Mathelin C, Youssef C, Brettes J-P, Rio M-C
Service de gynécologie-obstétrique, CHRU de Strasbourg, Strasbourg cedex, France.
Gynecol Obstet Fertil. 2007 May;35(5):449-56. doi: 10.1016/j.gyobfe.2007.02.026. Epub 2007 Apr 16.
Interactions between pregnancy and breast cancer are complex and paradoxical. Epidemiological data show that nulliparity and late full-term pregnancy increase breast cancer risk. By contrast, early full-term pregnancy and multiparity are thought to be the most effective means of decreasing lifetime breast cancer risk. Paradoxically, young women diagnosed with breast cancer during pregnancy have a higher risk of dying from their disease. Moreover, there is a transient increase in risk of breast cancer in the first three to four years after pregnancy. After breast cancer treatment, there is no evidence that pregnancy increases the risk of breast cancer recurrence. Thus, it is not contraindicated in women previously treated for breast cancer and free of recurrence. Various physio-pathological mechanisms are involved in the protective effect of pregnancy, like cellular differentiation of mammary cells, mammary gland involution, circulating anti-mucin antibody and excretion in the milk of breast carcinogens. In the past, unfavorable effects of pregnancy were mainly attributed to precancerous cell proliferation induced by pregnancy-associated hormonal changes. However, recent studies suggest that the remodeling of cellular microenvironment and extracellular matrix during pregnancy and involution may contribute to enhanced invasive and metastatic potential of breast carcinomas.
妊娠与乳腺癌之间的相互作用复杂且自相矛盾。流行病学数据表明，未生育和足月妊娠过晚会增加患乳腺癌的风险。相比之下，足月妊娠早和多胎妊娠被认为是降低终生患乳腺癌风险的最有效手段。自相矛盾的是，在孕期被诊断出患有乳腺癌的年轻女性死于该疾病的风险更高。此外，在产后的头三到四年中，患乳腺癌的风险会短暂上升。乳腺癌治疗后，没有证据表明妊娠会增加乳腺癌复发的风险。因此，对于既往接受过乳腺癌治疗且无复发的女性，妊娠并非禁忌。妊娠的保护作用涉及多种生理病理机制，如乳腺细胞的细胞分化、乳腺退化、循环抗粘蛋白抗体以及乳腺致癌物在乳汁中的排泄。过去，妊娠的不利影响主要归因于妊娠相关激素变化引起的癌前细胞增殖。然而，最近的研究表明，妊娠和退化过程中细胞微环境和细胞外基质的重塑可能有助于增强乳腺癌的侵袭和转移潜能。
