CHALLENGES IN MANAGING BREAST CANCER DURING PREGNANCY
Flora Zagouri
Alexandra Hospital, Medical School, University of Athens, Greece
Management of women during pregnancy with breast cancer is not well established and adds
complexity to physicians. Surgical resection remains the cornestone of breast cancer
treatment in pregnancy. Modified radical mastectomy is the gold standard in first trimester,
whereas breast-conserving surgery may be performed especially in the second and third
trimester. Interestingly enough, breast-conserving surgery is not contraindicated per se during
the first trimester, but due to the potential impact of delaying radiotherapy. Radiation therapy
is contraindicated during pregnancy. Furthermore, tamoxifen is forbidden during pregnancy,
due to the potential birth defects associated with this agent (up to 20% of exposures).
Chemotherapy is generally contraindicated during the first trimester due to the possible
damage to organogenesis. Anthracyclines-based chemotherapy is the most widely used is
breast cancer treatment and is associated with relatively favourable safety profile when given
during pregnancy. As for taxanes, accumulating data suggest that may be used in selected
cases during the second and third trimester. The use of trastuzumab is contraindicated during
pregnancy, given the high risk of oligo- and/or anhydramnios and may be postponed after
delivery. Consequently, it is quite clear that diagnosis of breast cancer during pregnancy adds
complexity to cancer treatment recommendations; a multidisciplinary therapeutic approach
amongst medical oncologists, gynaecologists, obstetricians, surgical oncologists,
hematologists and pediatricians is more than warranted.