Breast Cancer in Pregnancy

1. Breast Cancer in Pregnancy
Dr Umar M Aminu
Surgery Department
ATBUTH Bauchi

2. Introduction
• Breast cancer occurs in 1 of every 3000
pregnant women
• Usually metastatic with 75% already having
axillary lymph node involvement
• Age range from 32 to 38 average 34ys

3. Clinical features
• Breast lump
• Change in size of breast
• Dimpling or puckering of the overlying skin
• Nipple retraction or deviation
• Nipple discharge

4. Investigations
• Breast USS
• Needle biopsy
• Mammography rarely indicated
• Others; Full blood count, CXR, LFT, hormone
status of tumor

5. Treatment
• Depends on
– Stage
– age of pregnancy
• Options
– Surgery
– Chemotherapy
– Radiation

6. Surgery
• Carry minimal risk to
unborn child
• Options
– Modified redical
mastectomy
– Breast conserving surgery
– Lumpectomy
– Pertial mastectomy
– Segmental mastectomy
– Quadrantectomy
– Breast spearing surgery
• Not adequate as
monotherapy

7. Chemotherapy
• Not given
– in first trimester
– After 35weeks of pregnancy/within 3 weeks of due
date/planned delivery
• Usually a combination of 2/3 diffrent drugs
– Doxorubicin(Adriamycin)
– Cyclophosphamide
– Fluorouracil(5FU)
– Epitubicin
– Docetaxel

8. Radiation
• For women how have breast conserving
surgery
• May be
• External
• Internal
• Delayed till after delivery

9. Summary of Treatment by Stage
• Stage I and II
• Modified radical mastectomy
• Breast conserving surgery followed by radiation therapy
• Modified radical mastectomy/breast conserving surgery
during pregnancy followed by chemo after first
trimester
• Late stage disease(Stage III and IV)
• Radiation
• Chemotherapy

10. Other Treatment
• Hormone treatment
• Not recommended in any stage of pregnancy
• Biological treatment
• Not recommended in pregnancy
• Supportive therapy
• Antisickness drugs such as ondansetrone SAFE

11. Delivery and Breast feeding and
Pregnancy
• Timing depends on need and expected due
date
• Induction of labour/caesarean section
• Paediatrician examines baby and pathologist
examines placenta
• Chemotherapy and/hormonal therapy may
affect breast feeding
• Pregnancy later in life does not affect survival

12. Prognosis
• No different from women who are not
pregnant
• Factors affecting
• Stage of the cancer
• Type of cancer
• Hormone status

13. Conclusion
• Breast cancer in pregnancy presents a
challenge in presentation, diagnosis,
evaluation, treatment and prognosis of breast
cancer, but with appropriate modification, the
outcome may be as good as outside
pregnancy.

14. Reference
• E A Badoe, E Q Achampong, J T da Rocha-Afodu; Principles and
Practice of Surgery Including Pathology in the Tropics, Fourth
Edition,Ghana Publishing cooperation,2009, Page 511
• F C Brunicardi, D L Dunn, D K Andersen et al; Schwartz’s Principles of
Surgery; McGraw-Hill Education United States of America; Page 554
• www.cancerreearchuk.org accessed 29/08/2016
• www.cancer.gov/types/breast/patient/pregnancy-breast-
treatment-pdq accessed 29/08/2016
• www.nationalbreastcancer.org accessed 29/08/2016
• www.koman.org accessed 29/08/2016

15. THANK YOU FOR LISTENING