Diagnosing and Treating Breast Cancer in the Pregnant Woman

Because breast cancer is an uncommon occurrence during pregnancy, symptoms and signs of the disease may be overlooked, resulting in delays in treatment and potentially compromising survival. In many cases, the physician may mistake signs of disease for the normal physiologic changes of pregnancy. For this reason, it is imperative that physicians perform careful clinical breast examinations in all pregnant patients--particularly early in gestation, before the breasts become difficult to examine. Upon finding any suspicious breast mass, an open biopsy without delay is indicated. Once a diagnosis of breast cancer is confirmed, a modified radical mastectomy is the treatment of choice in a pregnant woman because of the hazards of adjuvant therapy to the fetus. The administration of adjuvant therapy, such as radiation therapy or chemotherapy, may pose a risk to the fetus and requires careful consideration by the physician and patient. In some cases, especially when disease presents early in gestation, an interruption of the pregnancy may be warranted. Importantly, stage for stage, breast cancer during pregnancy has a similar prognosis to that of breast cancer in young, nonpregnant women; pregnancy itself does not appear to have an adverse effect on the disease process. In addition, with careful counseling, pregnancy subsequent to breast cancer is possible for some women with good prognoses.