Pregnancy-associated breast cancer: How common is it?

By Dr. Sukriye Jülide Sağiroğlu, Specialist Breast & General Surgery, NMC Royal Hospital Sharjah, Sharjah

In just two months, the annual pink-themed initiatives and events will be occurring worldwide. October, known as Breast Cancer Awareness month, is an annual campaign to raise awareness about the impact of breast cancer. However, it shouldn’t be the only month to check for early detection of breast cancer. Especially, for the pregnant ladies out there – do not discount that little voice in your head saying ‘What if?’.

Breast cancer diagnosed during pregnancy or within the first year of childbirth is called ‘pregnancy-associated breast cancer (PABC), also known as gestational breast cancer. Over the past few years Dr. Sukriye Jülide Sağiroğlu, Specialist Breast & General Surgery, at the NMC Royal Hospital Sharjah, focuses predominantly on breast cancer surgery and reconstruction and has shed a light on why pregnant women should also be checked for breast cancer.

Dr. Sukriye Jülide Sağiroğlu says: “During pregnancy and the breast-feeding period, it is harder to detect breast cancer. A palpable mass or thickening of the breast skin can be simple signs of breast cancer in pregnancy, and while the breasts changes during pregnancy due to general swelling, expansion, and increased firmness and nodularity of the breast, it may often hide a breast mass which results in delayed diagnosis of PABC. And even though it is rare, approximately 1 in 3000 pregnant women are diagnosed with breast cancer and it is the second most common cancer type during pregnancy – the first being cervical cancer.” 

Women diagnosed with PABC are generally between the ages of 31 and 38. The last three decades showed a remarkable increase in PABC as more women prefer to postpone pregnancy to a later age. PABC is rare and associated with several factors; currently, many studies focus on the causes, management, and best treatment modalities.

“Once a diagnosis of breast cancer has been made, immediate action for treatment is crucial. If the patient is close to delivery, it is advised to give birth before treatment. Otherwise, treatment must be started by the pregnancy week” mentions Dr. Sukriye Jülide Sağiroğlu.

Mammography, ultrasound, and magnetic resonance imaging (MRI) are all used as breast imaging to diagnose PABC. Ultrasound is proven to be the safest in pregnancy while mammography exerts little radiation on the fetus with abdominal protection. Breast MRI is also useful in PABC, however during pregnancy, the safety of MRI contrast medium is still controversial. All suspected lumps undergo a biopsy (sampling) following the imaging step.

Surgery is the first line of treatment for PABC.

Radiotherapy is not used in pregnancy as it is hazardous to the fetus.

Chemotherapy agents are contraindicated in the first three months of pregnancy because they are hazardous to the fetus. Following the first trimester, chemotherapy for PABC is considered safe for the mother and baby.

Limitations of diagnosis and treatment make PABC a highly challenging disease both for the woman and fetus. Being aware of this accelerating type of cancer is the first precaution. Whether pregnancy and breastfeeding are protective against breast cancer, or this protection is only good for very young mothers, is still to be further researched.  

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