Surgical treatment of pregnancy associated breast cancer

As the average age of parity increases amongst American women, the incidence of pregnancy associated breast cancer is also rising. The physiologic changes of the breast in pregnancy must be appreciated and understood in order to accurately and expeditiously diagnose pregnancy associated breast cancer (PABC). Core biopsy provides the safest and most accurate diagnostic tool. Once a diagnosis is made, risks and benefits to both the mother and the fetus must be considered prior to accepting a definitive management strategy. Historically women with PABC were encouraged to undergo modified radical mastectomy and to terminate pregnancy in order to safely proceed with adequate adjuvant therapy. Current care, however, relies upon multimodality therapy directed by multidisciplinary teams. PABC diagnosed early in the first trimester is best managed surgically by modified radical mastectomy followed by adjuvant chemotherapy in the second trimester. Women diagnosed in the late first, or the second or third trimesters may be safely treated with the surgical techniques of their choosing. Neoadjuvant chemotherapy, sentinel node biopsy and breast conservation are now considered safe modalities in properly chosen pregnant patients.