Pregnancy and Breast Cancer

BJOG: An International Journal of Obstetrics & GynaecologyEarly View RCOG GUIDELINES Pregnancy and Breast Cancer Green-top Guideline No. 12 Anne Armstrong, Anne ArmstrongSearch for more papers by this authorAshu Gandhi, Ashu GandhiSearch for more papers by this authorSuzanne Frank, Suzanne FrankSearch for more papers by this authorDavid Williams, David WilliamsSearch for more papers by this authorSamantha Nimalasena, Samantha NimalasenaSearch for more papers by this author on behalf of the Royal College of Obstetricians and Gynaecologists, Corresponding Author the Royal College of Obstetricians and Gynaecologists [email protected] Correspondence: Royal College of Obstetricians and Gynaecologists ([email protected])Search for more papers by this author Anne Armstrong, Anne ArmstrongSearch for more papers by this authorAshu Gandhi, Ashu GandhiSearch for more papers by this authorSuzanne Frank, Suzanne FrankSearch for more papers by this authorDavid Williams, David WilliamsSearch for more papers by this authorSamantha Nimalasena, Samantha NimalasenaSearch for more papers by this author on behalf of the Royal College of Obstetricians and Gynaecologists, Corresponding Author the Royal College of Obstetricians and Gynaecologists [email protected] Correspondence: Royal College of Obstetricians and Gynaecologists ([email protected])Search for more papers by this author First published: 25 August 2025 https://doi.org/10.1111/1471-0528.18270 Funding: All those involved in the development of the Green-top Guidelines, including the Guidelines Committee, Guidelines Committee co- chairs, guideline developers, peer reviewers and other reviewers, are unpaid volunteers and receive no direct funding for their work in producing the guideline. The exceptions to this are the RCOG staff involved who are salaried employees of the College, and Guidelines Committee members who receive reimbursement for expenses for attending Guidelines Committee meetings. Please see more information on travel expense rules on the RCOG website. This is the third edition of this guideline. It replaces the previous editions published in March 2011 and January 2004, with earlier advice published in 1997. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookxLinkedInRedditWechatBluesky References 1 "Cancer Research UK Breast Cancer Survival Statistics," https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/survival. Google Scholar 2L. P. Middleton, M. Amin, K. Gwyn, R. Theriault, and A. Sahin, "Breast Carcinoma in Pregnant Women: Assessment of Clinicopathologic and Immunohistochemical Features," Cancer 98 (2003): 1055–1060. 10.1002/cncr.11614 PubMed Web of Science® Google Scholar 3 Office for National Statistics, "Births in England and Wales: 2020," https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2020. Google Scholar 4 "MBRRACE-UK: Mothers and Babies: Reducing Risk Through Audits and Confidential Enquiries Across the UK," Saving Lives, Improving Mothers' Care – Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017–19 (2021). Google Scholar 5 American College of Obstetricians and Gynecologists, "Refusal of Medically Recommended Treatment During Pregnancy," https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/06/refusal-of-medically-recommended-treatment-during-pregnancy. Google Scholar 6A. L. V. Johansson, T. M. L. Andersson, C. C. Hsieh, et al., "Stage at Diagnosis and Mortality in Women With Pregnancy-Associated Breast Cancer (PABC)," Breast Cancer Research and Treatment 139 (2013): 183–192. 10.1007/s10549-013-2522-1 PubMed Web of Science® Google Scholar 7E. Simoes, J. Graf, A. N. Sokolov, et al., "Pregnancy-Associated Breast Cancer: Maternal Breast Cancer Survival Over 10 Years and Obstetrical Outcome at a University Centre of Women's Health," Archives of Gynecology and Obstetrics 298 (2018): 363–372. 10.1007/s00404-018-4822-5 PubMed Web of Science® Google Scholar 8F. Amant, H. Lefrère, V. F. Borges, et al., "The Definition of Pregnancy-Associated Breast Cancer Is Outdated and Should No Longer Be Used," Lancet Oncology 22 (2021): 753–754. 10.1016/S1470-2045(21)00183-2 PubMed Web of Science® Google Scholar 9E. B. Callihan, D. Gao, S. Jindal, et al., "Postpartum Diagnosis Demonstrates a High Risk for Metastasis and Merits an Expanded Definition of Pregnancy-Associated Breast Cancer," Breast Cancer Research and Treatment 138 (2013): 549–559. 10.1007/s10549-013-2437-x PubMed Web of Science® Google Scholar 10H. A. Azim, L. Santoro, W. Russell-Edu, G. Pentheroudakis, N. Pavlidis, and F. A. Peccatori, "Prognosis of Pregnancy-Associated Breast Cancer: A meta-Analysis of 30 Studies," Cancer Treatment Reviews 38 (2012): 834–842. 10.1016/j.ctrv.2012.06.004 PubMed Web of Science® Google Scholar 11E. K. Hartman and G. D. Eslick, "The Prognosis of Women Diagnosed With Breast Cancer Before, During and After Pregnancy: A Meta-Analysis," Breast Cancer Research and Treatment 160 (2016): 347–360. 10.1007/s10549-016-3989-3 CAS PubMed Web of Science® Google Scholar 12C. Shao, Z. Yu, J. Xiao, et al., "Prognosis of Pregnancy-Associated Breast Cancer: A Meta-Analysis," BMC Cancer 20 (2020): 746. 10.1186/s12885-020-07248-8 PubMed Web of Science® Google Scholar 13L. Prior, R. O'Dwyer, A. R. Farooq, et al., "Pregnancy-Associated Breast Cancer: Evaluating Maternal and Foetal Outcomes. A National Study," Breast Cancer Research and Treatment 189 (2021): 269–283. 10.1007/s10549-021-06263-y CAS PubMed Web of Science® Google Scholar 14B. M. Beadle, W. A. Woodward, L. P. Middleton, et al., "The Impact of Pregnancy on Breast Cancer Outcomes in Women ≤35 Years," Cancer 115, no. 6 (2009): 1174–1184, https://doi.org/10.1002/cncr.24165. 10.1002/cncr.24165 PubMed Web of Science® Google Scholar 15F. Amant, G. von Minckwitz, S. N. Han, et al., "Prognosis of Women With Primary Breast Cancer Diagnosed During Pregnancy: Results From an International Collaborative Study," Journal of Clinical Oncology 31 (2013): 2532–2539. 10.1200/JCO.2012.45.6335 PubMed Web of Science® Google Scholar 16C. G. Murphy, D. Mallam, S. Stein, et al., "Current or Recent Pregnancy Is Associated With Adverse Pathologic Features but Not Impaired Survival in Early Breast Cancer," Cancer 118 (2012): 3254–3259. 10.1002/cncr.26654 PubMed Web of Science® Google Scholar 17B. B. M. Suelmann, C. van Dooijeweert, E. van der Wall, S. Linn, and P. J. van Diest, "Pregnancy-Associated Breast Cancer: Nationwide Dutch Study Confirms a Discriminatory Aggressive Histopathologic Profile," Breast Cancer Research and Treatment 186 (2021): 699–704. 10.1007/s10549-021-06130-w CAS PubMed Web of Science® Google Scholar 18S. Y. Bae, S. J. Kim, J. S. Lee, et al., "Clinical Subtypes and Prognosis of Pregnancy-Associated Breast Cancer: Results From the Korean Breast Cancer Society Registry Database," Breast Cancer Research and Treatment 172 (2018): 113–121. 10.1007/s10549-018-4908-6 PubMed Web of Science® Google Scholar 19A. L. V. Johansson, T. M. L. Andersson, C. C. Hsieh, et al., "Tumor Characteristics and Prognosis in Women With Pregnancy-Associated Breast Cancer," International Journal of Cancer 142 (2018): 1343–1354. 10.1002/ijc.31174 CAS PubMed Web of Science® Google Scholar 20C. C. O'Sullivan, S. Irshad, Z. Wang, et al., "Clinico-Pathologic Features, Treatment and Outcomes of Breast Cancer During Pregnancy or the Post-Partum Period," Breast Cancer Research and Treatment 180 (2020): 695–706. 10.1007/s10549-020-05585-7 PubMed Web of Science® Google Scholar 21F. Amant, V. Nekljudova, C. Maggen, et al., "Outcome of Breast Cancer Patients Treated With Chemotherapy During Pregnancy Compared With Non-Pregnant Controls," European Journal of Cancer 170 (2022): 54–63. 10.1016/j.ejca.2022.04.014 CAS PubMed Web of Science® Google Scholar 22A. Puchar, M. Despierres, A. S. Boudy, et al., "Prognosis of Triple-Negative Breast Cancer Associated With Pregnancy: A Propensity Score-Matched Analysis From the French CALG (Cancer Associé à la Grossesse) Network," Breast 61 (2022): 168–174. 10.1016/j.breast.2022.01.004 PubMed Google Scholar 23S. Loibl, S. N. Han, G. von Minckwitz, et al., "Treatment of Breast Cancer During Pregnancy: An Observational Study," Lancet Oncology 13 (2012): 887–896. 10.1016/S1470-2045(12)70261-9 CAS PubMed Web of Science® Google Scholar 24J. K. Litton, C. L. Warneke, K. M. Hahn, et al., "Case Control Study of Women Treated With Chemotherapy for Breast Cancer During Pregnancy as Compared With Nonpregnant Patients With Breast Cancer," Oncologist 18 (2013): 369–376. 10.1634/theoncologist.2012-0340 CAS PubMed Web of Science® Google Scholar 25K. J. Jerzak, N. Lipton, S. Nofech-Mozes, et al., "Clinical Outcomes and Prognostic Biomarkers Among Pregnant, Post-Partum and Nulliparous Women With Breast Cancer: A Prospective Cohort Study," Breast Cancer Research and Treatment 189 (2021): 797–806. 10.1007/s10549-021-06327-z CAS PubMed Web of Science® Google Scholar 26E. Shagisultanova, D. Gao, E. Callihan, et al., "Overall Survival Is the Lowest Among Young Women With Postpartum Breast Cancer," European Journal of Cancer 168 (2022): 119–127. 10.1016/j.ejca.2022.03.014 CAS PubMed Web of Science® Google Scholar 27H. Lefrère, G. Floris, M. K. Schmidt, et al., "Data Describing the Poor Outcome Associated With a Breast Cancer Diagnosis in the Post-Weaning Period," Data in Brief 38 (2021): 107354. 10.1016/j.dib.2021.107354 CAS PubMed Web of Science® Google Scholar 28H. Lefrère, G. Floris, M. K. Schmidt, et al., "Breast Cancer Diagnosed in the Post-Weaning Period Is Indicative for a Poor Outcome," European Journal of Cancer 155 (2021): 13–24. 10.1016/j.ejca.2021.06.009 PubMed Web of Science® Google Scholar 29H. Lefrère, L. Lenaerts, V. F. Borges, P. Schedin, P. Neven, and F. Amant, "Postpartum Breast Cancer: Mechanisms Underlying Its Worse Prognosis, Treatment Implications, and Fertility Preservation," International Journal of Gynecological Cancer 31 (2021): 412–422. 10.1136/ijgc-2020-002072 PubMed Web of Science® Google Scholar 30E. T. Goddard, S. Bassale, T. Schedin, et al., "Association Between Postpartum Breast Cancer Diagnosis and Metastasis and the Clinical Features Underlying Risk," JAMA Network Open 2 (2019): e186997. 10.1001/jamanetworkopen.2018.6997 PubMed Web of Science® Google Scholar 31V. F. Borges, T. R. Lyons, D. Germain, and P. Schedin, "Postpartum Involution and Cancer: An Opportunity for Targeted Breast Cancer Prevention and Treatments?," Cancer Research 80 (2020): 1790–1798. 10.1158/0008-5472.CAN-19-3448 CAS Google Scholar 32S. Jindal, J. Narasimhan, V. F. Borges, and P. Schedin, "Characterization of Weaning-Induced Breast Involution in Women: Implications for Young Women's Breast Cancer," npj Breast Cancer 6 (2020): 55. 10.1038/s41523-020-00196-3 CAS PubMed Web of Science® Google Scholar 33T. R. Lyons, J. O'Brien, V. F. Borges, et al., "Postpartum Mammary Gland Involution Drives Progression of Ductal Carcinoma In Situ Through Collagen and COX-2," Nature Medicine 17 (2011): 1109–1115. 10.1038/nm.2416 CAS PubMed Web of Science® Google Scholar 34V. F. Borges, A. M. Elder, and T. R. Lyons, "Deciphering Pro-Lymphangiogenic Programs During Mammary Involution and Postpartum Breast Cancer," Frontiers in Oncology 6 (2016): 227. 10.3389/fonc.2016.00227 PubMed Web of Science® Google Scholar 35A. M. Witt, M. Bolman, S. Kredit, and A. Vanic, "Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis," Journal of Human Lactation 32 (2016): 123–131. 10.1177/0890334415619439 PubMed Web of Science® Google Scholar 36H. R. Macdonald, "Pregnancy Associated Breast Cancer," Breast Journal 26 (2020): 81–85. 10.1111/tbj.13714 PubMed Web of Science® Google Scholar 37 Expert Panel on Breast Imaging, R. M. di Florio-Alexander, P. J. Slanetz, L. Moy, et al., "ACR Appropriateness Criteria Breast Imaging of Pregnant and Lactating Women," Journal of the American College of Radiology 15, no. 11S (2018): S263–S275, https://doi.org/10.1016/j.jacr.2018.09.013. 10.1016/j.jacr.2018.09.013 PubMed Google Scholar 38B. C. Yankaskas, S. Haneuse, J. M. Kapp, et al., "Performance of First Mammography Examination in Women Younger Than 40 Years," Journal of the National Cancer Institute 102 (2010): 692–701. 10.1093/jnci/djq090 PubMed Web of Science® Google Scholar 39V. A. Arasu, N. Kannan, P. M. Krishnarao, et al., "Imaging the Breast in Pregnant or Lactating Women," Current Radiology Reports 6 (2018): 10. 10.1007/s40134-018-0267-7 Google Scholar 40R. P. Candelaria, M. L. Huang, B. E. Adrada, et al., "Incremental Cancer Detection of Locoregional Restaging With Diagnostic Mammography Combined With Whole-Breast and Regional Nodal Ultrasound in Women With Newly Diagnosed Breast Cancer," Academic Radiology 24 (2017): 191–199. 10.1016/j.acra.2016.11.015 PubMed Web of Science® Google Scholar 41C. Mandoul, C. Verheyden, I. Millet, et al., "Breast Tomosynthesis: What Do We Know and Where Do We Stand?," Diagnostic and Interventional Imaging 100 (2019): 537–551. 10.1016/j.diii.2019.07.012 CAS PubMed Google Scholar 42G. Gennaro, D. Bernardi, and N. Houssami, "Radiation Dose With Digital Breast Tomosynthesis Compared to Digital Mammography: Per-View Analysis," European Radiology 28 (2018): 573–581. 10.1007/s00330-017-5024-4 PubMed Web of Science® Google Scholar 43A. R. Cepeda Martins, S. di Maria, J. Afonso, M. Pereira, J. Pereira, and P. Vaz, "Assessment of the Uterine Dose in Digital Mammography and Digital Breast Tomosynthesis," Radiography 28 (2022): 333–339. 10.1016/j.radi.2021.09.002 CAS PubMed Web of Science® Google Scholar 44M. John, "Eisenberg Center for Clinical Decisions and Communications Science. Core-Needle Biopsy for Breast Abnormalities," 2019. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD, https://effectivehealthcare.ahrq.gov/products/breast-biopsy-update/clinician. Google Scholar 45W. A. Berg, "Image-Guided Breast Biopsy and Management of High-Risk Lesions," Radiologic Clinics of North America 42 (2004): 935–946. 10.1016/j.rcl.2004.04.002 PubMed Web of Science® Google Scholar 46H. M. Johnson and K. B. Mitchell, "Low Incidence of Milk Fistula With Continued Breastfeeding Following Radiologic and Surgical Interventions on the Lactating Breast," Breast Disease 40 (2021): 183–189. 10.3233/BD-201000 PubMed Google Scholar 47I. Balasubramanian, C. A. Fleming, M. A. Corrigan, H. P. Redmond, M. J. Kerin, and A. J. Lowery, "Meta-Analysis of the Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration and Core Needle Biopsy in Diagnosing Axillary Lymph Node Metastasis," British Journal of Surgery 105, no. 10 (2018): 1244–1253. 10.1002/bjs.10920 CAS PubMed Web of Science® Google Scholar 48K. S. Myers, L. A. Green, L. Lebron, and E. A. Morris, "Imaging Appearance and Clinical Impact of Preoperative Breast MRI in Pregnancy-Associated Breast Cancer," American Journal of Roentgenology 209 (2017): W177–W183. 10.2214/AJR.16.17124 PubMed Web of Science® Google Scholar 49F. A. Peccatori, G. Codacci-Pisanelli, M. del Grande, G. Scarfone, F. Zugni, and G. Petralia, "Whole Body MRI for Systemic Staging of Breast Cancer in Pregnant Women," Breast 35 (2017): 177–181. 10.1016/j.breast.2017.07.014 PubMed Web of Science® Google Scholar 50C. Maggen, V. E. R. A. Wolters, E. Cardonick, et al., "Pregnancy and Cancer: The INCIP Project," Current Oncology Reports 22 (2020): 17. 10.1007/s11912-020-0862-7 PubMed Web of Science® Google Scholar 51A. L. Chartier, M. J. Bouvier, D. R. McPherson, J. E. Stepenosky, D. A. Taysom, and R. M. Marks, "The Safety of Maternal and Fetal MRI at 3 T," American Journal of Roentgenology 213 (2019): 1170–1173. 10.2214/AJR.19.21400 PubMed Web of Science® Google Scholar 52 Expert Panel on MR Safety, E. Kanal, A. J. Barkovich, et al., "ACR Guidance Document on MR Safe Practices: 2013," Journal of Magnetic Resonance Imaging 37 (2013): 501–530. 10.1002/jmri.24011 PubMed Web of Science® Google Scholar 53J. G. Ray, M. J. Vermeulen, A. Bharatha, W. J. Montanera, and A. L. Park, "Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes," JAMA 316 (2016): 952–961. 10.1001/jama.2016.12126 PubMed Web of Science® Google Scholar 54A. J. Kieturakis, R. A. Wahab, C. Vijapura, and M. C. Mahoney, "Current Recommendations for Breast Imaging of the Pregnant and Lactating Patient," American Journal of Roentgenology 216 (2021): 1462–1475. 10.2214/AJR.20.23905 PubMed Web of Science® Google Scholar 55H. S. Thomsen, S. K. Morcos, T. Almén, et al., "Nephrogenic Systemic Fibrosis and Gadolinium-Based Contrast Media: Updated ESUR Contrast Medium Safety Committee Guidelines," European Radiology 23 (2013): 307–318. 10.1007/s00330-012-2597-9 PubMed Web of Science® Google Scholar 56 American College of Obstetricians and Gynecologists, "Guidelines for Diagnostic Imaging During Pregnancy and Lactation," Number 723 (Replaces Committee Opinion Number 656, February 2016. Reaffirmed 2021), https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/10/guidelines-for-diagnostic-imaging-during-pregnancy-and-lactation. Google Scholar 57V. Vandecaveye, F. Amant, F. Lecouvet, K. Van Calsteren, and R. C. Dresen, "Imaging Modalities in Pregnant Cancer Patients," International Journal of Gynecological Cancer 31 (2021): 423–431. 10.1136/ijgc-2020-001779 PubMed Web of Science® Google Scholar 58B. Gui, F. Cambi, M. Micco, et al., "MRI in Pregnant Patients With Suspected Abdominal and Pelvic Cancer: A Practical Guide for Radiologists," Diagnostic and Interventional Radiology 26 (2020): 183–192. 10.5152/dir.2019.19343 PubMed Web of Science® Google Scholar 59 American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, "Committee Opinion No. 656: Guidelines for Diagnostic Imaging During Pregnancy and Lactation," Obstetrics and Gynecology 127, no. 2 (2016): e75–e80. 10.1097/AOG.0000000000001316 PubMed Google Scholar 60R. Woitek, D. Prayer, A. Hojreh, and T. Helbich, "Radiological Staging in Pregnant Patients With Cancer," ESMO Open 1, no. 1 (2016): e000017. 10.1136/esmoopen-2015-000017 PubMed Google Scholar 61R. M. Marsh and M. Silosky, "Patient Shielding in Diagnostic Imaging: Discontinuing a Legacy Practice," American Journal of Roentgenology 212 (2019): 755–757. 10.2214/AJR.18.20508 PubMed Web of Science® Google Scholar 62 American College of Radiology, "ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Adolescents and Women With Ionizing Radiation. Revised 2023 (Resolution 31)," https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/radiology-safety/radiation-safety. Google Scholar 63J. A. W. Webb, H. S. Thomsen, and S. K. Morcos, "The Use of Iodinated and Gadolinium Contrast Media During Pregnancy and Lactation," European Radiology 15 (2005): 1234–1240. 10.1007/s00330-004-2583-y PubMed Web of Science® Google Scholar 64T. D. Atwell, A. N. Lteif, D. L. Brown, M. McCann, J. E. Townsend, and A. J. LeRoy, "Neonatal Thyroid Function After Administration of IV Iodinated Contrast Agent to 21 Pregnant Patients," American Journal of Roentgenology 191 (2008): 268–271. 10.2214/AJR.07.3336 PubMed Web of Science® Google Scholar 65G. Bourjeily, M. Chalhoub, C. Phornphutkul, T. C. Alleyne, C. A. Woodfield, and K. K. Chen, "Neonatal Thyroid Function: Effect of a Single Exposure to Iodinated Contrast Medium In Utero," Radiology 256 (2010): 744–750. 10.1148/radiol.10100163 PubMed Web of Science® Google Scholar 66 The Royal College of Radiologists; Royal College of Physicians, "Evidence-Based Indications for the Use of PET-CT in the United Kingdon 2022," https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/evidence-based-indications-for-the-use-of-pet-ct-in-the-united-kingdom-2022/. Google Scholar 67P. Zanotti-Fregonara, "Radiation Absorbed Dose to the Embryo and Fetus From Radiopharmaceuticals," Seminars in Nuclear Medicine 52 (2022): 140–148. 10.1053/j.semnuclmed.2021.12.007 PubMed Web of Science® Google Scholar 68P. Zanotti-Fregonara, R. Laforest, and J. W. Wallis, "Fetal Radiation Dose From 18F-FDG in Pregnant Patients Imaged With PET, PET/CT, and PET/MR," Journal of Nuclear Medicine 56 (2015): 1218–1222. 10.2967/jnumed.115.157032 CAS PubMed Web of Science® Google Scholar 69M. Despierres, A. S. Boudy, L. Selleret, et al., "Feasibility, Safety and Impact of (18F)-FDG PET/CT in Patients With Pregnancy-Associated Cancer: Experience of the French CALG (Cancer Associé à La Grossesse) Network," Acta Oncologica (Madrid) 61 (2022): 302–308. 10.1080/0284186X.2021.2004323 CAS PubMed Web of Science® Google Scholar 70 International Atomic Energy Agency, "Radiation Protection of Pregnant Women in Radiology," https://www.iaea.org/resources/rpop/health-professionals/radiology/pregnant-women. Google Scholar 71H. M. Johnson, K. B. Mitchell, and Academy of Breastfeeding Medicine, "ABM Clinical Protocol #34: Breast Cancer and Breastfeeding," Breastfeeding Medicine 15 (2020): 429–434. 10.1089/bfm.2020.29157.hmj PubMed Web of Science® Google Scholar 72J. L. Meisel, K. E. Economy, K. Z. Calvillo, et al., "Contemporary Multidisciplinary Treatment of Pregnancy-Associated Breast Cancer," Springerplus 2 (2013): 297. 10.1186/2193-1801-2-297 PubMed Web of Science® Google Scholar 73S. S. Shachar, K. Gallagher, K. McGuire, et al., "Multidisciplinary Management of Breast Cancer During Pregnancy," Oncologist 22 (2017): 324–334. 10.1634/theoncologist.2016-0208 PubMed Web of Science® Google Scholar 74N. M. Shah, D. M. Scott, P. Kandagatla, et al., "Young Women With Breast Cancer: Fertility Preservation Options and Management of Pregnancy-Associated Breast Cancer," Annals of Surgical Oncology 26 (2019): 1214–1224. 10.1245/s10434-019-07156-7 PubMed Web of Science® Google Scholar 75A. Eskandari and S. Alipour, "Aspects of Anesthesia for Breast Surgery During Pregnancy," Advances in Experimental Medicine and Biology 1252 (2020): 107–114, https://doi.org/10.1007/978-3-030-41596-9_14. 10.1007/978-3-030-41596-9_14 PubMed Google Scholar 76T. G. Cheek and E. Baird, "Anesthesia for Nonobstetric Surgery: Maternal and Fetal Considerations," Clinical Obstetrics and Gynecology 52 (2009): 535–545. 10.1097/GRF.0b013e3181c11f60 PubMed Web of Science® Google Scholar 77P. Aylin, P. Bennett, A. Bottle, et al., "Estimating the Risk of Adverse Birth Outcomes in Pregnant Women Undergoing Non-Obstetric Surgery Using Routinely Collected NHS Data: An Observational Study," Health Services and Delivery Research 4 (2016): 1–76. 10.3310/hsdr04290 Google Scholar 78T. Konishi, M. Fujiogi, D. Shigemi, et al., "Surgical and Obstetric Outcomes of Breast Cancer Surgery During Pregnancy: A Nationwide Database Study in Japan," Breast Cancer Research and Treatment 195 (2022): 289–299. 10.1007/s10549-022-06659-4 PubMed Web of Science® Google Scholar 79 Royal College of Obstetricians and Gynaecologists, "Reducing the Risk of Venous Thromboembolism During Pregnancy and the Peurperium. Green-Top Guideline No 37a," (2015), https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/reducing-the-risk-of-thrombosis-and-embolism-during-pregnancy-and-the-puerperium-green-top-guideline-no-37a/. Google Scholar 80I. Paris, D. di Giorgio, L. Carbognin, et al., "Pregnancy-Associated Breast Cancer: A Multidisciplinary Approach," Clinical Breast Cancer 21 (2021): e120–e127. 10.1016/j.clbc.2020.07.007 PubMed Web of Science® Google Scholar 81F. Amant, S. Loibl, P. Neven, and K. Van Calsteren, "Breast Cancer in Pregnancy," Lancet 379 (2012): 570–579. 10.1016/S0140-6736(11)61092-1 PubMed Web of Science® Google Scholar 82B. Fisher, S. Anderson, J. Bryant, et al., "Twenty-Year Follow-Up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy Plus Irradiation for the Treatment of Invasive Breast Cancer," New England Journal of Medicine 347 (2002): 1233–1241. 10.1056/NEJMoa022152 PubMed Web of Science® Google Scholar 83J. Gu, G. Groot, C. Boden, A. Busch, L. Holtslander, and H. Lim, "Review of Factors Influencing Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early Stage Breast Cancer: A Systematic Review," Clinical Breast Cancer 18 (2018): e539–e554. 10.1016/j.clbc.2017.12.013 PubMed Web of Science® Google Scholar 84E. Heeling, J. B. van de Kamer, M. Methorst, et al., "The Safe Use of 125I-Seeds as a Localization Technique in Breast Cancer During Pregnancy," Cancers (Basel) 15 (2023): 3229. 10.3390/cancers15123229 CAS PubMed Web of Science® Google Scholar 85 Early Breast Cancer Trialists' Collaborative Group (EBCTCG), S. Darby, P. McGale, C. Correa, et al., "Effect of Radiotherapy After Breast-Conserving Surgery on 10-Year Recurrence and 15-Year Breast Cancer Death: Meta-Analysis of Individual Patient Data for 10 801 Women in 17 Randomised Trials," Lancet 378, no. 9804 (2011): 1707–1716, https://doi.org/10.1016/S0140-6736(11)61629-2. 10.1016/S0140-6736(11)61629-2 Google Scholar 86 The Royal College of Radiologists, "Guidance on Screening and Symptomatic Breast Imaging," (2019), https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/guidance-on-screening-and-symptomatic-breast-imaging-fourth-edition/. Google Scholar 87 National Institute for Health and Care Excellence, "Early and Locally Advanced Breast Cancer: Diagnosis and Management," NICE Guideline [NG101]; 18 July 2018 (updated 14 April 2025), https://www.nice.org.uk/guidance/ng101. Google Scholar 88S. Loibl, A. Schmidt, O. Gentilini, et al., "Breast Cancer Diagnosed During Pregnancy Adapting Recent Advances in Breast Cancer Care for Pregnant Patients," JAMA Oncology 1 (2015): 1145–1153. 10.1001/jamaoncol.2015.2413 PubMed Web of Science® Google Scholar 89A. Keleher, R. Wendt, E. Delpassand, A. M. Stachowiak, and H. M. Kuerer, "The Safety of Lymphatic Mapping in Pregnant Breast Cancer Patients Using Tc-99m Sulfur Colloid," Breast Journal 10 (2004): 492–495. 10.1111/j.1075-122X.2004.21503.x PubMed Google Scholar 90S. N. Han, F. Amant, E. H. Cardonick, et al., "Axillary Staging for Breast Cancer During Pregnancy: Feasibility and Safety of Sentinel Lymph Node Biopsy," Breast Cancer Research and Treatment 168 (2018): 551–557. 10.1007/s10549-017-4611-z CAS PubMed Web of Science® Google Scholar 91 Association of Breast Surgery, "ABS Summary Statement: Use of Blue Dye for SLNB," (2012), https://associationofbreastsurgery.org.uk/professionals/information-hub/guidelines/2009/abs-summary-statement-use-of-blue-dye-for-slnb. Google Scholar 92 Medicines and Healthcare products Regulatory Agency, "Blue Dyes: Risk of Serious Allergic Reactions," December 11, 2014, https://www.gov.uk/drug-safety-update/blue-dyes-risk-of-serious-allergic-reactions. Google Scholar 93L. Barthelmes, A. Goyal, R. G. Newcombe, F. McNeill, R. E. Mansel, and NEW START and ALMANAC study groups, "Adverse Reactions to Patent Blue V Dye – The NEW START and ALMANAC Experience," European Journal of Surgical Oncology 36 (2010): 399–403. 10.1016/j.ejso.2009.10.007 CAS PubMed Web of Science® Google Scholar 94V. Lohsiriwat, F. A. Peccatori, S. Martella, et al., "Immediate Breast Reconstruction With Expander in Pregnant Breast Cancer Patients," Breast 22 (2013): 657–660. 10.1016/j.breast.2013.06.005 PubMed Web of Science® Google Scholar 95D. L. Caragacianu, E. L. Mayer, Y. S. Chun, et al., "Immediate Breast Reconstruction Following Mastectomy in Pregnant Women With Breast Cancer," Journal of Surgical Oncology 114 (2016): 140–143. 10.1002/jso.24308 PubMed Web of Science® Google Scholar 96Y. Kijima, M. Hirata, N. Higo, et al., "Immediate Breast Reconstruction With Expander Following Recurrent Lesion Resection and Exchange to Silicon Breast Implant in a Pregnant Triple Negative Breast Cancer Patient: Case Repor