Gestational breast cancer: Epidemiology and diagnosis
- Jennifer K Litton, MD
Jennifer K Litton, MD
- Assistant Professor of Medicine
- The University of Texas MD Anderson Cancer Center
- Section Editors
- Harold Burstein, MD, PhD
Harold Burstein, MD, PhD
- Section Editor — Breast Cancer
- Associate Professor of Medicine
- Harvard Medical School
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Gestational or pregnancy-associated breast cancer is defined as breast cancer that is diagnosed during pregnancy, in the first postpartum year, or any time during lactation. Breast cancer occurring during pregnancy presents a challenging clinical situation since the welfare of both the mother and the fetus must be taken into account in any treatment planning. In addition, prospective studies of breast cancer during pregnancy are very few, and much of the clinical evidence is limited to retrospective case series and case reports.
The epidemiology and diagnosis of pregnancy-associated breast cancer will be reviewed here. The treatment and prognosis of pregnancy-associated breast cancer is discussed separately. (See "Gestational breast cancer: Treatment".)
Breast cancer is one of the most common cancers in nonpregnant and pregnant women . Up to 20 percent of breast cancers in women under age 30 are pregnancy-associated, but fewer than 5 percent of breast cancers diagnosed in women under age 50 are detected during pregnancy or in the postpartum period [2,3].
Pregnancy-associated or gestational breast cancer is a relatively uncommon event. The incidence of pregnancy-associated breast cancer (for the prenatal to postpartum period) is approximately 15 to 35 per 100,000 deliveries, with fewer breast cancer cases diagnosed during pregnancy than during the first postpartum year [4-7]. The incidence of pregnancy-associated breast cancer appears to be increasing as more women delay childbearing [6,8].
Women with a genetic predisposition to breast cancer may be overrepresented among pregnant women with cancer, although the available evidence is limited [9-11]. In women who inherit BRCA2 (but not BRCA1) mutations, the protective effect of multiparity on breast cancer risk may be lost .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Antonelli NM, Dotters DJ, Katz VL, Kuller JA. Cancer in pregnancy: a review of the literature. Part I. Obstet Gynecol Surv 1996; 51:125.
- Wallack MK, Wolf JA Jr, Bedwinek J, et al. Gestational carcinoma of the female breast. Curr Probl Cancer 1983; 7:1.
- Anderson BO, Petrek JA, Byrd DR, et al. Pregnancy influences breast cancer stage at diagnosis in women 30 years of age and younger. Ann Surg Oncol 1996; 3:204.
- Smith LH, Danielsen B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol 2003; 189:1128.
- Woo JC, Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Arch Surg 2003; 138:91.
- Stensheim H, Møller B, van Dijk T, Fosså SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol 2009; 27:45.
- Andersson TM, Johansson AL, Hsieh CC, et al. Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol 2009; 114:568.
- Ventura SJ. First births to older mothers, 1970-86. Am J Public Health 1989; 79:1675.
- Ishida T, Yokoe T, Kasumi F, et al. Clinicopathologic characteristics and prognosis of breast cancer patients associated with pregnancy and lactation: analysis of case-control study in Japan. Jpn J Cancer Res 1992; 83:1143.
- Shen T, Vortmeyer AO, Zhuang Z, Tavassoli FA. High frequency of allelic loss of BRCA2 gene in pregnancy-associated breast carcinoma. J Natl Cancer Inst 1999; 91:1686.
- Johannsson O, Loman N, Borg A, Olsson H. Pregnancy-associated breast cancer in BRCA1 and BRCA2 germline mutation carriers. Lancet 1998; 352:1359.
- Cullinane CA, Lubinski J, Neuhausen SL, et al. Effect of pregnancy as a risk factor for breast cancer in BRCA1/BRCA2 mutation carriers. Int J Cancer 2005; 117:988.
- Albrektsen G, Heuch I, Kvåle G. The short-term and long-term effect of a pregnancy on breast cancer risk: a prospective study of 802,457 parous Norwegian women. Br J Cancer 1995; 72:480.
- Lambe M, Hsieh C, Trichopoulos D, et al. Transient increase in the risk of breast cancer after giving birth. N Engl J Med 1994; 331:5.
- Wohlfahrt J, Andersen PK, Mouridsen HT, Melbye M. Risk of late-stage breast cancer after a childbirth. Am J Epidemiol 2001; 153:1079.
- Middleton LP, Amin M, Gwyn K, et al. Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features. Cancer 2003; 98:1055.
- Reed W, Hannisdal E, Skovlund E, et al. Pregnancy and breast cancer: a population-based study. Virchows Arch 2003; 443:44.
- Bonnier P, Romain S, Dilhuydy JM, et al. Influence of pregnancy on the outcome of breast cancer: a case-control study. Societe Francaise de Senologie et de Pathologie Mammaire Study Group. Int J Cancer 1997; 72:720.
- Berry DL, Theriault RL, Holmes FA, et al. Management of breast cancer during pregnancy using a standardized protocol. J Clin Oncol 1999; 17:855.
- Elledge RM, Ciocca DR, Langone G, McGuire WL. Estrogen receptor, progesterone receptor, and HER-2/neu protein in breast cancers from pregnant patients. Cancer 1993; 71:2499.
- King RM, Welch JS, Martin JK Jr, Coulam CB. Carcinoma of the breast associated with pregnancy. Surg Gynecol Obstet 1985; 160:228.
- Lethaby AE, O'Neill MA, Mason BH, et al. Overall survival from breast cancer in women pregnant or lactating at or after diagnosis. Auckland Breast Cancer Study Group. Int J Cancer 1996; 67:751.
- BUNKER ML, PETERS MV. Breast cancer associated with pregnancy or lactation. Am J Obstet Gynecol 1963; 85:312.
- Nettleton J, Long J, Kuban D, et al. Breast cancer during pregnancy: quantifying the risk of treatment delay. Obstet Gynecol 1996; 87:414.
- Saber A, Dardik H, Ibrahim IM, Wolodiger F. The milk rejection sign: a natural tumor marker. Am Surg 1996; 62:998.
- Goldsmith HS. Milk-rejection sign of breast cancer. Am J Surg 1974; 127:280.
- BYRD BF Jr, BAYER DS, ROBERTSON JC, STEPHENSON SE Jr. Treatment of breast tumors associated with pregnancy and lactation. Ann Surg 1962; 155:940.
- Collins JC, Liao S, Wile AG. Surgical management of breast masses in pregnant women. J Reprod Med 1995; 40:785.
- Behrman RH, Homer MJ, Yang WT, Whitman GJ. Mammography and fetal dose. Radiology 2007; 243:605; author reply 605.
- Liberman L, Giess CS, Dershaw DD, et al. Imaging of pregnancy-associated breast cancer. Radiology 1994; 191:245.
- Samuels TH, Liu FF, Yaffe M, Haider M. Gestational breast cancer. Can Assoc Radiol J 1998; 49:172.
- Yang WT, Dryden MJ, Gwyn K, et al. Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology 2006; 239:52.
- Ahn BY, Kim HH, Moon WK, et al. Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings. J Ultrasound Med 2003; 22:491.
- Shellock FG, Crues JV. MR procedures: biologic effects, safety, and patient care. Radiology 2004; 232:635.
- Ray JG, Vermeulen MJ, Bharatha A, et al. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. JAMA 2016; 316:952.
- Talele AC, Slanetz PJ, Edmister WB, et al. The lactating breast: MRI findings and literature review. Breast J 2003; 9:237.
- Dominici L, Kuerer H, Babiera G, et al. Wound complications from surgery in pregnancy-associated breast cancer. American Society of Breast Surgeons Annual Meeting 2009.
- Nicklas AH, Baker ME. Imaging strategies in the pregnant cancer patient. Semin Oncol 2000; 27:623.
- Baker J, Ali A, Groch MW, et al. Bone scanning in pregnant patients with breast carcinoma. Clin Nucl Med 1987; 12:519.
- Rosenthal DI. Radiologic diagnosis of bone metastases. Cancer 1997; 80:1595.
- PATHOLOGIC FEATURES
- Hormone receptor expression
- HER2 overexpression
- DIAGNOSIS AND STAGING
- Primary tumor
- - Mammography
- - Ultrasonography
- - Breast MRI
- - Biopsy
- Lymph nodes
- Systemic staging
- - Chest evaluation
- - Liver and brain evaluation
- - Bone evaluation
- Assessment of cardiac function
- MONITORING OF THE PREGNANCY
- SUMMARY AND RECOMMENDATIONS