Tumore della mammella in gravidanza: fattori di prognosi e risultati clinici in uno studio caso-controllo

PURPOSE: Pregnancy-associated breast cancer (PABC) is one of the most common malignancies during pregnancy (one in 3,000 pregnancies); up to 3% of breast cancers are diagnosed in pregnancy. Our objective is to verify if women with pregnancy-associated breast cancer (PABC) have poorer outcome than nonpregnant women with breast cancer. METHODS: We register in a Cancer and Pregnancy Registry the clinical course, treatment, and disease outcome of nonpregnant women with breast cancer and of women with PABC. In a retrospective control study (2:1) we compared the women with PABC (65 cases) with nonpregnant women with breast cancer (130 cases) matched for age at diagnosis, stage of disease and year of surgery. RESULTS: Of 65 cases diagnosed, 45 was early cancer and 20 was locally advanced or metastatic cancer. The pregnancy ended in a spontaneus miscarriage in 3 patients (5%), and 15 (23%) pregnancy were interrupted. The mean age at diagnosis was 36 ± 4.2 years. Treatment was started during pregnancy in 32 (49%) patients and after delivery in 33 (51%) patients. Of 65 cases, 49 (75%) women received chemotherapy, 52 (80%) women received radiotherapy and 46 (71%) women were diagnosed with an estrogen/progesterone receptors-positve tumor. The mean gestational age at delivery was 35.4 ± 2.1 weeks. Eleven women (17%) are deceased and 21 (32%) progressed with a median follow-up of 48 months. There are no difference between cases and control in term of biological features of cancer and treatment. CONCLUSIONS: The treatment of breast cancer in pregnancy should be executed by experienced specialists in a multidisciplinary setting and should adhere as closely as possible to standard protocols. As more women postpone child bearing until later in life, it is expected that PABC will become increasingly more common. The prognosis in pregnant women with breast cancer is worse than in nonpregnant women.