The management of
PABC is very difficult. The incidence of
PABC is low, but may be increasing because of the number of women who are becoming pregnant at a later age. More investigation is needed to understand whether the biology of
PABC is different from that of
breast cancer in nonpregnant women. One exciting area of further research is the potential relationship between mutations in known
breast cancer susceptibility genes and
breast cancer development during pregnancy. Diagnosis or
PABC remains challenging because of the anatomic and physiologic changes that occur in the breast during pregnancy. Understanding the generic influences on
PABC may help physicians in diagnosing this disease earlier, and understanding the
tumor-receptor characteristics of
PABC can help physicians deliver effective treatment. The various modalities available for treatment of
PABC and their risks and benefits must be discussed openly with patients and their families. Abortion is not usually recommended.
Modified radical mastectomy is the recommended treatment for
PABC diagnosed during the first trimester. Neoadjuvant or
adjuvant chemotherapy can be given with minimal risks to the fetus during the second or third trimester.
Radiation therapy is contraindicated during pregnancy because of the potential for injury to the fetus.
Breast conservation therapy, with
radiation treatments given after delivery or after
neoadjuvant chemotherapy, is an option for women with
PABC diagnosed late in pregnancy. Once the appropriate treatment modality is chosen, its implementation must not be delayed because of the pregnancy. Most of the literature shows that women with
PABC have the same survival stage for stage as nonpregnant women with
breast cancer. But some studies suggest that the prognosis is worse for patients who present with advanced-stage
PABC. Finally, recurrence and survival in most patients previously treated for
breast cancer do not appear to be adversely affected by subsequent pregnancy. Above all, the patient with
breast cancer diagnosed during pregnancy is best served by early and continued involvement of a multidisciplinary
cancer treatment team.