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 .
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- 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