Management of breast cancer during pregnancy and review of 23 treated cases in our clinic and Ostadalinasab hospital in tabriz (north west of IRAN).

Breast cancer is one of the most commonly diagnosed types of malignancy during pregnancy .Approximately0/2% to 2.6% of all breast cancer occur during pregnancy (BCP ).Many oncologist and obstetricians not have experience or only limited exposure to cancers diagnosed during pregnancy. Breast cancer during pregnancy has been characterized by more advanced disease stage, poorly differentiated tumors that areoften estrogen receptor-negative, and delays in diagnosis on the part of patient and physician, assuming breast changes are benign or related to pregnancy. Diagnosis was be made by a combination of ultrasonography, mammography, and/or MRI, followed by core needle biopsy. Modified radical mastectomy is standard care in first trimester, whereas breast- conserving surgery (lumpectomy with lymph node dissection) can be performed preferably in the second or third trimester. Radiation therapy is not favored during pregnancy. Tamoxifen is contraindicated during pregnancy and Aromatase inhibitors are not indicated in premenopausal women. Chemotherapy is generally contraindicated during first trimester because of the possible damage to organogenesis. In the adjuvant and neo-adjuvant and in the advanced/metastatic setting, Anthracycline - basedregiments(CA / CAF) remain the best choice, and Docetaxel or Paclitaxel can be administered in pregnancy if necessary. Chemotherapy dosage where equal to those for the nonpregnant patients and were based on body surface area. The use of Trastuzumab (Herceptin) and MTX contraindicated during pregnancy /and Lapatinib and Bevacizumab cannot be recommended during pregnancy. We review 23cases of breast cancer that diagnosed and treated during pregnancy in the north west of Iran (TABRIZ) .Material and Method : Between December 1998 to july 2014 , 23patients with breast cancer during pregnancy that have been treated as MRM with axillary dissection during pregnancy are referred to our center for adjuvant chemotherapy .The mean age of patients was 33/2years (20-47 years). They all received chemotherapy for 4- 6courses in 2th and 3th trimester of pregnancy with CA (in5) or CAF (in 14 ) or TEC (in 4 ) regiment in 1th dayand GCSF in 2th to 5th day of each course of chemotherapy. The last course of chemotherapy was at least 3 weeks before delivery (up to 35th weeks of pregnancy ) . Depending on the stage and hormone receptor states of tumors, ERT and/or Hormone therapy were given after delivery. The median follow up was 5years (9month to 12 years).. Results: The mean age of patients was33/2 years. There was seen 2 patients in stage I and 8 in stage II and 12 in stage III and one in stage IV. Lymph node involvement was seen in 68%of cases and greater than 3 lymph nodes in 52% of patients. Vascular and lymphatic invasion were seen in 70% of patients. ER was positive in 53% and PR in 45%, Her2 expression in 43%, P53 in 47%. Severe grade III/IV hematologic toxic complication of chemotherapy is developed in 4patients and neutropenic sepsis in 2cases (with out mortality).All 23 babies were delivered alive and near normal without any malformation, 9 babies with mild low birth weight. Due to 5 years follow up 5 patients were died and far metastases and loco regional recurrence are developed in 30% of patients, and 5 years survival were seen in 75% and 5years DFS in 65% of patients .Conclusion: Breast cancer during pregnancy needs special attention. Delayed diagnosis and its aggressive growth behavior du to biologic effects of pregnancy, diagnostic and therapeutic limitations during pregnancy like impossibility of doing bone scan, radiation and hormone therapy in all trimesters makes its management different somehow difficult. Regarding safety of FAC or CA or Taxens chemotherapies for mother and fetus from the second trimester of pregnancy ,it is suggested for the patients that need any form of chemotherapy for breast cancer during pregnancy

کلیدواژه ها:

breast cancer ، pregnancy ، treatment