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Query: UMLS:C0281663 (pregnancy and breast cancer)
 25 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Breast cancer in association with pregnancy and lactation is rare, but presents a therapeutic problem of considerable magnitude. The outlook for such patients is less favorable than that of nonpregnant, nonlactating women, probably because the stage of the disease is more advanced when it is discovered. The most significant factor in the poorer prognosis is physician delay in diagnosis and therapy. When mastectomy is carried out early in pregnancy, the operation can be as effective as in nonpregnant women of the same age groups. It is emphasized that when pregnancy and breast cancer are found concurrently, prompt therapy for the cancer should be undertaken. Interruption of pregnancy in nondisseminated breast cancer is of little value. If pregnancy is near term when the diagnosis of disseminated breast cancer is made, the desire of the husband and wife for a child should be considered. A modest delay in therapy to allow for delivery probably has no deleterious effect. Castration should be withheld and used only for the patient with metastatic disease. There may be a place for prophylactic castration in the treatment of disseminated disease, but its role is yet to be clearly defined. Subsequent pregnancies in a patient with axillary spread at the time of mastectomy are contraindicated, because of the high rate of treatment failure and decreased rate of survival. In patients desiring future pregnancies following mastectomy, a period of observation of at least 2 years seems wise. At the end of that period, if clinical evaluation, laboratory values, roentgenographic studies, and isotopic bone scanning are negative for disseminated disease, subsequent pregnancies seem safe. Prompt evaluation of any breast mass found during pregnancy and lactation should be carried out by needle or operative biopsies under local anesthesia. Although the prognosis of the pregnant or lactating woman with breast cancer is generally favorable, numerous long-term survivals are encountered in those women who undergo prompt mastectomy early in pregnancy. The former pessimistic outlook for such patients seems unjustified. With modern methods of diagnosis and treatment, therapy can be effective and successful.
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PMID:Pregnancy and breast cancer. 21 May 28

The simultaneous occurrence of breast cancer and pregnancy is rare. Little data are available about cytostatic treatment in patients with breast cancer during pregnancy. We report on a 31-year-old woman with a 28-week pregnancy and a T3 N+ Mx breast cancer treated with weekly doxorubicin chemotherapy. This was a well tolerated treatment without toxicity or complications for the mother. A partial response of the tumor was observed after 4 treatment courses. A normal baby was delivered. Doxorubicin and its metabolites were not detected in amniotic fluid collected through amniocentesis. Macroscopic and pathologic examinations of the placenta were normal. Although larger experiences are needed, weekly doxorubicin seems to yield satisfactory results without additional risks of fetal distress or malformations when given in women during the second and third trimester of pregnancy.
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PMID:Weekly doxorubicin chemotherapy for breast cancer in pregnancy. A case report. 149 9

The relations between age at first and last full-term pregnancy and breast cancer risk were investigated after 20 years of follow-up of 63,090 Norwegian women, among whom 1,565 breast cancer cases occurred. An association seen in preliminary analyses between early age at first birth and low risk of breast cancer was removed after adjustment for parity and age at last birth. Age at last birth showed initially no association with breast cancer. After adjustment for parity, however, a significant positive association emerged. The authors' observations suggest that the relation between age when a pregnancy occurs and breast cancer risk may be more complex than previously believed. Despite the overall association between increasing parity and lower risk, the women with many late pregnancies and those with few, widely spaced pregnancies had higher risk than nulliparous women, indicating that both the age when pregnancy occurs and the length of intervals between successive births may modify the protective effect. The findings are consistent with a dual effect of a pregnancy, causing a transient increase followed by a subsequent strong and long-lasting decrease in risk of breast cancer.
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PMID:A prospective study of reproductive factors and breast cancer. II. Age at first and last birth. 366 32

Breast cancer in women under 30 years old carries a poor prognosis, for reasons that have not been identified. This study aimed to identify prognostic factors in this age group. Special attention was paid to the history of pregnancy. The clinical presentation and course of breast cancer was documented for 407 women, aged 20-29 years, who registered between 1978 and 1988 at one of nine cancer centres. Eligible patients had histologically confirmed local or regional invasive breast carcinoma, and received part or all of their initial therapy at the participating hospital. For patients whose breast cancers were diagnosed during pregnancy, the risk of dying from breast cancer was significantly greater than that of women who had never been pregnant (relative risk 3.26 [95% CI 1.81-5.87], p = 0.0004). Adjustment for number of axillary nodes affected and tumour diameter reduced the relative risk only slightly (2.83 [1.24-6.45], p = 0.023). For each 1-year increment in the time between the latest previous pregnancy and breast cancer diagnosis, the risk of dying decreased by 15% (relative risk 0.85, p = 0.011). Thus concurrent or recent previous pregnancy adversely affects survival of breast cancer in young women. The size of the effect is such that it probably contributes substantially to the poor prognosis of breast cancer in this age group as a whole.
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PMID:Effect of pregnancy on prognosis for young women with breast cancer. 1100 70

Although breast cancer is the most common malignancy in pregnancy, its overall incidence remains low. It appears that pregnancy and breast cancer are merely coincidental and that pregnancy does not directly contribute to the development or accelerated progression of breast cancer. The majority of studies have documented a significant delay in diagnosis secondary to physiologic changes of the breast during pregnancy and have reasoned that this is the likely explanation for the advanced stage of disease upon initial presentation. Although pregnant patients present at a later stage of breast cancer, survival stage for stage is the same when pregnant patients are compared with young nonpregnant patients with breast cancer. A suspicious breast mass in a pregnant patient should be biopsied and appropriately treated, without need for extensive preoperative staging. Therapeutic abortion should be performed only on an individual basis, namely in patients in whom necessary radiation or chemotherapy would be detrimental to the developing fetus and in whom a significant delay of this treatment would be harmful. In patients with early-stage disease, it is recommended to wait 2 years after treatment of breast cancer for subsequent pregnancy; however, in women with advanced disease, subsequent pregnancy should be discouraged.
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PMID:Breast cancer in pregnancy and lactation. 861 Feb 63

The exact nature of the association between hormones and the development of breast cancer remains uncertain. Studies of endogenous hormone levels and breast cancer suggest a possible role of estrogens and androgens in the cause of breast cancer. Numerous studies have been conducted to assess the risk of breast cancer among women exposed to exogenous hormones. Several studies of women who have used oral contraceptives have shown a twofold increase in risk for the onset of breast cancer at an early age associated with 10 years of oral contraceptive use. One of the largest studies, the Cancer and Steroid Hormone Study, found no association between breast cancer and oral contraceptive use for women up to the age of 54. A meta-analysis combining the results of 31 published studies of the association between hormone replacement therapy and breast cancer revealed no increased risk of breast cancer associated with ever-use (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.93-1.12). Use of oral contraceptives for more than 10 years was associated with a small increased risk (RR, 1.23; 95% CI, 1.08-1.40), but few studies have examined very long term use. A recent study of pregnancy and breast cancer outcome found no adverse influence of pregnancy shortly before or after diagnosis of breast cancer on prognosis. The results of a wide range of studies should be considered when weighing the benefits and risks of hormone use among women at increased risk of breast cancer or with a history of breast cancer.
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PMID:Hormones and breast cancer. 863

A case-control study was carried out in Spain to assess associations between parity, lactation and age at first full-term pregnancy and breast cancer. From November 1989 to February 1992, 184 incident breast cancer histologically confirmed cases were interviewed and matched by age and residence to 184 hospitalized patients and 184 community controls selected by random digit dialing. Multiple logistic regression was used to assess the independent influence of each factor on the risk of breast cancer in relation to other factors included in the model. Age at first full-term pregnancy was associated with breast cancer risk with an estimated odds ratio of 3.5 (95% CI 1.41-9.83) for women with their first birth after 30 years in comparison with those whose first birth was before age 21. Breast cancer risk decreased with increasing number of full-term pregnancies, OR 0.3 (95% CI 0.16-0.78) for women who had had more than 3 full-term pregnancies in comparison with nulliparous women. Among parous women, the estimated OR for women with more than 3 children was 0.4 (95% CI 0.13-0.81) after allowance for age at first childbirth and lactation. The estimated OR was 2.6 (95% CI 1.4-4.7) for women with a positive history of breast cancer in first-degree relatives. Breast cancer was not associated with total duration of lactation. The study indicates that parity is an independent risk factor associated to breast cancer and that the women with a late age at first full-term pregnancy constitute a high-risk group.
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PMID:Age at first full-term pregnancy, lactation and parity and risk of breast cancer: a case-control study in Spain. 890 4

The concurrent diagnosis of breast cancer and pregnancy is a challenging clinical situation that historically has placed the welfare of the mother in conflict with that of the fetus. Modified radical mastectomy, the preferred surgical option in women with breast cancer during pregnancy, can be accomplished with minimal fetal risk. Although breast-conserving surgery (lumpectomy or quadrantectomy) can be performed, the radiation therapy required to complete local therapy for the breast must be delayed until after delivery because of the risks associated with fetal exposure to radiation. Although much of the literature on the pharmacologic treatment of breast cancer during pregnancy is anecdotal, recently published data from our institution support the premise that breast cancer can be treated safely during the second and third trimesters of pregnancy with combination chemotherapy consisting of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC). Therapeutic abortion does not appear to improve survival for the mother, but it may be an option if maternal health is jeopardized or fetal anomalies are seen or suspected.
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PMID:Breast cancer during pregnancy. 1205 66

This review presents guidelines for diagnosis, staging and management of breast cancer and pregnancy in order to help update the physician in making informed decisions. A number of controversies about the management of breast carcinoma and pregnancy produces uncertainties for treating physicians and their patients and the published advice on its management is somewhat conflicting. The various modalities used for screening diagnosis and staging of breast cancer, as well as therapy, are not always applicable during pregnancy. The main goal of this article is to offer to the pregnant woman diagnosed with breast cancer the optimal therapeutic modalities, while protecting the unborn fetus of immediate and late deleterious effects of radiation and chemotherapy. The management of both breast cancer and concurrent and subsequent pregnancy in an attempt to update the treating physicians in making informed decisions in diagnosis and therapy are reviewed. Suggested guidelines for diagnosis, staging and management of breast cancer and pregnancy, according to stages of the disease and gestational stages are outlined. They are based on the understanding of current literature and our clinical and research experience in the diagnosis and therapy of breast cancer and pregnancy.
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PMID:Breast cancer and related pregnancy: suggested management according to stages of the disease and gestational stages. 1293 4

The relationship between pregnancy and breast cancer is complex, and a paucity of available data further complicates decision-making for many women diagnosed with breast cancer during pregnancy or desiring to become pregnant after such a diagnosis. Treatment of breast cancer during pregnancy requires a multidisciplinary care team and careful consideration of the risk of the disease and gestational age of the fetus, in conjunction with the patient's preferences. Chemotherapy should be deferred beyond the first trimester. There is no evidence that pregnancy in a breast cancer survivor will decrease long-term survival; in fact, studies suggest a potential protective effect of pregnancy after breast cancer in terms of the risk of recurrence. However, the available studies are limited by substantial potential biases, and concerns remain for some women and their doctors about the risks of pregnancy after breast cancer. This article reviews what is known about the association between pregnancy and breast cancer, discusses treatment options for women diagnosed with the disease during pregnancy, and summarizes evidence regarding the safety of pregnancy after breast cancer.
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PMID:Pregnancy and breast cancer: epidemiology, treatment, and safety issues. 1597 47


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