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Breast cancer and cervical cancer are the two most commonly diagnosed cancers during pregnancy. Other malignant neoplasms are diagnosed less frequently, including ovarian cancer, melanoma, leukemia and lymphomas, including Hodgkin lymphoma. Pregnancy does not cause cancer and does not accelerate its growth. Cancers diagnosed during pregnancy are not inherently more “malignant” than those occurring in non-pregnant women. The more aggressive course of some cancers diagnosed during pregnancy is rather related to the younger age of the patients and the fact that more aggressive and less favorable types of breast cancer are more common in younger women. The more advanced stage of breast cancers diagnosed during pregnancy often results from delays in diagnosis and from the misconception that breast lumps during pregnancy are a “normal” occurrence.
This is cancer diagnosed at any time during pregnancy or within 1 year after delivery. It is estimated that cancer is diagnosed during pregnancy in approximately 1 in 1,000 to 1 in 10,000 women. Unlike melanoma, breast cancer does not metastasize to the fetus, although cases of placental metastases have been reported.
Every pregnant woman should undergo a breast ultrasound examination. In fact, every woman, regardless of pregnancy, should have a breast ultrasound examination once a year.
No breast lump detected during pregnancy should be ignored, particularly if the patient notices or suspects that the lump is increasing in size.
REMEMBER!
1. Young women can also develop breast cancer.
2. Not every breast lump is cancer, but no breast lump should be ignored.
3. Every woman should undergo a breast examination once a year, including pregnant women.
4. One of the greatest mistakes a pregnant woman can make is postponing diagnostic testing until “later”, for example until after pregnancy.
5. Pregnancy is not a contraindication to the diagnosis or treatment of breast cancer.
6. The earlier cancer is detected, the greater the chances of successful treatment.
The principles of diagnosis are generally the same as in women who are not pregnant. An exception concerns certain radiological examinations, such as mammography, which is performed when clinically justified, for example after cancer has already been confirmed or when it cannot be diagnosed adequately by other methods. The sensitivity of mammography in younger women is limited.
Several diagnostic procedures can be performed safely during pregnancy, including:
1. Breast ultrasound – can be performed at any stage of pregnancy. The sensitivity of breast ultrasound in women with palpable breast lumps is approximately 93–100%. In around 90% of women, ultrasound is sufficient to detect breast cancer.
2. Breast magnetic resonance imaging – the use of contrast depends on gestational age and MRI is not routinely performed during pregnancy.
3. FNA – fine-needle aspiration biopsy (fine-needle biopsy) – in cases where breast cancer is suspected (BI-RADS 4 and 5), performing fine-needle aspiration of a suspicious lesion should generally not be considered sufficient for diagnosis.
4. CNB – core needle biopsy (core needle biopsy) – particularly recommended in pregnant and breastfeeding women. A diagnosis of cancer must always be confirmed histopathologically, and the result of a fine-needle biopsy, which provides cytological confirmation only, is insufficient.
5. Vacuum-assisted breast biopsy – a type of core needle biopsy, particularly useful for small breast lesions.
All breast biopsies may be performed at any stage of pregnancy. There are also no contraindications to the use of local anesthesia.
The main objective is to cure the cancer whenever possible or to stop its further progression while protecting the unborn child. Treatment of breast cancer during pregnancy should be carried out in specialist referral centers and requires a comprehensive, multidisciplinary approach.
1. Gestational age – management differs depending on the trimester of pregnancy.
2. Stage of the cancer at the time of diagnosis.
3. Treatment goals and available therapeutic options.
4. The patient’s wishes.
Depending on these factors, treatment may include surgery, chemotherapy and, in a small number of cases, emergency radiotherapy, for example in patients with symptomatic brain metastases. Some anticancer treatments may be postponed until after delivery; for example, hormone therapy is deferred until after pregnancy. Compared with non-pregnant women of a similar age with a similar type and stage of breast cancer, the chances of successful treatment are comparable. In selected cases, delivery may also be brought forward so that appropriate oncological treatment can be started. Treatment after delivery does not differ from that used in women who are not pregnant.
Breastfeeding is contraindicated during systemic anticancer treatment, including chemotherapy, hormone therapy, bisphosphonates and denosumab.
No significant developmental disorders, including intellectual impairment, have been identified in children who were exposed to anticancer drugs in utero and were born healthy. Available data indicate that they generally develop normally and that their future fertility is not reduced.
However, chemotherapy during pregnancy is associated with an increased risk of preterm delivery.
If a woman has already given birth or if cancer is diagnosed after delivery, effective contraception is recommended. The choice of contraceptive method should be discussed with both an oncologist and a gynecologist.
Pregnancy after previous breast cancer has not been shown to increase the risk of cancer recurrence.
In women receiving adjuvant hormone therapy for breast cancer, treatment usually lasts approximately 5–10 years. After around 2–3 years, which is the period associated with the highest risk of recurrence, hormone therapy may in selected cases be temporarily interrupted for 1–2 years to allow pregnancy and childbirth. Breastfeeding for up to 6 months may also be considered. Hormone therapy should subsequently be resumed. Women previously treated for breast cancer who have no evidence of recurrent or persistent disease may be encouraged to breastfeed. Women with active, uncontrolled cancer should not become pregnant. In selected cases, a planned pregnancy should be discussed and agreed upon with the treating oncologist.
COMPREHENSIVE DIAGNOSIS OF BREAST LUMPS DURING PREGNANCY:
1. Breast ultrasound is performed by radiologist Dr Ewa Kołyszko.
2. In patients with a previously identified breast lump, further diagnostic assessment and treatment – including FNA (fine-needle aspiration biopsy), CNB (core needle biopsy), vacuum-assisted biopsy and surgical excision of a breast lump – are performed by surgical oncologists Dr Kamil Drucis and Dr Natalia Spychalska.
3. Gynecological care for pregnant patients with breast cancer is provided by gynecologist Dr Marek Korożan.
4. Patients diagnosed with a benign or malignant breast tumor who require consultation regarding treatment options, further diagnostics and oncological management are invited to consult clinical oncologist and radiation oncologist Dr Magdalena Korożan.
Book an appointment through our website (by e-mail, telephone or online registration in the Contact section) or via ZnanyLekarz: Dr Ewa Kołyszko, Dr Kamil Drucis, Dr Natalia Spychalska, Dr Marek Korożan, Dr Magdalena Korożan.
