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Gestational breast cancer: Treatment

Jennifer K Litton, MD
Section Editors
Harold Burstein, MD, PhD
Charles J Lockwood, MD, MHCM
Deputy Editor
Sadhna R Vora, MD


Gestational breast cancer (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. Gestational breast cancer presents a challenging clinical situation, since the welfare of both the mother and the fetus must be taken into account. There are limited prospective data about diagnosis, treatment, and outcome of breast cancer during pregnancy; much of the clinical evidence is limited to retrospective case series and case reports.

The treatment and prognosis of gestational breast cancer will be reviewed here. The epidemiology and diagnosis of gestational breast cancer is discussed separately. (See "Gestational breast cancer: Epidemiology and diagnosis".)


In general, pregnant women with breast cancer should be treated according to guidelines for nonpregnant patients, with some modifications to protect the fetus. However, the treatment should be approached with curative intent. Therefore, treatment of gestational breast cancer should not be unnecessarily delayed because of pregnancy. Informed consent is a critical component of choosing appropriate therapy. Although pregnancy termination may be considered during treatment planning, pregnancy termination has not been demonstrated to improve outcomes in gestational breast cancer. (See 'Elective termination of pregnancy' below.)

Importantly, all patients with gestational breast cancer should be evaluated for distant metastatic disease according to guidelines in nonpregnant patients with breast cancer. In order to protect the fetus, this can be attenuated to include: chest radiograph with fetal shielding, ultrasound of the liver, and magnetic resonance imaging (MRI) of the spine without contrast to evaluate for bone metastases [1,2]. (See "Gestational breast cancer: Epidemiology and diagnosis", section on 'Diagnosis and staging' and "Clinical features, diagnosis, and staging of newly diagnosed breast cancer", section on 'Post-diagnosis evaluation'.)

Locoregional treatment — The same local treatment options that are available for nonpregnant patients should be considered in pregnant women, with the exception of radiation therapy (RT). As in nonpregnant women, surgery is the definitive local treatment for gestational breast cancer. Breast and axillary lymph node surgery during any trimester of pregnancy appears to be associated with minimal fetal risk [3-8]. (See "Management of the pregnant patient undergoing nonobstetric surgery".)

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Literature review current through: Nov 2017. | This topic last updated: Aug 21, 2017.
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