Pregnancy Associated Breast Cancer: Clinicopathological profile and Management in the Department of Gynecology - Obstetrics II of the HASSAN II Teaching Hospital of Fez (Morocco)
Author(s): Solène Nyingone, Alpha Boubacar Conte, Fatima Zohra Fdili Alaoui, Sofia Jayi, Jihad Jamor, Bineta Jho Diagne, Hikmat Chaara, Moulay Abdelilah Melhouf
Background: Breast cancer represents in our department the most frequent cancer among gyneco mammary cancers. Its association with pregnancy rarely observed is reported to be the most common form of cancer diagnosed during pregnancy. Pregnancy-associated breast cancer (PABC) refers to breast cancer (BC) diagnosed during pregnancy, lactation, or in the postpartum period. We made this study in order to describe the clinicopathological profil of PABC and the management in our context.
Methodology: This is a retrospective study on 14 patients with Pregnancy-associated breast cancer managed in the service of Gynecology - Obstetrics II of the Hassan II teaching hospital in Fez (Morocco). We defined Pregnancy-associated breast cancer as any breast cancer discovered during an active pregnancy or during the 12 months following the pregnancy.
Results: The average age was 34,64years old. The most represented age group was that of 30 to 39 years old. 11 patients (78,6%) were pregnant and 3 (21,4%) were in postpartum period. Most of the patients (8/14: 57,1%) presented for breast nodule discovered by sefl-palpation Clinically, most of the tumors was at the stage of T3N1MX and T2N1MX. The breast ultrasound was in favor of lesions classified ACR5 in 57,1% of cases versus ACR4 in 42,9% of cases. Non-specific type invasive carcinoma was the most frequent histologic type (11/14 either 78,6% of cases). The majority of patients (78,6%) had an intermediate invasive grade of SBR (grade II). The frequent immunohistochemical type of the invasive carcinomas was Luminal B (57,1%). Chemotherapy was performed in 100% of cases. Among those in pregnancy 6 was neo-adjuvant (42,9%) and 8 was adjuvant (57,1%) at the median term of 24 weeks of gestation with extrems of 14 and 38 weeks of gestation. No patient was treated with herceptin during pregnancy. Adjuvant hormone therapy has been introduced in 6 patients’ treatment (42,9%). Radiotherapy was performed in all cases and no patient received radiotherapy during pregnancy. We recorded a death rate of 21,5%.
Conclusion: The diagnosis PABC during pregnancy requires a good sense approach to management with careful consideration given at all stages to the needs of the mother and risks to the fetus. Pregnancy might prevent the approach of optimal treatment as the cancer might prevent the good evolution of the pregnancy.