"Pregnancy-associated breast cancer" means the cancer is diagnosed while a woman is pregnant or during the year after pregnancy. The study reviewed here shows that women younger than 35 diagnosed with pregnancy-associated breast cancer had the same long-term outcomes as women who weren't pregnant when diagnosed, though the pregnant women were more likely to be diagnosed with later-stage cancer.
Pregnancy-associated breast cancer doesn't happen very often. Still, as more women wait to have children, it's likely the risk of pregnancy-associated breast cancer will go up. The levels of the hormones estrogen and progesterone change during pregnancy and these hormones can help breast cancers develop and grow. So doctors wondered if breast cancers that develop during and right after pregnancy could have a worse prognosis.
The researchers looked at the records of 652 women, all younger than 35, treated for breast cancer. About 100 of the women were diagnosed with pregnancy-associated breast cancer -- 51 during pregnancy and 53 in the year after delivery. The researchers compared the 10-year outcomes of the women diagnosed with pregnancy-associated breast cancer to the 10-year outcomes of the women who weren't pregnant when diagnosed.
Breast cancer came back in the same area where it was first diagnosed (locoregional recurrence) in:
Breast cancer came back some other place in the body, not the breast area (distant metastasis), in:
There was no difference in 10-year survival rates between the two groups of women:
Still, the women diagnosed with pregnancy-associated breast cancer were more likely to have later-stage breast cancer compared to the other women. This may be because pregnancy may make it harder to detect breast cancer symptoms. Pregnancy also may cause women to wait to get a mammogram.
Some of the women diagnosed with breast cancer while pregnant started treatment before the baby was born. Other women waited to start treatment until after the baby was born. In this study, 10-year survival rates were better among women who started treatment while pregnant (78.7%), compared to survival rates among women who waited until after they gave birth to start treatment (44.7%).
If you've been diagnosed with breast cancer while pregnant or in the year after you gave birth, the results of this study are reassuring. If you're diagnosed while pregnant, you might want to wait and start treatment after you have your baby. This is understandable. Still, this study suggests that starting treatment while you're pregnant may make more sense. In 2006, the National Comprehensive Cancer Network created Guidelines for Treating Early-Stage Breast Cancer During Pregnancy. Talk to your doctor about these guidelines and the treatment options that are best for your unique situation. Together you'll develop treatment approach that's best for both you and your baby.
HOUSTON, Feb. 9 (MedPage Today) -- Women under 35 with pregnancy-associated breast cancer do just as well in the long term as others with breast cancer, researchers here said.
In a retrospective study, both groups of women had statistically identical 10-years rates of locoregional recurrence, distant metastases, and overall survival, according to George Perkins, M.D., and colleagues at the University of Texas M.D. Anderson Cancer Center.
On the other hand, those with pregnancy-associated breast cancer have more advanced disease at diagnosis, suggesting that diagnosis, evaluation, and treatment may be delayed, Dr. Perkins and colleagues said online in Cancer.
Pregnancy-associated breast cancer -- defined as cancer diagnosed during or within a year after pregnancy -- is a "relatively rare entity that presents unique challenges for both diagnosis and management," Dr. Perkins and colleagues said.
But as maternal age at the time of pregnancy rises, its incidence is likely to increase as well, the researchers said.
To examine the long-term effects of such cancers, the researchers looked at medical records of 652 women (with 668 cancers) treated between 1973 and 2006 at the M.D. Anderson Cancer Center.
Of the 652, 104 had pregnancy-associated breast cancer, with 51 developing during pregnancy and 53 within a year of delivery.
The outcomes of interest were locoregional recurrence, distant metastases, and overall survival, but Dr. Perkins and colleagues also compared such clinical characteristics as T classification, N classification, American Joint Committee on Cancer (AJCC) stage, and stage group.
Analysis found no significant differences in the primary outcomes. Specifically:
There were also no significant differences in any of the outcomes when the researchers compared those whose cancer developed during pregnancy with those in which it appeared later.
On the other hand, patients with pregnancy-associated breast cancer had higher T and N classifications, higher AJCC stage, and higher stage group, at P<0.04 for all comparisons.
"This suggests that physicians who care for these patients should be more aggressive in the workup and diagnostic evaluation of breast symptoms in this population," the researchers argued.
"Pregnancy itself does not impart a worse prognosis," they said. "However, pregnancy does mask symptoms and hinder diagnosis."
In addition, for those patients who developed breast cancer during pregnancy, any treatment intervention during pregnancy provided a trend
toward improved overall survival compared with delaying evaluation and treatment until after delivery (78.7% vs 44.7%; P=0.068).
The study suffers from the usual limitations associated with retrospective investigations, the researchers said. In addition, the study covers several decades, during which treatment methods and ideas have changed.
The researchers did not report any external support for the study or any conflicts of interest.
Primary source: Cancer Source reference: Beadle BM et al. "The impact of pregnancy on breast cancer outcomes in women younger than 35 years old" Cancer 2009; DOI: 10.1002/cncr.24165.
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