Breast cancer and pregnancy: an association that becomes more frequent

Written by Sandeep Nehra

The age of first pregnancy retreating, the discovery of breast cancer in pregnant women, always a source of questions, the situation becomes more common, according to experts gathered this week in Congress in Strasbourg.

Breast cancer remains outstanding before 35 years (2% of cases), but the risk increases with age. However later pregnancies are becoming more common because of the rising age of conception of first child or even reconstituted families.

“The age of first pregnancy is increasing year by year and there are more and more pregnancies after 40 years,” said Roman Rouzier, gynecologic oncologist at the Tenon Hospital (Paris).

The association pregnancy and cancer in 0.1% of pregnant women, 700 to 800 cases per year, says Dr. Rouzier, a leading network of “Cancer and pregnancy” was initiated in 2006 (www.colorectal-and- grossesse.fr).

Breast cancer is one of those most frequently associated with pregnancy, about 60% of cases according to the data network.

This exceptional situation is “emotionally charged and complicated to manage,” said Olivier Graesslin, chief of obstetrics and gynecology at the University Hospital of Reims.

Hence the value of a reference center, able to guide physicians faced with these cases. “The goal is to have a uniform support throughout,” says Dr. Rouzier.

This is a situation that is “always a source of questions” and “reflex is to provide an abortion.” But, he says, the interruption of pregnancy “is not legitimate in terms of survival” because it does not improve the prognosis of cancer.

Other ethical issues may still arise, “he admits.

“Any mass in the breast during pregnancy should be explored” in order not to delay diagnosis, “he insists. Ultrasound and biopsy can be performed in pregnant women. Mammography is also possible, the exposure rate remains very low. MRIs are also possible.

Regarding treatment, the recommendations are based on the term of pregnancy. But surgery is possible, chemotherapy as well (except in the first quarter), with an efficiency “like” the classic situations.

“We know what medications can be given” by taking into account the health of the unborn child, says Dr. Rouzier. A long-term evaluation is underway, but at this stage there is “no disturbing signal” on child development, says he.

However, too few data are available today on the use of targeted therapies during pregnancy.

Radiotherapy is “theoretically possible, but today we prefer to delay it after childbirth.”

The use of tamoxifen (HT), associated with cases of fetal malformation, should be postponed until after delivery.

The psychological impact of this situation is also very ambivalent in the study with the University Paris-Descartes, says Dr. Rouzier. She is interested in the mother but also to the father and child.

The 32nd Day of the French Society of Breast Pathology and Senology (SFSPM) had as its theme this year “The young woman facing breast cancer.”

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