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Breast carcinoma during pregnancy

International recommendations from an expert meeting

  1. Sibylle Loibl M.D.1,†,*,
  2. Gunter von Minckwitz M.D.1,2,
  3. Karin Gwyn M.D.3,
  4. Paul Ellis M.D.4,
  5. Jens U. Blohmer M.D.5,
  6. Brigitte Schlegelberger M.D.6,
  7. Monika Keller M.D.7,
  8. Sebastian Harder M.D.8,
  9. Richard L. Theriault D.O., M.B.A.3,
  10. Diana Crivellari M.D.9,
  11. Thomas Klingebiel M.D.10,
  12. Frank Louwen M.D.1,
  13. Manfred Kaufmann M.D.1

Article first published online: 9 DEC 2005

DOI: 10.1002/cncr.21610

Issue

Cancer

Cancer

Volume 106, Issue 2, pages 237–246, 15 January 2006

Additional Information

How to Cite

Loibl, S., von Minckwitz, G., Gwyn, K., Ellis, P., Blohmer, J. U., Schlegelberger, B., Keller, M., Harder, S., Theriault, R. L., Crivellari, D., Klingebiel, T., Louwen, F. and Kaufmann, M. (2006), Breast carcinoma during pregnancy. Cancer, 106: 237–246. doi: 10.1002/cncr.21610

Author Information

  1. 1

    Department of Obstetrics and Gynaecology, J.W.-Goethe University, Frankfurt am Main, Germany

  2. 2

    German Breast Group, Neu-Isenburg, Germany

  3. 3

    Department of Breast Medical Oncology, M.D. Anderson Cancer Center, The University of Texas, Houston, Texas

  4. 4

    Department of Medical Oncology, Kings, St Thomas' Cancer Centre, Guy's Hospital, London, UK

  5. 5

    St. Gertrauden, Berlin, Germany

  6. 6

    Institute of Cell and Molecular Pathology, Medizinische Hochschule Hannover, Hannover, Germany

  7. 7

    Department of Surgery, Psychosocial Care Unit, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany

  8. 8

    Institute for Clinical Pharmacology at the Pharmazentrum, J.W.-Goethe University, Frankfurt am Main, Germany

  9. 9

    Division of Medical Oncology C, Centro di Riferimento Oncologico, Aviano, Italy

  10. 10

    Department of Paediatric Oncology, J.W.-Goethe University, Frankfurt am Main, Germany

  1. †

    Fax: (011) 49-69-6301-7938

*J.W.-Goethe University, Department of Obstetrics and Gynaecology, Theodor-Stern-Kai 7; 60590 Frankfurt am Main, Germany

Publication History

  1. Issue published online: 5 JAN 2006
  2. Article first published online: 9 DEC 2005
  3. Manuscript Accepted: 11 AUG 2005
  4. Manuscript Revised: 16 JUL 2005
  5. Manuscript Received: 9 MAY 2005

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REFERENCES

  • 1
    White TT. Prognosis of breast cancer for pregnant and nursing women. Surg Gynecol Obstet. 1955; 100: 661–666.
  • 2
    Anderson JM. Mammary cancers and pregnancy. Br Med J. 1979; 1: 1124–1127.
  • 3
    Haas JF. Pregnancy in association with newly-diagnosed cancer: a population-based epidemiologic assessment. Int J Cancer. 1984; 34: 229–235.
    Direct Link:
  • 4
    Statistisches Bundesamt Deutschland. Bevolkerung. Available at: http://www.stabu.de/allg/d/impr/d_impr.htm [Accessed March 13, 2005].
  • 5
    Ventura SJ. First births to older mothers, 1970–1986. Am J Public Health. 1989; 79: 1675–1677.
  • 6
    Parente JT, Amsel M, Lerner R, Chinea F. Breast cancer associated with pregnancy. Obstet Gynecol. 1988; 1: 861–864.
  • 7
    Tobon H, Horowitz LF. Breast cancer during pregnancy. Breast Dis. 1993; 6: 127–134.
  • 8
    King RM, Welch JS, Martin JK Jr., Coulam CB. Carcinoma of the breast associated with pregnancy. Surg Gynecol Obstet. 1985; 160: 228–232.
  • 9
    Fisher CJ, Egan MK, Smith P, Wicks K, Millis RR, Fentiman IS. Histopathology of breast cancer in relation to age. Br J Cancer. 1997; 75: 593–596.
  • 10
    Shousha S. Breast carcinoma presenting during or shortly after pregnancy and lactation. Arch Pathol Lab Med. 2000; 124: 1053–1060.
  • 11
    Ishida T, Yokoe T, Kasmu 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: 1143–1149.
  • 12
    Middleton LP, Amin M, Gwyn K, Theriault R, Sahin A. Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features. Cancer. 2003; 98: 1055–1060.
    Direct Link:
  • 13
    Maru D, Middleton LP, Wang S, Valero V, Sahin A. HER-2/neu and p53 overexpression as biomarkers of breast carcinoma in women age 30 years and younger. Cancer. 2005; 103: 900–905.
    Direct Link:
  • 14
    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: 2499–2506.
    Direct Link:
  • 15
    Lebeau A, Deimling D, Kaltz C, et al. Her-2/neu analysis in archival tissue samples of human breast cancer: comparison of immunohistochemistry and fluorescence in situ hybridization. J Clin Oncol. 2001; 19: 354–363.
  • 16
    Petrek JA. Breast cancer during pregnancy. Cancer. 1994; 74: 518–527.
    Direct Link:
  • 17
    Petrek JA, Dukoff R, Rogatko A. Prognosis of pregnancy-associated breast cancer. Cancer. 1991; 67: 869–872.
    Direct Link:
  • 18
    Maggard MA, O'Connell JB, Lane KE, Liu JH, Etzioni DA, Ko CY. Do young breast cancer patients have worse outcomes? J Surg Res. 2003; 113: 109–113.
  • 19
    Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ. Meeting highlights expert consensus on the primary therapy of early breast cancer. J Clin Oncol. 2003; 21: 3357–3365.
  • 20
    Carlson RW, Edge SB, Theriault RL. NCCN Breast Cancer Practice Guidelines Panel NCCN: breast cancer. Cancer Control. 2001; 8: 54–61.
  • 21
    Oxford Centre for Evidence-Based Medicine Levels of Evidence (May 2001; http://minerva.minervation.com/cebm/).
  • 22
    Liberman L, Giess C, Dershaw DD, Deutch BM, Petrek JA. Imaging of pregnancy associated breast cancer. Radiology. 1994; 191: 245–248.
  • 23
    Ahn BY, Kim HH, Moon WK, et al. Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings. J Ultrasound Med. 2003; 22: 491–497.
  • 24
    Mazonakis M, Varveris H, Damilakis J, Theoharopoulos N, Gourtsoyiannis N. Radiation dose to conceptus resulting from tangential breast irradiation. Int J Radiat Oncol Biol Phys. 2003; 55: 386–391.
  • 25
    Blohmer JU, Schmalisch G, Kurten A, Chaoui R, Lichtenegger W. Relevance of sonographic criteria to differential diagnosis of mammary tumor. Eur J Ultrasound. 1997; 6: 35–41.
  • 26
    Novotny DB, Maygarden SJ, Shermer RW, Frable WJ. Fine needle aspiration of benign and malignant breast masses associated with pregnancy. Acta Cytol. 1991; 35: 676–686.
  • 27
    Gupta RK. The diagnostic impact of aspiration cytodiagnosis of breast masses in association with pregnancy and lactation with an emphasis on clinical decision making. Breast J. 1997; 3: 131–134.
    Direct Link:
  • 28
    Barker PJ. Milk fistula: an unusual complication of breast biopsy. Coll Surg Edinb. 1988; 33: 106.
  • 29
    Schackmuth EM, Harlow CL, Norton LW. Milk fistula: a complication after core biopsy. Am J Roentgenol. 1993; 161: 961–962.
  • 30
    Mazze RI, Kallen B. Reproduction outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol. 1989; 161: 1178–1185.
  • 31
    Duncan PG, Pope WDB, Cohen MM, Greer N. Fetal risk of anesthesia and surgery during pregnancy. Anesthesiology. 1986; 64: 790–794.
  • 32
    Tummers P, De Sutter P, Dhont M. Risk of spontaneous abortion in singleton and twin pregnancies after IVF/ICSI. Hum Reprod. 2003; 18: 1720–1723.
  • 33
    Berry DL, Theriault RL, Holmes FA, et al. Management of breast cancer during pregnancy using a standardized protocol. J Clin Oncol. 1999; 17: 855–861.
  • 34
    Kuerer HM, Gwyn K, Ames FC, Theriault RL. Conservative surgery and chemotherapy for breast carcinoma during pregnancy. Surgery. 2002; 131: 108–110.
  • 35
    Kaufmann M, von Minckwitz G, Smith R, et al. International expert panel on the use of primary (preoperative) systemic treatment of operable breast cancer: review and recommendations. J Clin Oncol. 2003; 21: 2600–2608.
  • 36
    Gentilini O, Cremonesi M, Trifiro G, et al. Safety of sentinel node biopsy in pregnant patients with breast cancer. Ann Oncol. 2004; 15: 1348–13451.
  • 37
    Keleher A, Wendt R 3rd, Delpassand E, Stachowiak AM, Kuerer HM. The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulfur colloid. Breast J. 2004; 10: 492–495.
    Direct Link:
  • 38
    Albo D, Wayne JD, Hunt KK, et al. Anaphylactic reactions to isosulfan blue dye during sentinel lymph node biopsy for breast cancer. Am J Surg. 2001; 182: 393–398.
  • 39
    Crivellaro M, Senna G, Dama A, Bonadonna P, Passalacqua G. Anaphylaxis due to patent blue dye during lymphography, with negative skin prick test. J Investig Allergol Clin Immunol. 2003; 13: 71–72.
  • 40
    National Commission on Radiological Protection. Pregnancy and Medical Radiation. Ann IRCP. 2000; 30.
  • 41
    Fenig E, Mishaeli M, Kalish Y, Lishner M. Pregnancy and radiation. Cancer Treat Rev. 2001; 27: 1–7.
  • 42
    Kalter H, Warkany J. Congenital malformations. N Engl J Med. 1983; 308: 424–431, 491–497.
  • 43
    Doll DC, Ringenberg QS, Yarbro JW. Antineoplastic agents in pregnancy. Semin Oncol. 1989; 16: 337–346.
  • 44
    Ebert U, Loffler H, Kirch W. Cytotoxic therapy and pregnancy. Pharmacol Ther. 1997; 74: 207–220.
  • 45
    Woo JC, Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Arch Surg. 2003; 138: 91–98.
  • 46
    Giacalone PL, Laffargue F, Benos P. Chemotherapy for breast carcinoma during pregnancy: a French national survey. Cancer. 1999; 86: 2266–2272.
    Direct Link:
  • 47
    Zemlickis D, Lishner M, Degendorfer P, et al. Maternal and fetal outcome after breast cancer in pregnancy. Am J Obstet Gynecol. 1992; 166: 781–787.
  • 48
    De Santis M, Lucchese A, De Carolis S, Ferrazani S, Caruso A. Metastatic breast cancer in pregnancy: first case of chemotherapy with docetaxel. Eur J Cancer Care. 2000; 9: 235–237.
    Direct Link:
  • 49
    Gadducci A, Cosio S, Fanucchi A, et al. Chemotherapy with epirubicin and paclitaxel for breast cancer during pregnancy: case report and review of the literature. Anticancer Res. 2003; 23: 5225–5229.
  • 50
    Gonzalez-Angulo AM, Walters RS, Carpenter RJ, et al. Paclitaxel chemotherapy in a pregnant patient with bilateral breast cancer. Clin Breast Cancer. 2004; 5: 317–319.
  • 51
    Arceci RJ, Croop JM, Horwitz SB, Housman D. The gene encoding multidrug resistance is induced and expressed at high levels during pregnancy in the secretory epithelium of the uterus. Proc Natl Acad Sci U S A. 1988; 85: 4350–4354.
  • 52
    Smit JW, Huisman MT, van Tellingen O, Wiltshire HR, Schinkel AH. Absence or pharmacological blocking of placental P-glycoprotein profoundly increases fetal drug exposure. J Clin Invest. 1999; 104: 1441–1447.
  • 53
    Watson WJ. Herceptin (trastuzumab) therapy during pregnancy: association with reversible anhydramnios. Obstet Gynecol. 2005; 10: 642–643.
  • 54
    Cunha GR, Taguchi O, Namikawa R, Nishizuka Y, Robboy SJ. Teratogenic effects of clomiphene, tamoxifen, and diethylstilbestrol on the developing human female genital tract. Hum Pathol. 1987; 18: 1132–1143.
  • 55
    Oksuzoglu B, Guler N. An infertile patient with breast cancer who delivered a healthy child under adjuvant tamoxifen therapy. Eur J Obstet Gynecol Reprod Biol. 2002; 104: 79.
  • 56
    Isaacs RJ, Hunter W, Clark K. Tamoxifen as systemic treatment of advanced breast cancer during pregnancy — case report and literature review. Gynecol Oncol. 2001; 80: 405–408.
  • 57
    Cullins SL, Pridjian G, Sutherland CM. Goldenhar's syndrome associated with tamoxifen given to the mother during gestation. JAMA. 1994; 271: 1905–1906.
  • 58
    Tewari K, Bonebrake RG, Asrat T, Shanberg AM. Ambiguous genitalia in infant exposed to tamoxifen in utero. Lancet. 1997; 350: 183.
  • 59
    Clark S. Prophylactic tamoxifen. Lancet. 1993; 342: 168.
  • 60
    Gralla RJ, Osoba D, Kris MG, et al. Recommendations for the use of antiemetics — evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol. 1999; 17: 2971–2994.
  • 61
    Rodriguez-Pinilla E, Martinez-Frias ML. Corticosteroids during pregnancy and oral clefts: a case-control study. Teratology. 1998; 58: 2–5.
    Direct Link:
  • 62
    Magee LA, Mazzotta P, Koren G. Evidence-based view of safety and effectiveness of pharmacologic therapy for nausea and vomiting of pregnancy (NVP). Am J Obstet Gynecol. 2002; 186: 256–261.
  • 63
    Tincello DG, Johnstone MJ. Treatment of hyperemesis gravidarum with the 5-HT3 antagonist ondansetron (Zofran). Postgrad Med J. 1996; 72: 688–689.
  • 64
    Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obstet Gynecol. 1996; 174: 1565–1568.
  • 65
    Briggs GC, Freeman RK, Yaffee SM. A reference guide to fetal and neonatal risk: drugs in pregnancy and lactation. Philadelphia: Lippincott Williams & Wilkins, 1998.
  • 66
    Ozer H, Armitage JO, Bennett CL, et al. American Society of Clinical Oncology. 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. J Clin Oncol. 2000; 18: 3558–3585.
  • 67
    Johannson O, Loman N, Borg A, Ollson H. Pregnancy-associated breast cancer in BRCA1 and BRCA2 germline mutation carriers. Lancet. 1998; 352: 1359–1360.
  • 68
    Oduncu FS, Kimmig R, Hepp H, Emmrich B. Cancer in pregnancy: maternal-fetal conflict. J Cancer Res. 2003; 129: 133–146.
  • 69
    Rowland J, Massie M. Breast cancer. In: HollandJC, editor. Psycho-oncology. New York: Oxford University Press, 1998: 380–401.
  • 70
    ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002; 77: 67–75.
  • 71
    Lamont RF. International Preterm Labour Council. Evidence-based labour ward guidelines for the diagnosis, management and treatment of spontaneous preterm labour. J Obstet Gynaecol. 2003; 23: 469–478.
  • 72
    Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal re-hospitalization. JAMA. 2000; 283: 2411–2416.
  • 73
    Alexander A, Samlowski WE, Grossman D, et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol. 2003; 21: 2179–2186.
  • 74
    Dunn JS Jr., Anderson CD, Brost BC. Breast carcinoma metastatic to the placenta. Obstet Gynecol. 1999; 94: 846.
  • 75
    Theriault RL, Stallings CB, Buzdar AU. Pregnancy and breast cancer: clinical and legal issues. Am J Clin Oncol. 1992; 15: 535–539.
  • 76
    Maghfoor I, Doll DC. Chemotherapy in pregnancy. In: PerryMC, editor. The chemotherapy source book. Philadelphia: Lippincott Williams & Wilkins, 2001: 537–546.
  • 77
    Aviles A, Neri N. Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2001; 2: 173–177.
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