Gestational breast cancer

To study the problems of breast imaging in gestational breast cancer.

Retrospective review of the charts of 19 patients with breast cancer detected during pregnancy or lactation or within 1 year of delivery, who were referred to a tertiary centre for adjuvant therapy between 1986 and 1996. For 10 patients who underwent breast imaging, mammograms and breast ultrasonograms or reports were requested from outside facilities.

The patients ranged in age from 23 to 41 years (mean 31 years). All 19 patients presented with palpable tumours; in 7 patients, the tumours were stage T2 or higher; in 11 patients, the tumours were at an advanced stage with positive axillary nodes. In 11 of the patients there was a delay in diagnosis, which ranged from 2 to 16 months. Of the 8 mammograms that could be reviewed, 5 showed infiltrating ductal carcinomas with typical features, which were detected as a mass (in 1 case), a mass with microcalcifications (in 1 case), microcalcifications (in 2 cases) and asymmetry (in 1 case). Three mammograms were negative, including 1 obtained from a patient with extensive comedocarcinoma. Breast ultrasonograms obtained from 4 patients (2 of whom also had mammograms) showed solid hypoechoic masses; in 2 of the ultrasonograms, the masses simulated a benign lesion.

Although breast cancer during pregnancy and lactation is rare, this study suggests that radiologists should include it in the differential diagnosis of a solid breast mass seen during pregnancy or lactation. Clinicians appear to be reluctant to use breast imaging in these patients; however, this can lead to a delay in diagnosis. Ultrasonography is the modality of choice for initial analysis of such a mass in this age group. Mammography with shielding of the abdomen is recommended if there is suspicion of cancer. Clinical, mammographic and sonographic findings should be integrated for optimum interpretation.