First Guidelines Created for Treating Early-Stage Breast Cancer During Pregnancy

Reviewed study: "First Guidelines Created for Treating Early-Stage Breast Cancer During Pregnancy" from National Comprehensive Cancer Network, March 13, 2006

Is this for me? If you are pregnant and have been diagnosed with breast cancer, you might want to read this article.

Background and importance of the study: For a woman who develops breast cancer during pregnancy, there are so many issues to deal with: Will the cancer affect the baby? Will my cancer treatments be safe for the baby? Will I have more health complications during pregnancy? Will the pregnancy affect my outcome after breast cancer? Will I be able to take care of myself and the baby?

Because breast cancer during pregnancy is relatively rare, only small studies have been done on this topic. But the National Comprehensive Cancer Network (NCCN) recognized the importance of creating guidelines for treating breast cancer during pregnancy. NCCN is a group of 19 leading cancer institutions in the United States that develops guidelines for treating all types of cancer. Hundreds of institutions around the world use these guidelines.

Study design: While no new study was completed for the development of the guidelines, members of the NCCN Breast Cancer Panel reviewed all the information and research available. The guidelines are for women with early-stage breast cancer. Early-stage breast cancer is only in the breast or underarm lymph nodes and has not spread to any other part of the body.

Guidelines for Treating Early-Stage Breast Cancer during Pregnancy

The treatment guidelines are different for each stage of pregnancy, so that mother and baby both receive the best possible care.

First trimester: If you've been pregnant for three months or less, the guidelines discuss the possibility of ending the pregnancy. The guidelines do not say that you have to end your pregnancy because you've been diagnosed with breast cancer. But it is one of the choices available to you, and it's important to consider all your options when making a decision.

In the first three months of pregnancy, if you decide to continue your pregnancy, the next step is mastectomy with axillary lymph node dissection. Mastectomy is recommended over lumpectomy and radiation at this stage of the pregnancy. That's because radiation is not safe during pregnancy. (In women who aren't pregnant, lumpectomy plus radiation is as good as mastectomy.)

After surgery, the guidelines suggest beginning chemotherapy in the second trimester. Chemotherapy should not be given during the first trimester. It is important to note that if radiation and hormonal therapy are necessary, they should wait until after the baby is born.

Second trimester: If breast cancer is found during the second trimester of pregnancy, the guidelines recommend either mastectomy or lumpectomy, with axillary lymph node dissection. Chemotherapy could be started before surgery. If you and your doctor opt for lumpectomy, then any necessary radiation therapy and hormonal therapy would be given after your child is born.

Third trimester: The guidelines recommend that if you are diagnosed with breast cancer in your third trimester you have either mastectomy, or lumpectomy with axillary lymph node dissection. Chemotherapy can be safely used if needed. Radiation and hormonal therapy, if necessary, would be given after the baby is born.

Type of chemotherapy: The guidelines note that most pregnant women diagnosed with breast cancer have been safely treated with combinations of Adriamycin (chemical name: doxorubicin), Cytoxan (chemical name: cyclophosphamide), and fluorouracil. We don't know yet if taxanes (Taxol (chemical name: paclitaxel) or Taxotere (chemical name: docetaxel) are safe to use during pregnancy.

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