Breast cancer in pregnancy.

The traditional view that breast cancer during pregnancy is associated with poor prognosis is no longer tenable. The reported poor prognosis usually is the result of late stage of presentation. It is important for physicians to consider breast cancer in the differential diagnosis of a breast problem discovered during pregnancy. When patients are separated into similar stage at presentation with positive or negative lymph nodes, the 5- and 10-year rates of survival for pregnancy-associated or nonpregnancy-associated breast cancer are identical. The breasts should be carefully examined at least during the first prenatal visit and thereafter if signs and symptoms appear. Operable disease in the first and second trimesters should be treated by modified radical mastectomy, and chemotherapy should be considered if indicated during the second and third trimesters. Breast-conservation treatment presents special problems, and the risks and benefits should be discussed with the patient. There is no evidence that termination of pregnancy improves survival.