Experience of personalized management of patients with breast cancer associated with pregnancy

Abstract

The clinical case of a patient with pregnancy-associated breast cancer observed in Sverdlovsk Regional Oncological Dispensary was analyzed. The information obtained from the electronic map of obstetric database and the medical history of oncological dispensary regarding the results of clinical examination as well as the data of instrumental and laboratory research were used. The tactics of managing this patient was discussed at the Regional Obstetric and Interdisciplinary Consultation with the participation of oncologists; a compromise concept was chosen, which implies surgical treatment of malignant neoplasms followed by chemotherapy during pregnancy and early delivery at the term when a child is viable– 34 weeks of pregnancy. At present, preference is given to personalized tactics of pregnancy management and treatment of pregnancy-associated breast cancer using an interdisciplinary approach with the participation of medical specialists: obstetrician-gynecologist, oncologist-surgeon, oncologist-chemotherapist, radiotherapist, anesthesiologist-resuscitator, neonatologist, pathologist. The described clinical case demonstrates successful implementation of this approach, as evidenced by the favourable outcome of childbirth as well as the absence of recurrence and progression of the tumor process in dynamics.

Keywords

cancer / mammary gland / pregnancy / childbirth

References

[1] Informacionnaja bjulleten' Vsemirnoj organizacii zdravoohranenija (VOZ) ot 26 marta 2021g., available at: https://www.who.int/ ru/news-room/fact-sheets/detail/breast-cancer (in Russian).

[2] Информационная бюллетень Всемирной организации здравоохранения (ВОЗ) от 26 марта 2021г., available at: https://www.who.int/ru/news-room/fact-sheets/ detail/breast-cancer.

[3] Kaprin A.D., Starinskij V.V., Petrova G.V. Zlokachestvennye novoobrazovanija v Rossii v 2019 godu (zabolevaemost' i smertnost'). Moscow 2020, available at: https://glavonco.ru/ (in Russian).

[4] Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2019 году (заболеваемость и смертность). М. 2020, available at: https:// glavonco.ru/.

[5] Dobrohotova Ju.Je., Borovkova E.I., Arutjunjan A.M. Associirovannyj s beremennost'ju rak molochnoj zhelezy. Rossijskij vestnik akushera-ginekologa 2019; 19 (4): 77–81. DOI: 10.17116/rosakush20191904177 (in Russian).

[6] Доброхотова Ю.Э., Боровкова Е.И., Арутюнян А.М. Ассоциированный с беременностью рак молочной железы. Российский вестник акушера-гинеколога 2019; 19 (4): 77–81. DOI: 10.17116/rosakush20191904177.

[7] Johansson A.V.L., Stensheim H. Epidemiology of Pregnancy-Associated Breast Cancer. Exp Med Biol. 2020; 1252: 75–79. DOI: 10.1007/978-3-030-41596-9_9.

[8] Taskin F., Polat Y., Erdogdu I.Y., Soyder A. Pregnancy-associated breast cancer: A review of 47 women. Clin Imaging. 2019; 58: 182–186. DOI: 10.1016/j.clinimag.2019.07.012.

[9] Taskin F., Polat Y., Erdogdu I.Y., Soyder A. Pregnancy-associated breast cancer: A review of 47 women. Clin Imaging. 2019; 58: 182–186. DOI: 10.1016/j.clinimag.2019.07.012.

[10] Gooch J.C., Chun J, Kaplowitz E. et al. Pregnancy-associated breast cancer in a contemporary cohort of newly diagnosed women. Breast J. 2020; 26 (4): 668–671. DOI: 10.1111/tbj.13510.

[11] Janni W., Rack B., Gerber B. Pregnancy-associated breast cancer – special features in diagnosis and treatment. Onkologie. 2006; 29 (3): 107–112. DOI: 10.1159/000091012

[12] Janni W., Rack B., Gerber B. Pregnancy-associated breast cancer -- special features in diagnosis and treatment. Onkologie. 2006; 29 (3): 107–112. DOI: 10.1159/000091012

[13] Sun J., Lee M.C. Clinical Presentation, Diagnosis and Prognosis of Pregnancy-Associated Breast Cancer. Adv Exp Med Biol. 2020; 1252: 87–93. DOI: 10.1007/978-3-030-41596-9_11.

[14] Suelmann B.B.M., Bakhuis C.F.J., van Dooijeweert C. et al. Prognosis of pregnancy-associated breast cancer: inferior outcome in patients diagnosed during second and third gestational trimesters and lactation. Breast Cancer Res Treat. 2022; 192 (1): 175–189. DOI: 10.1007/s10549-021-06471-6

[15] Middleton L.P. Amin M., Gwyn K. et al. Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features. Cancer. 2003; 98 (5): 1055–1060. DOI: 10.1002/cncr.11614

[16] Ob utverzhdenii perechnja medicinskih pokazanij dlja iskusstvennogo preryvanija beremennosti: prikaz M-va zdravoohranenija i social'nogo razvitija Ros. Federacii № 736n ot 3 dekabrja 2007g. Moscow 2007; 10 (in Russian).

[17] Об утверждении перечня медицинских показаний для искусственного прерывания беременности: приказ М-ва здравоохранения и социального развития Рос. Федерации № 736н от 3 декабря 2007 г. М. 2007; 10.

[18] Omranipour R. Surgery for Pregnancy-Associated Breast Cancer. Adv Exp Med Biol. 2020; 1252: 95–99. DOI: 10.1007/978-3-030-41596-9_12 (in Russian).

[19] Omranipour R. Surgery for Pregnancy-Associated Breast Cancer. Adv Exp Med Biol. 2020; 1252: 95–99. DOI: 10.1007/978-3-030-41596-9_12.

[20] Rak molochnoj zhelezy: klinicheskie rekomendacii. Moscow 2021, available at: https://cr.minzdrav.gov.ru/ (in Russian).

[21] Рак молочной железы: клинические рекомендации. М. 2021, available at: https:// cr.minzdrav.gov.ru/.

[22] Paris I., Di Giorgio D., Carbognin L. et al. Pregnancy-Associated Breast Cancer: A Multidisciplinary Approach. Clin Breast Cancer. 2021; 21 (1): 120–127. DOI: 10.1016/j.clbc.2020.07.007

[23] Paris I., Di Giorgio D., Carbognin L. et al. Pregnancy-Associated Breast Cancer: A Multidisciplinary Approach. Clin Breast Cancer. 2021; 21 (1): 120–127. DOI: 10.1016/j.clbc.2020.07.007

[24] Cubillo A., Morales S., Goñi E. et al. Multidisciplinary consensus on cancer management during pregnancy. Clin Transl Oncol. 2021; 23 (6): 1054–1066. DOI: 10.1007/s12094-020-02491-8.

[25] Zaharova N.V., Tereshin O.S., Bulynskij D.N. i dr. Rak molochnoj zhelezy, associirovannyj s beremennost'ju. Ural'skij medicinskij zhurnal. 2021; 20 (2): 75–79. DOI: 10.52420/ 2071-5943-2021-20-2-75-79 (in Russian).

[26] Захарова Н.В., Терешин О.С., Булынский Д.Н. и др. Рак молочной железы, ассоциированный с беременностью. Уральский медицинский журнал 2021; 20 (2): 75–79. DOI: 10.52420/2071-5943-2021-20-2-75-79

[27] Amouzegar Hashemi F. Radiotherapy in Pregnancy-Associated. Adv Exp Med Biol. 2020; 1252: 125–127. DOI: 10.1007/978-3-030-41596-9_16/

[28] Amouzegar Hashemi F. Radiotherapy in Pregnancy-Associated. Adv Exp Med Biol. 2020; 1252: 125–127. DOI: 10.1007/978-3-030-41596-9_16

[29] Chen Q., Qiu Y.R., Zhang M.D. et al. Clinical practice guidelines for pregnancy-associated breast cancer: Chinese society of breast surgery (CSBrS) practice guidelines 2021. Practice Guideline. Chin Med J. 2020; 134 (20): 2395–2397. DOI: 10.1097/CM9.0000000000001686.

[30] Arteaga-Gómez A.C., Vázquez-Castellanos G., Sepúlveda-Rivera C.M. et al. Perinatal outcomes in young women with breast cancer and pregnancy. Expand Gac Med Mex. 2021; 157 (4): 416–421. DOI: 10.24875/GMM.M21000584.

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