Breast Cancer During Pregnancy

Fortunately this occurs in less than 5% of breast cancer patients. It usually presents as a breast mass, and delays in diagnosis are common. This is due to the considerable enlargement of the breast associated with pregnancy precluding effective clinical breast examination. Mammography is generally not utilized during pregnancy because the proliferative changes in the breast result in a "white out" of the mammogram. Although surgical biopsy or US guided core biopsy are generally well tolerated in pregnant women, delays in performing biopsy are common. US is usually performed in place of mammography for diagnostic purposes. Because of the inability to shield the fetus from radiation, breast conserving therapy must be carefully considered. There has not been any documented advantage to aborting the fetus. Although it has been thought that breast cancer presenting during pregnancy carries a worse prognosis, the decreased survival rate is probably attributable to the later stage of presentation, i.e., double the rate (61%) of pregnant patients presenting with positive nodes than nonpregnant patients (38%). Chemotherapy is controversial during pregnancy and can usually be delayed so as to not threaten the fetus.

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