregnant at the time of diagnosis are limited; hence the management guidelines are mostly from retrospective chart reviews and case reports. Teratogenic effects to the fetus are major in first trimester of pregnancy, so invasive examination and treatment should be avoided. Investigation by chest X-ray plain film with Lead-shields protection is acceptable, but other imaging scans such as CT scan have impacts to fetus. Chemotherapy is suggested in second and third trimester of pregnancy. The regimen of 5-Fluorouracil, Doxorubicin and Cyclophosphomide is safety regimens for fetus. However new drugs, for example Tamoxifen and trastusumab are not recommended because of evident of teratogenic effects. Furthermore therapeutic abortion is not suggested because it does not improve the change of recovery.