BREAST-CANCER DURING PREGNANCY

Breast cancer during pregnancy involves a host of psychosocial, ethica l, religious, and legal considerations, as well as medical multidiscip linary decisions. Treatment modalities. Breast or chest wall radiation therapy should be avoided because the fetal dose, regardless of the t rimester, can cause permanent complications. In the second and third t rimester, chemotherapy is associated with intrauterine growth retardat ion and prematurity in approximately half of the infants; the risk of birth defects is a concern during the first several weeks. Typical ane sthetic agents readily reach the fetus but are not known to be teratog enic. Modified radical mastectomy without delay is the best option in pregnant patients with Stage I or II and some Stage III cancer. Althou gh abortion allows full treatment to the mother, it is not known wheth er the procedure is therapeutic. Early in pregnancy abortion deserves strong consideration. Prognosis. The poor prognosis of pregnancy-assoc iated breast cancer in the past probably is attributable to a combinat ion of initial delay and possibly to the unfavorable biologic characte ristics of pregnancy. When pregnant patients are matched stage for sta ge with control subjects, survival seems equivalent, although pregnant patients have more advanced stage disease.