Raphael J, Trudeau M E, Chan K
Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON.
Curr Oncol. 2015 Mar;22(Suppl 1):S8-S18. doi: 10.3747/co.22.2338.
An increasing number of young women are delaying childbearing; hence, more are diagnosed with breast cancer (bca) before having a family. No clear recommendations are currently available for counselling such a population on the safety of carrying a pregnancy during bca or becoming pregnant after treatment for bca.
Using a Web-based search of PubMed we reviewed the recent literature about bca and pregnancy. Our objective was to report outcomes for patients diagnosed with bca during pregnancy, comparing them with outcomes for non-pregnant women, and to evaluate prognosis in women diagnosed with and treated for bca who subsequently became pregnant.
"Pregnancy and bca" should be divided into two entities. Pregnancy-associated bca tends to be more aggressive and advanced in stage at diagnosis than bca in control groups; hence, it has a poorer prognosis. With respect to pregnancy after bca, there is, despite the bias in reported studies and meta-analyses, no clear evidence for a different or worse disease outcome in bca patients who become pregnant after treatment compared with those who do not.
Pregnancy-associated bca should be treated as aggressively as and according to the standards applicable in nonpregnant women; pregnancy after bca does not jeopardize outcome. The guidelines addressing risks connected to pregnancy and bca lack a high level of evidence for better counselling young women about pregnancy considerations and preventing unnecessary abortions. Ideally, evidence from large prospective randomized trials would set better guidelines, and yet the complexity of such studies limits their feasibility.
越来越多的年轻女性推迟生育；因此，更多女性在组建家庭前被诊断出患有乳腺癌（BCA）。目前尚无明确建议可用于为这类人群提供咨询，告知她们在患BCA期间怀孕的安全性或BCA治疗后怀孕的相关情况。
通过基于网络搜索PubMed，我们回顾了近期关于BCA与怀孕的文献。我们的目的是报告孕期被诊断为BCA的患者的结局，并将其与非孕妇女性的结局进行比较，同时评估被诊断并接受BCA治疗后随后怀孕的女性的预后情况。
“怀孕与BCA”应分为两个实体。与对照组的BCA相比，妊娠相关BCA在诊断时往往更具侵袭性且分期更晚；因此，其预后较差。关于BCA后的妊娠，尽管报告的研究和荟萃分析存在偏差，但尚无明确证据表明，接受治疗后怀孕的BCA患者与未怀孕的患者相比，疾病结局有所不同或更差。
妊娠相关BCA应与非孕妇女性一样积极治疗，并遵循适用的标准；BCA后怀孕不会危及结局。关于与怀孕和BCA相关风险的指南缺乏高水平证据，无法更好地为年轻女性提供有关怀孕考虑因素的咨询并防止不必要的流产。理想情况下，大型前瞻性随机试验的证据将制定更好的指南，但此类研究的复杂性限制了其可行性。
