Presentation on theme: "Breast Cancer in Pregnancy"— Presentation transcript:
1Breast Cancer in Pregnancy Steven Stanten MDRupert Horoupian MDAltaBates Summit Medical CenterOakland, California
2Introduction One of the most commonly diagnosed cancers of pregnancy More advanced stagePoorer prognosisPregnancy-associatedDuring pregnancyDuring lactationUp to 12 months post-partum
3Epidemiology 12.67% within their lifetime Mean age 61 12.7% between 20 and 44Of women with breast cancer before 40, 10% will be pregnant1/3000 pregnancies
4Pathology Invasive ductal predominates Larger in size at presentation Higher frequency of lymphovascular invasionHigher nuclear gradeHigher hormonal independenceHer-2/neu – no concensus
5Diagnosis Clinical exam Medical Imaging Usually a mass Broad differential diagnosisMost are benignMedical ImagingMammography usually not helpfulSafety and efficacy
6Diagnosis (con’t) Medical Imaging Screening - not when pregnant UTZ CXROther staging modalities
7Diagnosis (con’t) Cytology and Histology Biopsy recommended if questions persistFNA, core needle biopsy, excisional biopsy-rare milk fistula and infection
8Treatment Surgery Radiotherapy Chemotherapy Obstetric outcome Endocrine therapySupporting agents
9Treatment (con’t) No longer a role for termination of pregnancy Goals are to achieve control of disease and prevent distant metastasisFetal protective modificationsMulti-disciplinary teamMedical oncology, surgical oncology, high-risk obstetrics, genetic counseling, psychological support
10Treatment (con’t) Surgery Lumpectomy Mastectomy Axillary dissection Sentinel node biopsy*Breast conservation is the standard of care when appropriate in a non-pregnant patient
11Treatment (con’t) NSABP trials B06 - established the safety of breast conserving surgery for early stage breast cancer and demonstrated the importance of adjuvant breast radiation to minimize risk of in-breast recurrence.
12Treatment (con’t) Surgery Lumpectomy Anesthesia Wire localization X-ray confirmationWide margins
13Treatment (con’t) Surgery Try to wait until the 12th week Breast conservation - i.e.. LumpectomyNeed to consider need for XRTDon’t give during pregnancyConsider neo-adjuvant chemotherapy
14Treatment (con’t) Axillary Surgery – Veronessi demonstrated that sentinel lymph node biopsy was accurate and reliable.B32 – sentinel lymph node biopsy is safe and relaible* ~8-10% false negative rate
15Treatment (con’t) Axillary surgery Blue dye Radioisotope Filtered vs. unfilteredInjection siteTiming
16Treatment Axillary Surgery Increased incidence of nodal involvement Consider neo-adjuvant treatmentUTZ and FNASentinel node biopsy has problemsIsosulfan blueRadiocolloidConsider axillary dissection
28Prognosis Use TNM staging Most women have stage II or III disease Same prognosis stage for stageDelay in diagnosis has impact60-100% - 5 year survival31-52% - 10 year survival
29Pregnancy after Treatment Conflicting data2 years5 yearsEver?
30ConclusionDue to lack of prospective randomized clinical studies, both ongoing studies and future evidence are expected to solve problems related to breast cancer management during pregnancy.Must balance aggressive maternal care with appropriate modifications that will ensure fetal protection.