Pregnancy affects breast cancer risk
Pregnancy stops monthly menstrual cycles and shifts the hormone balance to progesterone instead of estrogen; thus women who become pregnant while they are young and have many pregnancies may have slightly lower risk of breast cancer later on because they are exposed to less estrogen.
Breast Cancer diagnosis while pregnant
- Mammograms are considered fairly safe during pregnancy.
- Breast biopsy – ie core needle biopsy can be done during pregnancy.
- MRI without contrast can be done while pregnant.
- Chest X-Rays can be done.
Treating Breast Cancer while Pregnant
- Surgeries can be done; however, SLN might be limited.
- Radiation is usually given after delivery.
- Chemo can start in the second trimester. Induction chemotherapy can start (ie. for tumors fixed to the skin – stage III)
- Hormone therapy should not be used during pregnancy.
Locally Advanced Breast Cancer
10-30% of all primary breast cancers are diagnosed as locally advanced which prohibits breast conservation methods. Stage III breast cancer is considered locally advanced.
Stage (grade) III Breast Cancer
An example would be a 6 cm breast mass diagnosed as infiltrating ductal carcinoma with spread to lymph nodes. (T3 N1 Mx)
- Tumor is larger than 5 cm with positive spread to axillary lymph nodes, but the lymph nodes aren’t attached to each other. Stage IIIA.
- Tumor is smaller than 5 cm with positive spread of lymph nodes growing into each other and surrounding tissue. Stage IIIA.
- Tumor is smaller than 5 cm, but the cancer has spread to lymph nodes above the collar bone. Stage IIIB.
- Inflammatory breast cancer is considered stage IIIB breast cancer.
Treatment of locally advanced breast cancer
Neoadjuvant therapy is a historical term. Now called primary systemic therapy. This is giving chemotherapy prior to operation.
Workup includes bone scan and abdominal CT prior to initiating chemotherapy.