Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
Ann Surg Oncol. 2019 May;26(5):1214-1224. doi: 10.1245/s10434-019-07156-7. Epub 2019 Jan 24.
Breast cancer is the most common malignancy diagnosed in women of childbearing age. A breast cancer diagnosis in this young patient population can be uniquely complex to navigate when considering the potential impact of fertility loss associated with specific gonadotoxic therapies. Another unique challenge for young breast cancer patients is pregnancy-associated breast cancer (PABC), which occurs in approximately 1 of every 3000 pregnancies. Pregnancy adds a layer of complexity to breast cancer treatment planning as many therapies can affect the developing fetus. These two clinical challenges require nuanced multidisciplinary approaches to facilitate optimal treatment outcomes. We sought to review and summarize the management strategy options for both fertility preservation and PABC.
A guideline and literature review was performed for fertility preservation, young patients with breast cancer, and pregnancy-associated breast cancer.
Fertility preservation options, both established and experimental, are detailed. Suggested clinical practice guidelines for PABC are also presented, which delineate breast cancer treatment recommendations based on pregnancy trimester.
A multidisciplinary approach to patient care, including oncologists and early referral to reproductive specialists, can provide young breast cancer patients with options for fertility preservation. Under the guidance of a multidisciplinary treatment team, PABC can also be diagnosed and treated to permit the best possible outcomes for the mother and the developing fetus.
乳腺癌是生育期女性最常见的恶性肿瘤。对于年轻的乳腺癌患者，在考虑特定性腺毒性治疗相关的生育力损失潜在影响时，诊断可能会变得非常复杂。年轻乳腺癌患者面临的另一个独特挑战是妊娠相关性乳腺癌（PABC），大约每 3000 例妊娠中就会发生 1 例。妊娠为乳腺癌的治疗计划增加了一层复杂性，因为许多治疗方法会影响发育中的胎儿。这两个临床挑战需要细致的多学科方法来促进最佳治疗效果。我们旨在回顾和总结生育力保存和妊娠相关性乳腺癌的管理策略选择。
对生育力保存、年轻乳腺癌患者和妊娠相关性乳腺癌的指南和文献进行了综述。
详细介绍了生育力保存的选择，包括已确立和实验性的方法。还提出了妊娠相关性乳腺癌的临床实践指南，根据妊娠的不同阶段提出了乳腺癌治疗建议。
多学科的患者护理方法，包括肿瘤学家和早期转介给生殖专家，可以为年轻的乳腺癌患者提供生育力保存的选择。在多学科治疗团队的指导下，也可以对 PABC 进行诊断和治疗，以实现母亲和发育中胎儿的最佳结果。
