Pregnancy and Breast Cancer GTG 12

Question 1

What is the lifetime risk of breast cancer in women?

Answer 1

1 in 9

Question 2

What percentage of breast cancer is diagnosed under the age of 45?

Answer 2

15%

Question 3

How many women of reproductive age does breast cancer affect every year?

Answer 3

5000

Question 4

When breast cancer is diagnosed in women aged 30 and under, what percentage of these are associated with pregnancy or up to one year postnatal?

Answer 4

10-20%

Question 5

Incidence of breast cancer in women per 10,000 live births

Answer 5

1.3-2.4 cases of breast cancer in women per 10,000 live births

Question 6

What is the five-year survival rate for women under the age of 50?

Answer 6

80%

Question 7

In pregnancy if a women is found to have a suspicious breast lump how should this be managed?

Answer 7

Refer to breast team/MDT
1) USS if breast ca then 2) Mammogram to assess the extent of disease and contralateral breast
Tissue diagnosis (US-guided biopsy) to be sent for histology (rather than cytology as proliferative change in pregnancy renders cytology inconclusive).

Question 8

If there is suspicion of mets which investigations should and should not be carried out?

Answer 8

Staging with Liver USS and CXR.
Bone scanning/pelvic X-ray/ CT are NOT recommended due to risks to baby.
If there are concerns about bone - plain film or MRI to be done.

Question 9

In which trimester is it safe to do surgery for breast cancer?

Answer 9

Can be done in any trimester.
Breast conserving surgery or mastectomy can be considered based on MDT discussion.
(Reconstruction should be delayed to reduce anaesthetic time and allow optimal symmetrisation of breasts post delivery)

Question 10

Is radiotherapy contraindicated in pregnancy?

Answer 10

Yes.
Unless it is required as life saving procedure e.g. Spinal compression
Otherwise defer until after delivery

Question 11

When is it safe to offer chemotherapy in pregnancy?

Answer 11

C/I in T1 (high rate of fetal abnormality)
Safe from T2 onwards
There is no evidence of increased risk of miscarriage or fetal growth restriction with the use of chemotherapy from T2

Question 12

Is Tamoxifem safe in pregnancy?

Answer 12

No.
Tamoxifem and Trastuzumab (herceptin) are contraindicated in pregnancy.
If taking any of these adviced NOT to breastfeed.

Question 13

Which chemotherapy agent/regimen are safe to use in pregnancy?

Answer 13

Anthracycline regimens are safe.
There is fewer data on Taxanes (reserved for high risk (node positive) or metastatic disease)
No data on safety of use of bevacizumab.

Question 14

When should delivery be planned for a women with breast cancer?

Answer 14

Women can go to term and be induced post dates - delivery should be >2-3weeks from the last chemotherapy treatment to allow bone marrow recovery and minimise problems related to neutropenia.

Question 15

What contraceptive advice should be given to these women postnatally?

Answer 15

Hormonal contraception is C/I (UKMEC 4)

Hormonal contraception may be considered after 5 years free of recurrence (UKMEC 3)

Question 16

Pre conceptual advice:

When should women try to conceive?

Answer 16

Most women should wait at least 2 years after treatment before conceiving (risk of recurrence is highest in first two years)
They are advised Tamoxifem should be taken for five years but if they wish to conceive they should stop it 3 months prior to trying to conceive.

Question 17

In women previous affected by breast cancer - what antenatal care should they receive?

Answer 17

MDT
Echocardiogram: they are at risk of cardiomyopathy- anthracyclines (e.g. Doxorubicin, epirubicin) can cause a cumulative dose-dependent left ventricular dysfunction and rarely cardiomyopathy.