Steroid hormone receptors in breast tumours presenting during pregnancy or lactation

Cytosol oestrogen receptor (ER) and progesterone receptor (PR) levels were measured in tumours from three patients with breast cancer during pregnancy and from three patients developing breast cancer while lactating. All lactating patients were ER-positive and two were PR-positive, whereas pregnant patients were uniformly ER-negative and PR-negative. Pregnant patients had a significantly shorter disease-free survival compared with matched nonpregnant women with breast cancer. Of five patients developing metastatic disease, one from the lactating group had a complete remission with chemotherapy and one had static disease with endocrine treatment, whereas all others had progressive disease despite a variety of treatments. Although numbers are too small to permit generalisation, these provisional data suggest that patients presenting with breast cancer during pregnancy may have mainly receptor-negative tumours, a short disease-free interval, and may be relatively resistant to treatment of metastatic disease. By comparison, patients with breast tumours during lactation have receptor-positive disease and metastases may respond to systemic therapy.     

妊娠相关乳腺癌33例临床病理特征及预后分析

目的：分析妊娠相关乳腺癌的临床病理特征、治疗及预后。方法回顾性分析33例妊娠相关乳腺癌患者的临床资料,总结其临床诊治特点、病理特征、组织分型及预后,并结合国内外相关文献分析其发病机制及临床特征。结果33例妊娠相关乳腺癌诊断时中位年龄30岁（24～38岁）,Ⅰ期及Ⅱ期者占27.3%（9/33）,Ⅲ期占63.6%（21/33）,Ⅳ期占9.1%（3/33）;伴腋窝淋巴结转移者占78.8%（26/33）,28例手术患者中pN3者占53.6%（15/28）。浸润性导管癌占87.9%（29/33）,浸润性小叶癌占6.1%（2/33）,其他浸润癌占6.1%（2/33）。激素受体阳性者占54.5%（18/33）,三阴性乳腺癌占24.2%（8/33）,HER2表达型占21.2%（7/33）。1例于妊娠期接受新辅助化疗,足月生产,胎儿健康。中位随访时间32个月（9～142个月）,28例手术患者中位无病生存期16.7个月（0.9～57.9个月）,中位总生存期68.1个月（8.8～142.1个月）。结论妊娠相关乳腺癌的诊断及治疗常被延误,诊断时腋窝淋巴结转移多且分期晚,应对妊娠及哺乳期间的乳腺肿块引起重视,争取早诊断早治疗。     

14例妊娠期乳腺癌的诊疗体会及文献回顾

目的探讨妊娠期乳腺癌综合治疗的方法及特点。方法回顾性分析14例妊娠期乳腺癌患者的临床资料,探讨临床综合治疗的特点和体会并文献分析。结果 14例妊娠期乳腺癌患者中Ⅱ期6例,Ⅲ期7例,Ⅳ期1例;随访结果显示3例患者死亡,3例患者失访,8例患者无病生存。结论妊娠期乳腺癌恶性程度较高,预后较差,除胎儿因素外,其治疗原则与非妊娠期乳腺癌相同;在治疗中需要综合考虑胎儿安全及患者因素,根据具体情况制定合适的诊疗方案。     

妊娠哺乳期乳腺癌20例临床分析

目的探讨妊娠哺乳期乳腺癌的临床特征和治疗方法。方法分析我院妊娠哺乳期乳腺癌20例,妊娠期乳腺癌8例,哺乳期12例;其中Ⅰ期1例,Ⅱ期9例,Ⅲ期8例,Ⅳ期2例。并与同期非妊娠哺乳期乳腺癌患者在诊断、TNM分期、治疗方法、5年生存率等方面相比较。结果妊娠哺乳期乳腺癌5年总生存率70.0%(14/20),比同期非妊娠哺乳期乳腺癌5年总生存率76.4%(1074/1405)低,但无统计学意义。结论妊娠哺乳期乳腺癌的治疗预后与非妊娠哺乳期乳腺癌患者相同,妊娠因素不能改变生存率。     

The experience of pregnancy and early motherhood in women diagnosed with gestational breast cancer

Objective: To explore the psychosocial experiences of pregnancy in women diagnosed with breast cancer during or shortly after pregnancy. Methods: A retrospective qualitative design was employed. Fifteen women who had received a gestational breast cancer (GBC) diagnosis participated in semi‐ structured interviews. The interviews sought to identify the emotional and social issues related to the experiences of pregnancy and motherhood in women diagnosed with gestational breast cancer. Results: Women diagnosed with GBC experience difficulties in adjusting to two different and conflicting life events; the threat of their breast cancer alongside the news of their pregnancy. They have to make difficult decisions that impact on their own life, the life of their foetus/new baby and that of their existing family. Women who received a GBC diagnosis reported high levels of anxiety and stress, which pervaded their whole GBC experience. Women reported their anxiety was linked to the conflict between the concern for their baby's health and the concern for their own health and wellbeing. Conclusions: Women diagnosed with GBC attributed different meanings to their experience of pregnancy and motherhood and made choices based on their own beliefs, values and how complete they believed their family was. Copyright © 2011 John Wiley & Sons, Ltd.     

妊娠期乳腺癌的诊治进展

妊娠期乳腺癌是一种特殊类型的乳腺癌。妊娠期间,乳腺组织增生明显,使肿瘤不易早期发现。妊娠是否会影响乳腺癌的生物学行为以及各种诊疗措施对母婴可能的作用,使妊娠期乳腺癌临床表现、诊断、治疗、预后都有其特殊性,妊娠期乳腺癌患者的治疗方案尚存在一些争议。本文综述妊娠期乳腺癌的研究结果,针对妊娠期乳腺癌的特殊处理进行探讨。     

Lactation following conservation surgery and radiotherapy for breast cancer

A 38-year-old woman with early stage invasive breast cancer was treated with wide excision of the tumor, axillary lymph node dissection, and breast irradiation. Three years later, she gave birth to a normal baby. She attempted breast feeding and had full lactation from the untreated breast. The irradiated breast underwent only minor changes during pregnancy and postpartum but produced small amounts of colostrum and milk for 2 weeks postpartum. There are only a few reports of lactation after breast irradiation. These cases are reviewed, and possible factors affecting breast function after radiotherapy are discussed. Because of scant information available regarding its safety for the infant, nursing from the irradiated breast is not recommended.     

乳腺癌治疗后妊娠的可行性及安全性

目的 随着乳腺癌逐渐年轻化及国家二胎政策的放开,乳腺癌患者对生育要求增加.本研究旨在探讨乳腺癌治疗后妊娠对患者预后的影响.方法 应用检索维普、万方、CNKI、Medline期刊全文数据库的检索系统,以“乳腺癌、综合治疗、妊娠、预后”等为关键词,检索1957-01-2016-06的相关文献,共检索到英文文献307条,中文文献106条.纳入标准:(1)有关乳腺癌治疗后妊娠;(2)有关生育方面问题.剔除标准:(1)妊娠期乳腺癌;(2)非乳腺癌治疗后妊娠.根据纳入排除标准,符合分析的文献24篇.结果 目前的研究结果显示,乳腺癌治疗后妊娠对预后无不良影响.乳腺癌综合治疗,尤其是化疗,可能会影响患者生育能力,患者治疗前可以考虑卵巢保护措施,化疗中选择对卵巢损害小的药物,以保障治疗后妊娠相对较高的成功率.乳腺癌患者治疗后妊娠不增加其后代畸形或者智力低下的风险.对于早期的乳腺癌患者,建议结束治疗后两年妊娠;Ⅲ期乳腺癌患者建议五年后妊娠.结论 本研究在现有的循证医学证据下发现,在充分的卵巢保护,合理的选择化疗用药,并在乳腺癌综合治疗结束后间隔足够时间的前提下选择妊娠,对乳腺癌患者的预后无不利影响.     

Reducing delay in the diagnosis of pregnancy-associated breast cancer: how imaging can help us

Introduction: The evaluation of breast symptoms during pregnancy or lactation can be challenging but prompt, appropriate assessment of symptoms may lead to earlier cancer detection. Methods: A review of breast imaging from 22 women with breast cancer during or within 1 year of pregnancy was undertaken as part of a large population‐based study of gestational breast cancer. Consensus findings of three reads using the Breast Imaging Reporting and Data System lexicon were recorded. Results: The commonest presenting symptom was a lump. Diagnosis by percutaneous biopsy was made correctly in 21 of 23 lesions. Lesions were predominantly invasive ductal carcinoma (91%). One third had extensive associated ductal carcinoma in situ (DCIS). Ultrasound (US) was abnormal in all symptomatic patients. The most common sonographic finding was a solitary hypoechoic mass with irregular margins. ‘Expanded stroma’ with prominent ducts and architectural distortion was noted in three cases; all had extensive high‐grade DCIS. In three women, bilateral breast US detected cancer in the asymptomatic breast. Mammography (performed in 86% of women) was abnormal in 74%, despite the presence of dense breast tissue in 47%. Widespread calcifications were visible in 26%, with detection of asymptomatic contra‐lateral disease in one patient. MRI was performed in six patients. Background parenchymal enhancement did not impair lesion detection; however, overestimation of lesion size can occur. Conclusions: Ultrasonography is recommended for the initial diagnosis of breast symptoms during pregnancy and lactation. A negative study should not delay direct fine needle aspiration of a palpable lesion. Mammography is indicated where initial assessment suggests malignancy. MRI may have a role in selected cases.     

Pregnancy after breast cancer. A comprehensive review

Pregnancy after breast cancer treatment has become an important issue since many young breast cancer patients have not completed their family. Generally, these patients should not be discouraged to become pregnant when they want to, since published data suggest no adverse effect of pregnancy on survival. As fertility may be impaired by chemotherapy, different fertility preserving strategies have been developed. Births seem to sustain no adverse effects, while breastfeeding appears to be feasible and safe. J. Surg. Oncol. 2010; 101:534–542. © 2010 Wiley‐Liss, Inc.     

Current or recent pregnancy is associated with adverse pathologic features but not impaired survival in early breast cancer

BACKGROUND:

Pregnancy‐associated breast cancer (PABC) may be defined as breast cancer diagnosed during pregnancy or within 1 year of giving birth. Conflicting data exist regarding the impact of pregnancy on clinical features and prognosis of breast cancer.

METHODS:

A single‐institution retrospective chart review was performed of 99 patients identified with PABC between 1992 and 2007. Non‐PABC controls were matched 2:1 to PABC cases by year of diagnosis and age. The differences in clinical features were compared between cases and controls using chi‐square tests. Univariate and multivariate analyses were performed to assess the effect of PABC on survival.

RESULTS:

Of the 99 PABC cases, breast cancer was diagnosed during pregnancy in 36 patients, and after delivery in 63. PABC cases were more likely than controls to be negative for estrogen receptor (59% vs 31%, P < .0001) and negative for progesterone receptor (72% vs 40%, P < .0001). Cases were also more likely to have advanced T class (P = .0271) and N class (P = .0104) and higher grade tumors (P = .0115). With a median follow‐up of 6.3 years for cases and 4.7 years for controls, overall survival did not differ between cases and controls (P = .0787). On multivariate analysis, the independent prognostic factors for overall survival were estrogen receptor status (P = .0031) and N class (P = .0003). The diagnosis of PABC was not an independent prognostic factor (P = .1317).

CONCLUSIONS:

PABC is associated with more adverse tumor features than non‐PABC matched for age and year of diagnosis. After correcting for pathologic features, the diagnosis of PABC is not in itself an adverse prognostic factor for survival. Cancer 2011. © 2011 American Cancer Society.     

Comparison of age at first full-term pregnancy between women with breast cancer and women with benign breast diseases

Benign breast diseases have a broadly similar risk profile to that of breast cancer, possibly reflecting a similar underlying endocrine milieu. We have hypothesized that a crucial distinction between breast cancer and benign breast diseases is that mammary gland terminal differentiation has not been successfully accomplished among women who tend to develop breast cancer. From October 2001 to December 2002, information concerning breast cancer risk factors and sociodemographic characteristics was collected from 174 women with breast cancer and 116 women with benign breast diseases, all 30 years old or older, who were histologically diagnosed at a major prevention center in Athens, Greece. Among the examined breast cancer risk factors, only age at first full-term pregnancy was significantly associated with the odds of having breast cancer rather than benign breast disease, and the association was evident among premenopausal [odds ratio (OR) per 5 years = 1.76, 95% confidence interval (CI) 1.10-2.93] and postmenopausal (OR = 2.10, 95% CI 1.16-3.71) women, as well as among all women (OR = 1.93, 95% CI 1.34-2.70). There was no evidence that any of the remaining breast cancer risk factors could discriminate between breast cancer and benign breast diseases. We conclude that early age at first pregnancy may convey substantial protection against breast cancer risk among women with benign breast diseases, probably operating through induction of terminal differentiation of mammary gland cells. The finding is accentuated by the fact that women with benign breast diseases are already at a relatively high risk for breast cancer.     

Prognostic role of pregnancy occurring before or after treatment of early breast cancer patients aged <35 years

BACKGROUND:

Usual practices recommend waiting at least 2 years between diagnosis of early breast cancer (EBC) and pregnancy. Few data highlighted a harmful effect of an early pregnancy for low‐risk patients. The authors analyzed retrospectively data from women younger than 35 years who became pregnant before or after treatment of EBC.

METHODS:

Between 1990 and 1999, 908 consecutive EBC patients were analyzed. The primary endpoint was to compare overall survival (OS) between pregnant and nonpregnant patients. The secondary endpoint was to establish a score index laying down the risk of distant recurrence.

RESULTS:

Within the year before the diagnosis, 105 (11.6%) patients became pregnant and 118 (13%) were pregnant after treatment. In a multivariate model, a pregnancy before the diagnosis was not predictive of death but of local relapse. A pregnancy subsequent to breast cancer therapy resulted in a 77% decrease of death (P < .001). In good‐prognosis score index patients, the annual risk of relapse remained low. In patients having the higher score, recurrences occurred mainly during the first years after the treatment. Beyond 80 months, the annual risk of relapse seemed to be similar to those of lower‐risk subgroups.

CONCLUSIONS:

In women aged younger than 35 years, a pregnancy occurring before or after the diagnosis of breast cancer was not an independent prognostic factor of death. In the subset of patients having a high risk of relapse, it may be preferable to postpone a pregnancy beyond 5 years after the breast cancer therapy. Cancer 2009. © 2009 American Cancer Society.     

妊娠期乳腺癌9例的诊断和综合治疗

目的：研究妊娠期乳腺癌在诊断和手术、化疗、放疗综合治疗方面的特殊性。方法：1992年12月-1999年6月,法国巴黎第十二大学附属Henri Mondor医院放疗科收治9例妊娠期乳腺癌患者,其中3例诊断于妊娠期,6例诊断于分娩后1年内。5例行乳心保留治疗,4例改良根治术。所有病例行术后放疗。7例接受化疗。结果：9例钼靶摄片中7例和所有的5例超声检查提示肿瘤征象,诊断时总体病期晚,I、Ⅱ、Ⅲ期比例分别为11%、44%和44%。中位随访60月（9-89月）时,6例无病生存,3例在治疗结束后14月-48月出现局部复发或远处转移。结论：妊娠期乳腺癌诊断延误较为常见,对分娩后确诊的患者,应重视妊娠、哺乳期乳房体检和超声检查在鉴别诊断房肿块中的作用。治疗原则必须兼顾疾病的迫切性和胎儿的安全性。在可以及时开展化疗和放疗的综合治疗的前提下,乳房保留治疗在早期妊娠期乳腺癌中是可行的。     

Metastatic breast cancer in pregnancy: first case of chemotherapy with docetaxel

The focus of this paper is a case study of a woman in the first trimester of pregnancy who presented with metastatic breast cancer. The bony spread of the metastases was rapid and it was necessary to treat the patient as soon as possible after the period of organogenesis (days 18–60 of human gestation). This stage is the phase of greatest sensitivity of teratogens and the malformations are observed most often. Yet, the choice of third-line chemotherapy was difficult because of anthracycline-resistant metastatic breast cancer. The world literature reported cytotoxic combinated regimens as the standard of care for the management of the metastases. The development of new antitumoral strategies with less toxicity and their encouraging results led us to the approval of docetaxel for the treatment of the patient even though it had never been tested in pregnancy. Docetaxel is a potent inhibitor of microtubule depolymerization and has a unique ability to alter certain classes of microtubules. The monochemotherapy was administered once every 3 weeks for a total of three cycles until 30 weeks of gestation. During the 32nd week of pregnancy the patient delivered a female infant whose birthweight and Apgar score were normal. The infant did not have any anomalies. The woman finished her treatment in puerperium and she received three cycles of docetaxel. The patient has been receiving vinorelbine (one cycle every 2 weeks) for 2 years; her last follow-up was good and showed that the progression of the metastases had stopped. The daughter's psychophysical development was normal.     

39例乳腺癌并肝转移诊治体会

目的：总结乳腺癌并肝转移的临床诊断及治疗特点。方法：回顾性分析2008年1月到2013年8月期间西安交通大学医学院第二附属医院收治的39例乳腺癌并肝转移患者的临床详细资料。结果：本文对39例乳腺癌并肝转移患者进行分析,随访3年余,生存27例,死亡12例,均死于肿瘤进展,中位疾病进展时间（PFS）为25个月,中位随访时间（MSR）为17个月,诊治过程中肿瘤反反复复,呈难治、多药耐药倾向。结论：乳腺癌并肝转移预后差,治疗棘手,关键在于早期发现、早期诊治。对于HER-2阳性患者,赫塞汀靶向治疗是一个有效的治疗选择;对于疗效较好的患者,维持治疗是非常必要的。通过积极综合治疗,可以延长生存期,提高生活质量。     

Pre-eclampsia in pregnancy and subsequent risk for breast cancer

Women who experience pre-eclampsia or hypertension during pregnancy may have a reduced risk for breast cancer later in life. The evidence is based on case-control studies, and here we report the results of a cohort study exploring the link between pre-eclampsia and gestational hypertension diagnosed in the first pregnancy and subsequent risk for breast cancer. We combined information from the Medical Birth Registry and the Cancer Registry in Norway, which are both nation-wide. Between 1967, when the birth registry was established, and 1998, 694 657 women were recorded with a first birth, and classified according to whether pre-eclampsia and/or hypertension was diagnosed in the first pregnancy. Linkage to the Norwegian Cancer Registry identified 5474 new cases of breast cancer diagnosed subsequently to their first delivery. Compared to other parous women, women with pre-eclampsia and/or hypertension diagnosed in their first pregnancy had 19% lower risk (95% confidence interval, 9 to 29%) for breast cancer, after adjustment for attained age, calendar period of diagnosis, age at first birth, and parity. This result was similar for term and preterm deliveries, across the range of offspring birth weight, and for pre- and postmenopausal women. These results suggest that the pathophysiology surrounding pre-eclampsia and gestational hypertension plays an important role in breast cancer etiology. A better understanding of the underlying processes could provide an insight into the pathogenesis of breast cancer.     

妊娠期乳腺癌的诊治研究进展

妊娠期乳腺癌临床表现、病理、诊治、预后都有其特殊性。由于延迟诊断，患者的生存率低，预后较差。需临床医生尽早明确诊断，通过手术、放化疗等个体化综合治疗方案，改善患者预后，延长生存期。     

妊娠哺乳期乳腺癌（附38例报告）

本文报告我院１９８４年１月～１９９２年１２月收治的３８例妊娠或哺乳期乳腺癌。其中Ⅲ、Ⅳ期２７例（７１．１％），腋淋巴结癌转移３１例（８１．５％），误诊３０例（７８．９％），３年及５年生存率分别为７０．３％和３７．５％。本组病人年轻，首发症状仍为乳腺肿块，针吸细胞学检查或切除活检是行之有效的确诊方法。本文对误诊原因和治疗方法等问题进行了探讨。