breast cancer in pregnancy

Question 1

Discuss the prognosis of breast cancer in pregnancy cf non pregnant age matched controls

Answer 1

pregnancy does not itself worsen the prognosis of breast cancer compared with non pregnant age and stage matched controls provided standard treatment guidelines are adhered to
breast cancers diagnosed in pregnant woman are cancers occurring in a younger population and are inherently more aggressive

Question 2

assess the use of USS as an imaging modality for breast cancer in pregnancy

Answer 2

1st line imaging for pregnant woman with breast lump
aids USS guided biopsy
USS preferable over mammography as in pregnancy the breast density makes interpretation of mammography more difficult

Question 3

assess the use of mammography for investigating breast lump in pregnancy

Answer 3

usually the 1st line management option
in pregnancy the increased breast density and water content results in mammography being more difficult to use and interpret than in non pregnant women
if used needs to be performed with fetal shielding - only used once cancer is confirmed to review contralateral breast

Question 4

assess the use of USS guided biopsy for investigation of breast lump in pregnancy

Answer 4

can be used preferentially over FNA in pregnancy
safe
performed with Local anaesthetic use for pain relief

Question 5

Is radiotherapy used in pregnancy?

Answer 5

no, not unless life saving or organ preserving

if given during pregnancy - fetal shielding is required

Question 6

Is chemotherapy used in pregnancy?

Answer 6

• it is contraindicated in the first trimester but okay in 2nd and 3rd trimester
• no evidence of adverse outcome (including growth restriction)

Question 7

Can tamoxifen be used in pregnancy?

Answer 7

no

Question 8

if someone is having chemotherapy during pregnancy when would you recommend delivery?

Answer 8

aim for 2-3 weeks after previous round of chemotherapy to allow bone marrow to recover

Question 9

Can you be on chemotherapy while breast feeding?

Answer 9

not recommended

wait 2 weeks following chemotherapy cycle to clear from maternal cycle

Question 10

what VTE prophylaxis would you give someone with breast cancer?

Answer 10

• 6 weeks of clexane

Question 11

what would you advise a woman with breast cancer about future pregnancy?

Answer 11

• if early stage disease then future pregnancy will not impact prognosis
• if metastatic disease recommend against due to poor prognosis and may impact on treatment
• ## chemotherapy may have an impact on fertility but depends on agents used