Bajpai Jyoti, Pathak Rima, Shylasree T S, Rugo Hope S
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India.
Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.
Expert Rev Anticancer Ther. 2022 Dec;22(12):1301-1308. doi: 10.1080/14737140.2022.2150167.
Pregnancy-associated breast cancer (PABC) encompasses breast cancer diagnosed during pregnancy (BCP) or postpartum (PPBC). BCP is especially challenging with concerns regarding maternal and fetal safety synchronously. This review provides a comprehensive global view to optimize care of this unique entity. Areas covered Published literature and practices across the globe including real world published data from the first Indian registry are thoroughly reviewed to derive inferences. Diagnostic delays are common with resultant upstaging and inferior outcomes. Sonography-mammography and a biopsy with immunohistochemistry for estrogen, progesterone and HER-2neu receptors is mandatory. Multidisciplinary specialist teams are critical for trimester dependent management. Stage-wise surgical and systemic treatment remains largely similar to that of the nonpregnant women. Anthracyclines- and taxane-based chemotherapy is found to be safe after the 1st trimester. Frequent fetal and maternal monitoring is required to minimize complications. Chemotherapy should stop three weeks prior to the delivery to prevent peripartum infection/bleeding. Anti- Her-2 targeted therapy, endocrine therapy and radiation therapy are administered post-delivery. Iatrogenic premature delivery leads to poor neurocognition and should be avoided. Expert opinion Stage-wise outcomes are similar to that of non-pregnant patients with breast cancer, and underscores the importance of early detection especially in low- and middle-income countries. Global collaborations are warranted.
Published literature and practices across the globe including real world published data from the first Indian registry are thoroughly reviewed to derive inferences. Diagnostic delays are common with resultant upstaging and inferior outcomes. Sonography-mammography and a biopsy with immunohistochemistry for estrogen, progesterone and HER-2neu receptors is mandatory. Multidisciplinary specialist teams are critical for trimester dependent management. Stage-wise surgical and systemic treatment remains largely similar to that of the nonpregnant women. Anthracyclines- and taxane-based chemotherapy is found to be safe after the 1st trimester. Frequent fetal and maternal monitoring is required to minimize complications. Chemotherapy should stop three weeks prior to the delivery to prevent peripartum infection/bleeding. Anti- Her-2 targeted therapy, endocrine therapy and radiation therapy are administered post-delivery. Iatrogenic premature delivery leads to poor neurocognition and should be avoided.
Stage-wise outcomes are similar to that of non-pregnant patients with breast cancer, and underscores the importance of early detection especially in low- and middle-income countries. Global collaborations are warranted.
妊娠相关乳腺癌（PABC）包括孕期诊断的乳腺癌（BCP）或产后乳腺癌（PPBC）。BCP尤其具有挑战性，因为要同时关注母婴安全。本综述提供了一个全面的全球视角，以优化对这一独特疾病的治疗。
全面回顾了全球已发表的文献和实践，包括来自印度首个登记处的真实世界发表数据，以得出推论。诊断延迟很常见，会导致分期上升和预后较差。超声-乳腺钼靶检查以及对雌激素、孕激素和HER-2neu受体进行免疫组化的活检是必不可少的。多学科专家团队对于依赖孕期的管理至关重要。分期手术和全身治疗在很大程度上仍与非孕期女性相似。基于蒽环类和紫杉类的化疗在孕早期后被发现是安全的。需要频繁监测胎儿和母亲以尽量减少并发症。化疗应在分娩前三周停止，以预防围产期感染/出血。抗HER-2靶向治疗、内分泌治疗和放射治疗在产后进行。医源性早产会导致神经认知不良，应予以避免。
各阶段的预后与非妊娠乳腺癌患者相似，强调了早期检测的重要性，尤其是在低收入和中等收入国家。有必要开展全球合作。
全面回顾了全球已发表的文献和实践，包括来自印度首个登记处的真实世界发表数据，以得出推论。诊断延迟很常见，会导致分期上升和预后较差。超声-乳腺钼靶检查以及对雌激素、孕激素和HER-2neu受体进行免疫组化的活检是必不可少的。多学科专家团队对于依赖孕期的管理至关重要。分期手术和全身治疗在很大程度上仍与非孕期女性相似。基于蒽环类和紫杉类的化疗在孕早期后被发现是安全的。需要频繁监测胎儿和母亲以尽量减少并发症。化疗应在分娩前三周停止，以预防围产期感染/出血。抗HER-2靶向治疗、内分泌治疗和放射治疗在产后进行。医源性早产会导致神经认知不良，应予以避免。
各阶段的预后与非妊娠乳腺癌患者相似，强调了早期检测的重要性，尤其是在低收入和中等收入国家。有必要开展全球合作。
