ABSTRACT
Introduction: Breast cancer is the most common malignancy in pregnant women, occurring at a rate of about 1 in 3000 pregnancies. Unfortunately, this will sometimes occur during the firsttrimester of pregnancy and this situation warrants discussion of management options with regard to the mother and child, especially with the current trend of deferring child bearing to a later age. Clinical Picture: We present a 34-year-old primigravida who had a breast lump prior to confirmation of her pregnancy and received her diagnosis of invasive breast cancer at 7 weeks’ amenorrhoea. The oncologic management options of this pregnant patient with breast cancer are discussed. Treatment: The patient eventually opted to undergo wide excision of the breast cancer with sentinel lymph node biopsy and possible axillary clearance together with termination of her pregnancy. Results: The patient successfully underwent surgery for her breast cancer and was subsequently treated with adjuvant therapy as per normal protocol for a non-pregnant patient. Conclusion: The management of breast cancer and pregnancy occurring concurrently is a complex problem fraught with many dilemmas for both the medical team, the patient and her family. The option chosen must involve a multidisciplinary team and have full informed consent of the patient.
Cancer complicates approximately 1 per 1000 pregnancies and accounts for one third of maternal deaths during gestation.1,2 The reproductive system is affected by malignant growth more frequently than any other systems during pregnancy. Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy, lactation or 1-year postpartum. The median maternal age at the time of diagnosis of breast cancer during pregnancy is 32 to 38 years and the median gestational age at diagnosis is 17 to 25 weeks.2 The management of a pregnant mother with cancer is difficult and complex with decisions to be made which can impact both mother and the unborn child. In addition, various ethical and religious issues complicate the final decision when the management of the pregnant patient with breast cancer is incompatible with continuation of gestation. Breast cancer is uncommon in young, premenopausal women especially as local data shows a peak increase in incidence during the fourth and fifth decades of life in Singapore.3 However, the trend to defer childbearing to a later age will make the issue of pregnancy and breast cancer of increasing importance. This is because many more women will still be in the process of starting or completing their families when a discovery of breast cancer is made. We describe a case of breast cancer in a patient who was diagnosed during her first trimester of pregnancy (7 weeks amenorrhoea).
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