Management of breast cancer in pregnant women – experiences from a large university breast center

Objective: Breast cancer (BC) is the most frequent cancer disease in women. An increasing number of women are delaying childbearing and diagnosis of BC during pregnancy is more and more frequent. We analyzed clinical and fetal outcome of BC treatment during pregnancy.

Methods: Pregnant women treated for primary BC at Tuebingen University between 06/2002 and 03/2016 were enrolled. Characteristics of patients, pregnancy and cancer treatment were evaluated based on medical records.

Results: 13 patients were enrolled. Median age at BC diagnosis was 32 years. Distribution of tumor stage was: c/pT1 (17%), c/pT2 (66%), c/pT3 (17%); c/pN0 (50%), c/pN+ (50%); G2 (39%), G3 (61%); hormone receptor positive (39%); HER2-positive (78%). Mean gestational age (GA) at BC diagnosis was 29.1 weeks. 7 patients (58%) completed neoadjuvant treatment with Epirubicin/Cyclophosphamid, 4 patients (31%) received this treatment during pregnancy and 3 patients (23%) after delivery. 93% of patients received docetaxel after delivery. A clinical response was shown in 39% of patients. Surgery was performed in 85% of patients: 46% received breast conserving surgery, 15% received surgery during pregnancy. Mean GA at the time of delivery was 35.1 weeks. Cesarean section was performed in 7 patients (58%); spontaneous birth was achieved in 4 patients (33%); one patient (8%) is still pregnant. In all cases fetal outcome was good. 2 patients died during long-term follow-up.

Conclusions: As fetal outcome seems unaffected, BC during pregnancy should be treated according to guidelines and in highly qualified and experienced centers, due to the very demanding management.