Although it is not common for breast cancer to occur during pregnancy (occurs in 1 in 3,000 pregnant women), the truth is that women in the Western world are currently delaying the time of having the first child and each time produce more pregnancies around 35-40 years. And it is a known fact that the risk of suffering from this type of cancer increases with age, so it is expected that the number of pregnant women with gestational breast cancer will increase .
But there are also other risk factors to consider, especially in women who postpone the time of motherhood:
- Having had an early menarche (first rule).
- Having the first pregnancy after age 30 or not having children.
- Prolonged use of oral contraceptives.
Difficulties in the diagnosis of gestational breast cancer
Pregnancy hinders the diagnosis of gestational breast cancer essentially because the breasts increase in size, have bumps and become more sensitive, which makes it difficult to locate nodules with self-examination, not Be overly large. Even breast tissue can make tumor detection difficult by mammography when it is in its initial phase. In fact, most cases of breast cancers that are detected during pregnancy are in more advanced stages than when there is no pregnancy, and usually with lymph node involvement.
Fear that mammography radiation may affect the fetus may also delay diagnosis. However, it should be taken into account that the amount of radiation is small and focuses directly on the chest, so it is a test that does not pose an excessive danger to the fetus, especially because the abdomen is protected with a lead plate. Likewise, the diagnosis of a breast cancer cannot be carried out without performing a biopsy to obtain a tissue sample, which requires the use of local anesthesia and in some cases general; although it can be carried out without excessive risks to the fetus.
The problem arises from the need to perform other tests necessary to determine the degree of evolution of breast cancer. Ultrasound and MRI can be performed (as long as they are performed without contrast) without any danger to the fetus. A chest x-ray can also be performed, properly protecting the gestational bag. But, PET, CT or bone scans would expose the fetus to a large amount of radiation, so they are not recommended, unless strictly necessary.
Gestational Breast Cancer Treatment
Studies in women who have suffered from gestational breast cancer reveal that survival is very similar to that of other women, even though the treatment during pregnancy has certain complications, since it depends on the size and location of the tumor, the month of pregnancy in which the woman is and if metastases have occurred.
Surgery, as the first treatment option, can be carried out without great risks to the fetus at any stage of pregnancy. Even so, it will be necessary to determine the best time to perform the intervention, what type of anesthesia to use and what surgical techniques to apply. If the pregnancy is advanced, the obstetrician should be present in the operating room in case of complications and the delivery of a caesarean section should be caused.
When it comes to chemotherapy and radiotherapy, things are different. If the cancer has been detected at the beginning of pregnancy, the problem is that delaying treatment, especially if the cancer is aggressive, would be detrimental to the woman and the application of chemotherapy, radiotherapy and hormonal treatments pose a clear risk to the fetus. Faced with this dilemma, doctors may recommend termination of pregnancy, although the final decision will fall on the patient. If, on the other hand, the wait to start treatment (chemotherapy and radiotherapy) is detected in the third trimester would not seriously harm the woman and even, if necessary, the possibility of anticipating delivery.
Chemotherapy cannot be used in the first trimester of pregnancy. In the first place because there are no studies that have determined the possible effects on the fetus. But also because it is the period in which all internal organs are formed and the risk of abortion is greater. However, some studies have been conducted in which it has been found that if certain drugs are used between the fourth and ninth month of pregnancy, the risk of malformations, fetal death or health problems for the baby after delivery is not increased, if well the possible long-term risks have not been evaluated.
However, chemotherapy should be administered immediately after surgery, so the start of treatment should be postponed until at least the second trimester. But it must also be taken into account that it should not be applied after the 35th week of gestation, since it could increase the chances of complications during childbirth. Hence, a break in treatment should be imposed at this time. In any case, hormonal medications, such as tamoxifen, or monoclonal antibodies directed at specific molecular targets should not be used during pregnancy, as they put the fetus at risk.