Obstetricians should perform a thorough breast examination of pregnant women to detect breast cancer, according to a study presented today (20 June). Too often the diagnosis is delayed because doctors and pregnant women assume that lumps in the breast are due to normal hormonal changes.
The threat of breast cancer is frightening for anyone, particularly during pregnancy, but it is not uncommon. Around one in every thousand women gets breast cancer every year. Pregnant women and physicians should be more aware of the risk of cancer. Speaking at the European Society for Medical Oncology conference in Edinburgh, Dr Blanca Hernando from the University Hospital Clinic in Valencia, Spain, said, "The obstetrician is usually more focused on the health of the unborn baby than the mother's possible illness but should be more aware of the risk of breast cancer." Women should examine their breasts regularly and tell their doctor about any changes they discover.
Not only is diagnosis often delayed, but there is a high rate of false-negative results of a mammography due to the increased density of the breast during pregnancy.
Ultrasonogaphy is the best way to check for cancerous lumps in pregnant and lactating women. Many studies have shown that the tumours in pregnant women are larger and are more likely to spread.
Pregnant women should be encouraged to know that treatment is as successful and safe as in non-pregnant women. Surgery is the best route although there is a small risk of premature labour. Radiation therapy is not offered during pregnancy but patients can be safely treated with certain forms of chemotherapy from three months onwards. This may be continued after the baby is born, although mothers should not breast feed their babies while they are having chemotherapy.
In a study of 18 women with breast cancer, Dr Hernando reported that there was a 10- week delay in the diagnosis meaning that patients were treated when their cancer had progressed. All the patients had surgery to remove the lump and chemotherapy. Four women diagnosed in the first three months chose to have an abortion and another four patients needed a caesarean. All the babies born were healthy.
"Breast cancer during pregnancy has about the same prognosis as other breast cancer, when compared to women of a similar age," said Dr Hernando. "It is, of course, a very serious illness but it can be treated successfully. The most important thing is to be diagnosed and treated at an early stage to prevent it spreading to other parts of the body."
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Notes to Editors
About the European Society for Medical Oncology (ESMO)
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Abstract 49PD - Discussion Time: 10.00-10.45, Sunday, 22 June 2003, Fintry Suite
Management of Breast Cancer during pregnancy
Blanca Hernando Fernandez de Aranguiz (1) (1) Servicio Oncologia y Hematologia medica, Hospital Clinico universitario, Valencia, Spain
To review the management of breast cancer during pregnancy, we present our experience with the use of combination chemotherapy. Patients and methods: 4784 women with stage I-IV breast cancer were diagnosed since October 1982 to July-2002. A total of 18 women (0.0037%) were diagnosed of breast cancer during pregnancy. All were managed by outpatient chemotherapy, surgery and radiation therapy as clinically indicated. Chemotherapy included antracyclines after the first trimester of pregnancy. Median age was 35 years old (29-41). Patients were diagnosed: 4/18 in the first trimester, 5/18 at the second trimester, 3/18 at the third trimester and 6/18 in the postpartum period. Delay in diagnosis was 2,5 months (1-8). They were 55 % stage III-IV. 66% node positive tumors. 50% had negative estrogen and /or progesterone receptors status. 88% were invasive ductal carcinoma. 22% were inflammatory carcinomas. 7 of 9 evaluated tumor had high nuclear grade (II or III). 6/9 evaluated tumor had overexpression of the Her-2/neu. All patients had surgical treatment (with radical mastectomy in 77%). Postpartum radiation therapy was administered in 66%. All patients received chemotherapy including antracyclines, 31% during the second and third trimester and 66% in the postpartum period. No anterpartum complications attributable to systemic therapy were noted. Four patients required cesarean. Immediate postpartum health was reported to be normal for all the children. Four patients diagnosed and informed of the risk of treatment during first trimester, choose therapeutic abortion. Median follow-up was 34 months. Seven patients still remain progression free survival. 3-year survival was estimated at 65%. For the matched comparison nonpregnant women group, survival was 66%. Conclusions:3–year survival is similar to that for nonpregnant women when adjusted for age. Breast cancer can be safely treated with chemotherapy including antracyclines during the second and third trimesters of pregnancy without complications.
Blanca HERNANDO FERNÁNDEZ DE ARÁNGUIZ
Curriculum Vitae
Academic training: MD Degree from 1993-1999 at University of Navarra, Pamplona
Medical Oncology Degree: Training period from 2000-2003, at the Haematology and Medical Oncology Department of the University Hospital Valencia
Doctorate Courses: Metodología de la investigación, Hematología y Oncología
Congresses attended: Advanced Ovarian cancer, optimal therapy update (ESMO/MORA) 28-02-2003. Simposio en avances y nuevas perspectivas en neoplasias hematológicas; Colorectal reviews; Breast cancer surgical and medical treatment symposium
Research projects Co–investigator: Phase II trial of Vinflunina in patients with advanced ovarian cancer unresponsive to chemotherapy based on platinum/taxanes. Protocol 0L00071N208E2
Collaborate investigator: Investigation project at University Hospital Valencia: "Predictive factors in response to Darbopoetin alfa in patients with lung cancer receiving chemotherapy with platinum".
Journal
Annals of Oncology