Gestational breast cancer: literature review

Abstract

Gestacional breast cancer is a malignancy identified either during gestation or up to one year after conception. It is the second most frequent gestational malignancy, coming after cancer of the uterine cervix. Pregnancies at an older age, an increasing incident of breast cancer in yonger women, greater efficacy of available diagnostic methods, and strict screening programs are factors related to a greater prevalence of gestational breast cancer. The physiological changes the breast undergoes during pregnancy make both the clinical and mammographic diagnoses more difficult. Ultrasound scanning is clinically indicated for the diagnosis of gestational breast tumors due to its safety throughout pregnancy. Besides characterizing the nodules, ultrasound scanning guides fine-needle aspiration, providing material for oncotic cytology or histopathology and screening for breast cancer. Once diagnosed, staging is paramount for definition or appropriate management. The TNM saging system established by the International Union Against Cancer, in 1987, is used. Prognosis is similar to non-gestational breast cancer, lymph node metastases being the main prognostic factor. Abortion does not influence prognosis. Mastectomy and levels I and II axillary lymph node dissection are the traditional treatments of choice. Patients in the third trimester may undergo conservative surgery followed by postpartum radiotherapy. Chemotherapy is relatively safe during pregnancy and must be used as from the second trimester. Radiotherapy and hormonal therapy with tamoxifen citrate are contraindicated during gestation. The time span that should be observed until the patient gets pregnant again is controversial, with intervals from two to five years being recommended according to tumor staging