ROADMAP to BREAST CANCER IN PREGNANCY.pdf

Management protocol for breast cancer in pregnancy

1. Breast cancer
in pregnancy

2. ROADMAP
INTRODUCTION
INTRODUCTION AND DEFINITION
CHALLENGES FACED
DIAGNOSIS
TREATMENT

3. INTRODUCTION
DEFINITION-Pregnancy associated breast cancer is defined as breast cancer diagnosed
during pregnancy or within a year after delivery.
Breast cancer is the most common form of cancer diagnosed during pregnancy .
median age at diagnosis is 33 years .
associated with more metastases, and subsequently poorer outcomes, than breast
cancer in non-pregnant women .

4. CHALLENGES FACED
DIAGNOSIS
TREATMENT
1)Physiological breast changes associated
with pregnancy make detection difficult
clinically
2)imaging and radiology has to be safe
for the fetus
1)Radiation therapy is contraindicated during
pregnancy during all trimesters
2)chemotherapy -risk of congenital
malformations,spontaneous abortions

3)whether BCS is possible in pregnancy?

5. DIAGNOSIS
TRIPLE ASSESSMENT
IMAGING-
USG-Safest,non-ionising, high sensitivity and 1.
specificity
2.Mammogram- When the fetus is shielded
adequately, it has been established that the
estimated dose of radiation from a standard
two-view mammogram is not associated with any
fetal harm
3.non contrast MRI-only in inconclusive cases

6. CT scan and nuclear imaging (Bone scan/PET scan)are
contraindicated during pregnancy
TO LOOK FOR METS-Chest Xray with abdominal shielding
USG W/A
MRI spine -may be done for spinal mets
TISSUE DIAGNOSIS-CORE NEEDLE BIOPSY
Termination of pregnancy in the hope of minimizing hormonal
stimulation of the tumor does not alter maternal survival and is not
recommended .

7. TREATMENT
a)SURGERY
MRM can be done at any trimester safely.
BCS is no longer an absolute contraindication in pregnancy -may be
done in second/third trimester and defer radiotherapy to once baby
is delivered
The surgery may be deferred till 12th gestational week to avoid the risk of
spontaneous abortion, which is highest in the first trimester.

8. TREATMENT
b)CHEMOTHERAPY
in first trimester -associated with an increased incidence of
spontaneous abortion, teratogenesis, or fetal malformations.
no increased risk of fetal malformation associated with chemotherapy
administered during the second and third trimesters.
Endocrine therapy(eg.Tamoxifene) and anti HER 2 neu(Trastuzumab) is
contraindicated in pregnancy.To give after delivery.

9. TREATMENT
c)RADIOTHERAPY
CONTRAINDICATED in pregnancy in all trimesters.
can be given only after delivery.

10. TAKE HOME
MESSAGE

11. Sort the grouped ideas into even larger buckets.

12. MRM



MRM/BCS+ALND/SLNB


LABC
PREGNANT PATIENT with breast cancer
1st TRIMESTER
Adjuvant chemotherapy in 2nd trimester
+/-
Adjuvant radiotherapy postpartum
+/-
Adjuvant Hormonal therapy postpartum

2nd/3rd TRIMESTER
Early Breast Cancer
either
MRM/BCS+ALND/SLNB
or NACT then surgery

13. Big Group
Discussion
Can you add something
to one of the ideas or
improve an idea bucket?

14. Individual
Reflection
Which solutions have
resonated with you?
Which solutions most
align with the research?

15. Time to vote

16. Next Steps
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17. Thanks for your time!