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[Shared Decision Making with a Breast Cancer Case Diagnosed During Pregnancy-A Case Report]
Tetsunori Yoshimura1, Haruya Koshiishi, Noriko Ohshima
1Dept. of Surgery, Tokyo Metropolitan Ohtsuka Hospital.
Gan to Kagaku Ryoho. Cancer & Chemotherapy
|February 2, 2024
Summary
Shared decision making (SDM) guided treatment for a pregnant patient with breast cancer. The patient
Area of Science:
- Oncology
- Maternal-Fetal Medicine
- Surgical Oncology
Background:
- Breast cancer diagnosis during pregnancy presents unique challenges for treatment planning.
- Shared decision making (SDM) is vital for navigating complex choices in pregnant patients with cancer.
- Limited high-grade evidence exists for managing breast cancer during pregnancy.
Observation:
- A pregnant patient in her 30s diagnosed with Stage I breast cancer at 20 weeks gestation.
- Patient opted for conservative surgery (partial mastectomy) and lymph node sampling over recommended total mastectomy and sentinel biopsy.
- Radiotherapy was postponed post-delivery to accommodate breastfeeding, commencing 6 weeks postpartum.
Findings:
- The patient's treatment choices, guided by SDM, prioritized personal circumstances (breastfeeding) over immediate optimal oncological protocols.
- Successful surgical management was achieved with conservative breast surgery and lymph node sampling during pregnancy.
- Delayed adjuvant radiotherapy was initiated after the cessation of breastfeeding.
Implications:
- SDM is essential for tailoring breast cancer treatment in pregnant patients, respecting individual values and circumstances.
- Case highlights the need for individualized care plans balancing maternal health, fetal well-being, and oncological outcomes.
- Further research is needed to establish optimal treatment guidelines for breast cancer during pregnancy, considering patient preferences and evidence limitations.
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