Pregnancy and breast cancer

Breast cancer is rare in young women, with an increase in incidence in the fourth and fifth decades. A trend is to defer childbearing to later in life. The issues of pregnancy and breast cancer are of importance as some women discover their breast cancer while pregnant and some may not have completed their family at the time of treatment. We discuss the case of a woman whose breast cancer was diagnosed during pregnancy. We review the choices she was faced with at the time of diagnosis and after treatment. To review the effects of pregnancy on outcome in patients with breast cancer we included all studies after 1990 by searching Medline, CINAHL, and Embase combining the headings “pregnancy” and “breast neoplasm”. To investigate the outcome of breast cancer in pregnant women who underwent a termination after being diagnosed during pregnancy, we included all studies published after 1980 personally known to us. For the effects of chemotherapy and radiotherapy given during pregnancy, we searched Medline combining the headings “breast neoplasm”, “radiotherapy”, and the relevant chemotherapy agents. To assess whether delayed administration of chemotherapy impairs outcome, we searched Medline with the term “delay adj chemotherapy” combined with the heading “breast neoplasm”. A 33 year old woman with a four year old child presented to her doctor with a painless lump in her right breast. On examination a discrete lump was felt in the upper half of the breast. The doctor referred the woman to a rapid access breast clinic, where a 1.5 cm lump and an area of increased nodularity was confirmed. The features on palpation were indeterminate for type of lesion. Ultrasound guided core biopsies were carried out as ultrasonography and mammography suggested a carcinoma (figs 1 and 2). While awaiting an appointment for the result of the biopsies, the …