{"product_id":"pregnancy-associated-breast-cancer-understanding-diagnosis-and-treatment-during-pregnancy-and-postpartum","title":"Pregnancy-Associated Breast Cancer: Understanding Diagnosis and Treatment During Pregnancy and Postpartum","description":"\u003cp\u003ePregnancy-associated breast cancer (PABC) is a rare but aggressive form of breast cancer that occurs during pregnancy, within the first year after delivery, or while breastfeeding. A comprehensive review by researchers at Sapienza-University of Rome examines why this cancer is often diagnosed late and how doctors can improve detection and treatment while protecting both mother and baby. The review highlights that ultrasound should be the first-line imaging tool, mammography is safe with proper precautions, and newer MRI techniques may help earlier diagnosis.\u003c\/p\u003e\n\n\u003ch1\u003ePregnancy-Associated Breast Cancer: Understanding Diagnosis and Treatment During Pregnancy and Postpartum\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#introduction\"\u003eIntroduction: Why This Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#epidemiology\"\u003eBackground and Epidemiology: How Common Is PABC?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#clinical\"\u003eClinical Presentation: What Symptoms Should Raise Concern?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#imaging\"\u003eImaging: How Doctors Look for Breast Cancer in Pregnant Women\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#histology\"\u003eHistology: What the Cancer Looks Like Under the Microscope\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eClinical Implications for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations of Current Knowledge\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003ePABC occurs during pregnancy, first postpartum year, or lactation; incidence is 1 in 3,000 pregnancies.\u003c\/li\u003e\n\u003cli\u003eA persistent breast lump, skin changes, or non-dairy nipple discharge in pregnancy requires prompt imaging workup.\u003c\/li\u003e\n\u003cli\u003eUltrasound is first-line; mammography is safe with abdominal shielding, equivalent to 7 weeks background radiation.\u003c\/li\u003e\n\u003cli\u003eContrast-enhanced MRI is avoided in pregnancy, but unenhanced DWI may help earlier diagnosis.\u003c\/li\u003e\n\u003cli\u003eDelaying PABC treatment until after delivery is associated with poor prognosis; multidisciplinary care is essential.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"introduction\"\u003eIntroduction: Why This Matters\u003c\/h2\u003e\n\u003cp\u003ePregnancy-associated breast cancer (PABC) is defined as breast cancer that occurs during pregnancy, throughout the first year after giving birth (postpartum), or during lactation (breastfeeding). While it is a rare circumstance, it is actually one of the most common types of cancer occurring during pregnancy and lactation — and its incidence is growing in developed countries. This increase is due to two converging trends: breast cancer is appearing at younger ages, and women are choosing to have children later in life.\u003c\/p\u003e\n\n\u003cp\u003eAll breast disorders that emerge during pregnancy or lactation need to be \"handled with care,\" as the authors put it. On one hand, hormone-induced changes in breast tissue during milk production (lactogenesis) can make lesions look different on imaging tests and physical exams. On the other hand, pregnancy and the postpartum period are extremely delicate moments in a woman's life, and the psychological aspects of fear and anxiety — especially during major life changes — must always be considered.\u003c\/p\u003e\n\n\u003cp\u003eDelayed diagnosis is common in PABC, mainly because of a lack of awareness of this clinical entity, fear of X-ray-based diagnostic examinations such as mammography, and possibly a certain degree of denial of suspicious signs and symptoms. However, a quick and precise clinical and radiological assessment is essential, along with fast multidisciplinary management.\u003c\/p\u003e\n\n\u003cp\u003eCritically, the review emphasizes that PABC is often aggressive — so postponing management until after delivery or after the end of lactation should be avoided, because delay is associated with a poor prognosis. The authors present and discuss the diagnostic and therapeutic aspects of PABC based on available literature, current international clinical guidelines, and systematic clinical practice.\u003c\/p\u003e\n\n\u003ch2 id=\"epidemiology\"\u003eBackground and Epidemiology: How Common Is PABC?\u003c\/h2\u003e\n\u003cp\u003eBreast cancer, cervical cancer, hematological diseases (cancers of the blood), and melanoma are the most common malignancies that develop during pregnancy and lactation. Breast and cervical cancers together account for 50% of gestational cancers (cancers diagnosed during pregnancy), followed by hematological cancers, which comprise a further 25% of gestational cancer cases. Less common oncological diseases during pregnancy include ovarian, thyroid, and colon cancers.\u003c\/p\u003e\n\n\u003cp\u003ePABC affects approximately \u003cstrong\u003e1 in 3,000 pregnant women\u003c\/strong\u003e, representing about 7% of all breast cancers in women under 45 years old, 10% in women under 40, and rising to 15.6% in women under 35. The reported incidence of PABC is 15–35 per 100,000 deliveries.\u003c\/p\u003e\n\n\u003cp\u003eNotably, the incidence is higher in the postpartum period, with the great majority of cases detected within six months after giving birth. Delayed diagnosis happens frequently because physiological changes or minor disorders related to pregnancy can mask the initial signs or symptoms of breast cancer.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eWhy is PABC so aggressive?\u003c\/strong\u003e The particular aggressiveness typical of this condition is explained by several factors:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eYoung age at the time of diagnosis\u003c\/li\u003e\n  \u003cli\u003eAdvanced T stage (larger or more invasive tumors)\u003c\/li\u003e\n  \u003cli\u003eHigh frequency of estrogen receptor (ER) and progesterone receptor (PR) negativity\u003c\/li\u003e\n  \u003cli\u003eHigh frequency of Human Epidermal Growth Factor Receptor 2 (HER2) positivity\u003c\/li\u003e\n  \u003cli\u003eMore common lymphovascular invasion (cancer cells in blood or lymph vessels)\u003c\/li\u003e\n  \u003cli\u003eMore frequent lymph node involvement\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAs a consequence, the clinical outcome is poorer and mortality is higher in women with PABC compared with women who have never given birth (nulliparous women). In addition, the treatment of PABC can be limited or delayed to ensure fetal safety. Most patients have no family history of breast cancer, though women who carry BRCA gene mutations are at high risk of developing PABC.\u003c\/p\u003e\n\n\u003ch2 id=\"clinical\"\u003eClinical Presentation: What Symptoms Should Raise Concern?\u003c\/h2\u003e\n\u003cp\u003ePABC mainly presents as a persistent breast mass. In a study including 142 patients, in 100% of patients, the first symptom was a self-discovered breast mass. This finding is consistent with most of the available literature. Other symptoms include:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eSkin thickening\u003c\/li\u003e\n  \u003cli\u003eNipple discharge — either bloody or purulent (pus-like)\u003c\/li\u003e\n  \u003cli\u003eLymph node involvement (swollen or enlarged lymph nodes under the armpit)\u003c\/li\u003e\n  \u003cli\u003eInflammatory changes (redness, swelling, warmth)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eHowever, during pregnancy and lactation, there are several physiological changes of the breast tissue that may mask palpable masses and other breast cancer features. In addition, physical examination — whether self-examination or examination by a doctor — is particularly difficult during this time. The engorged and edematous (swollen with fluid) appearance of breast tissues can be misleading in the detection of lesions, increasing both false negative rates (missing a cancer that is there) and false positive rates (interpreting purely physiological findings as pathological).\u003c\/p\u003e\n\n\u003cp\u003eIt should also be considered that young, premenopausal women do not undergo breast imaging screening frequently, making it more difficult to detect non-palpable breast masses (lumps that cannot be felt).\u003c\/p\u003e\n\n\u003cp\u003eThe authors emphasize a key takeaway: the presence of palpable breast lumps, skin changes, or non-dairy nipple discharge in pregnant or lactating patients should \u003cstrong\u003enot\u003c\/strong\u003e be automatically assumed to be related to their condition (like a blocked milk duct or infection). Instead, these findings require a thorough clinical examination and imaging work-up to reduce the delay in PABC diagnosis and treatment.\u003c\/p\u003e\n\n\u003ch2 id=\"imaging\"\u003eImaging: How Doctors Look for Breast Cancer in Pregnant Women\u003c\/h2\u003e\n\n\u003ch3\u003eUltrasound: The First-Line Tool\u003c\/h3\u003e\n\u003cp\u003eUltrasound (US) is the first-line imaging modality in women with suspected PABC, with reported high sensitivity (ability to detect cancer) and high negative predictive values (meaning a negative result reliably rules out cancer). The typical appearance of PABC at ultrasound examination is a hypoechoic mass (a mass that appears darker than surrounding tissue on ultrasound) with a fluid component, related to central necrosis (tissue death in the center of the tumor) or cystic degeneration due to the tumor outgrowing its blood supply. These masses are typically characterized by \u003cstrong\u003eirregular margins and posterior shadowing\u003c\/strong\u003e (an acoustic shadow behind the mass).\u003c\/p\u003e\n\n\u003cp\u003eThe article describes an example of invasive ductal carcinoma in a 36-year-old woman at the 6th week of pregnancy. The lesion had the typical characteristics of malignancy: hypoechoic pattern, irregular margins, and posterior shadowing. An ipsilateral axillary suspicious lymph node was also seen, with cortical thickening measuring 7 mm — an indicator that the disease had spread to the lymph nodes.\u003c\/p\u003e\n\n\u003cp\u003eHowever, physiological changes associated with pregnancy and lactation may alter typical ultrasound hallmarks. Therefore, the new onset of a palpable complex cystic mass during pregnancy and lactation needs tissue sampling — it should not be ignored or \"downgraded\" to a benign condition like a galactocele (a milk-filled cyst) or an abscess (a pocket of infection), unless signs and symptoms are strongly suggestive of those benign conditions.\u003c\/p\u003e\n\n\u003cp\u003eThe value of breast ultrasound during pregnancy goes beyond merely detecting breast cancer. It can also provide information about nodal disease (cancer in lymph nodes) and response to neoadjuvant chemotherapy (chemotherapy given before surgery to shrink tumors), and can guide biopsy procedures of suspicious lesions. When the histopathological result of tissue sampling is not consistent with radiological findings, surgical excision (removing the lesion surgically) should be considered.\u003c\/p\u003e\n\n\u003ch3\u003eMammography: Safe With Precautions\u003c\/h3\u003e\n\u003cp\u003eThe role of mammography is relatively diminished during pregnancy and lactation, due to concerns about radiation exposure to the fetus and the increased mammographic density of the breast parenchyma (breast tissue) that occurs during this time. As in non-pregnant women, mammography can visualize calcifications, masses, and architectural distortion (distortion of the normal breast tissue pattern). However, the increased mammographic density may reduce the sensitivity of this technique.\u003c\/p\u003e\n\n\u003cp\u003eThe article provides a reassuring message about radiation safety: \u003cstrong\u003emammography is nowadays considered safe in pregnancy\u003c\/strong\u003e. The radiation dose from a bilateral two-view standard mammogram is less than 3 mGy per view — equivalent to about 7 weeks of background radiation (the natural radiation we are all exposed to from the environment). Moreover, appropriate abdominal shielding allows a further reduction in the fetal radiation dose.\u003c\/p\u003e\n\n\u003cp\u003eAccording to the latest American College of Radiology (ACR) appropriateness criteria, mammography is usually appropriate and should be used as an adjunct (complementary tool) to ultrasound.\u003c\/p\u003e\n\n\u003cp\u003ePractical advice for lactating patients: women who are breastfeeding should be advised to nurse or pump immediately before mammography, in order to decrease parenchymal density related to the presence of milk. This simple step improves the quality and accuracy of the images.\u003c\/p\u003e\n\n\u003cp\u003eThe article illustrates this with two clinical examples. A 42-year-old woman in the 7th week of pregnancy underwent standard mammography. Both the mediolateral oblique and craniocaudal views showed a high-density irregular mass surrounded by parenchymal distortion and some contextual calcifications between the upper quadrants of the left breast. A second example shows a 36-year-old breastfeeding woman at 6 months postpartum. In a context of generally increased density due to breastfeeding, a voluminous, high-density mass with irregular margins was visible between the inner quadrants of the right breast. In the mediolateral oblique view, axillary lymphadenopathies (enlarged lymph nodes in the armpit) were also evident.\u003c\/p\u003e\n\n\u003ch3\u003eMRI: A Controversial but Evolving Role\u003c\/h3\u003e\n\u003cp\u003eDespite its evident diagnostic superiority, contrast-enhanced breast magnetic resonance imaging (CE-MRI) is not currently considered a safe modality during pregnancy. There are two main concerns:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFetal exposure to gadolinium-based contrast agents\u003c\/strong\u003e — these agents are able to cross the placental barrier, and their safety for the fetus has not been established\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eThe prone position\u003c\/strong\u003e (lying face down) required for the examination, which may be uncomfortable or problematic during pregnancy\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eAs a consequence, experiences of breast MRI during pregnancy are currently limited to examinations performed before an elected abortion or using unenhanced protocols (MRI without contrast dye).\u003c\/p\u003e\n\n\u003cp\u003eIn recent years, novel unenhanced functional techniques such as \u003cstrong\u003ediffusion-weighted imaging (DWI)\u003c\/strong\u003e have been widely investigated to improve breast MRI accuracy. DWI is having an increasing role as a valuable diagnostic tool during pregnancy and lactation, helping to facilitate an earlier diagnosis of PABC.\u003c\/p\u003e\n\n\u003cp\u003eA recent study investigating the role of DWI as a stand-alone modality for pregnant patients at high risk or with newly diagnosed PABC suggested a potential additive diagnostic role of DWI for a non-invasive approach in breast evaluation during pregnancy. Moreover, the same study demonstrated that breast MRI in the prone position is feasible and tolerable during pregnancy, allowing a further reduction of the total examination time in the first or second trimester.\u003c\/p\u003e\n\n\u003cp\u003eDWI is also useful in lactating patients. When whole-body MRI using DWI with background body suppression (DWIBS) is ordered, it can provide non-invasive information about the presence of cancer and distant metastases (cancer spread to other parts of the body). However, there is no current concern about an increase in radiation dose when performing digital breast tomosynthesis (a type of 3D mammography) in pregnant or lactating women, which remains a recommended option.\u003c\/p\u003e\n\n\u003cp\u003eThere are important limitations of this technique that patients should understand:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eRadiation dose exposure to the fetus (though with abdominal shielding, this is minimal)\u003c\/li\u003e\n  \u003cli\u003eThe use of iodinated contrast medium (which increases the risk of hypothyroidism — underactive thyroid — in the fetus when used after the 12th week of gestation)\u003c\/li\u003e\n  \u003cli\u003ePregnancy-associated increase in background parenchymal enhancement (BPE) — the normal enhancement of breast tissue on MRI — which is known to reduce diagnostic accuracy of contrast-enhanced breast imaging\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIndeed, the marked BPE effect in lactating patients means that tumor visibility is reduced by about 60% compared with non-lactating controls, while the number of contrast agent doses required increases by 138%. One study compared MRI images from 60 patients with PABC to those of age-matched controls who underwent CE-MRI (control group). BPE was more pronounced in the PABC patients than in the control group, highlighting the challenge of interpreting these images. On the contrary, DWI has demonstrated lower sensitivity in cases of sub-centimeter lesions (lesions smaller than 1 cm), especially in cases of non-mass enhancement (a pattern of contrast uptake that doesn't form a distinct mass).\u003c\/p\u003e\n\n\u003cp\u003eThere is good news for breastfeeding women: \u003cstrong\u003ebreastfeeding discontinuation for 1–2 weeks is usually sufficient to decrease BPE levels\u003c\/strong\u003e to make MRI more accurate. Likewise, in the post-weaning period (after a woman stops breastfeeding), lactation-related BPE significantly drops, and CE-MRI utility returns to the optimum level.\u003c\/p\u003e\n\n\u003cp\u003eIn conclusion, there is wide agreement that ultrasound should be the first-line modality in the diagnostic work-up of PABC. Mammography is safe with the proper precautions but is currently considered ancillary (secondary) to ultrasound. The role of MRI in PABC work-up is still controversial due to concerns about the prone position and fetal exposure to gadolinium-based contrast media. However, the development of unenhanced functional MRI techniques has the potential to increase the use of breast MRI during pregnancy and lactation, facilitating earlier diagnosis of PABC.\u003c\/p\u003e\n\n\u003ch2 id=\"histology\"\u003eHistology: What the Cancer Looks Like Under the Microscope\u003c\/h2\u003e\n\u003cp\u003eAs in non-pregnant women, \u003cstrong\u003eductal invasive carcinoma\u003c\/strong\u003e (cancer that starts in the milk ducts and invades surrounding tissue) is the most common histological type of PABC, representing 78–88% of cases, usually with low estrogen receptor (ER) and progesterone receptor (PR) expression. Invasive lobular carcinoma (cancer starting in the milk glands or lobules) and other less common histological types have been found to be uncommon in patients with PABC.\u003c\/p\u003e\n\n\u003cp\u003eThe article provides a detailed clinical example: a 36-year-old breastfeeding patient at 6 months postpartum underwent CE-MRI of the breast, which showed multiple enlarged, highly suspicious lymph nodes in the right armpit and a voluminous, heterogeneous mass with central areas of necrosis (dead tissue) and not circumscribed margins, located between the inner quadrants of the right breast. Histological examination revealed a G2 invasive lobular carcinoma with ER = 98%, PR = 1%, HER2-negative, and Ki67 = 50% at immunohistochemistry (a technique that uses antibodies to detect specific proteins in tissue samples).\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eWhy does PABC develop?\u003c\/strong\u003e Both hormonal changes and transient immunosuppression (temporary weakening of the immune system) during pregnancy have been considered responsible for the development of PABC. In addition, involution (the natural shrinking of the breast tissue after breastfeeding ends) and other changes in breast tissue are considered important risk factors, as they share characteristics with a proinflammatory microenvironment (an environment that promotes inflammation, which can fuel cancer growth).\u003c\/p\u003e\n\n\u003cp\u003eThe results of a systematic review of 14 case–control studies conducted by Marikakis et al. found that \u003cstrong\u003ehormone-receptor-negative cases were more frequent in PABC than in non-PABC patients\u003c\/strong\u003e. PABC is frequently more aggressive, with a high histologic grade (meaning the cancer cells look very abnormal and grow quickly) and a more advanced stage at diagnosis. Moreover, a higher incidence of inflammatory breast cancer (a particularly aggressive form) compared with non-pregnant women was found.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eThe role of lactation cessation:\u003c\/strong\u003e Termination of lactation induces mammary remodeling (reorganization of breast tissue), regulated by fibroblasts (connective tissue cells), endothelial cells (cells lining blood vessels), and immune cells. The activation of these cells can lead to the growth and development of transformed (cancerous) cells. An in vitro (laboratory) study has demonstrated how mammary involution can favor the growth of existing tumor cells.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eThe genomic picture:\u003c\/strong\u003e A recent review of studies about the genomic profile of PABC has shown aberrant (abnormal) expression of several oncogenes (genes that can cause cancer), tumor suppressor genes (genes that normally prevent cancer), apoptosis (programmed cell death) and transcription regulators (proteins that control gene expression), and genes involved in DNA repair mechanisms, cell proliferation, the immune response, and other significant biological processes. However, the molecular nature of PABC remains partially unexplained, and the authors concluded that more studies are required to formulate conclusions and recommendations regarding diagnosis, prognosis, and possible treatment.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eKey molecular pathways:\u003c\/strong\u003e Two pathways are enriched in PABC: the G protein-coupled receptor pathway and the serotonin receptor pathway. The up-regulation (increased activity) of serotonin can induce tumorigenesis (cancer formation) by cellular proliferation; moreover, the serotonin receptor pathway is also involved in the regulation of the expression of cathepsin S (an enzyme involved in cancer progression), which is highly expressed in several cancer subtypes.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eHER2 expression — a complex picture:\u003c\/strong\u003e HER2 expression in PABC is unclear. Some authors have found negative expression during pregnancy and lactation, with positive expression after delivery or cessation of lactation. This could be secondary to stable high estrogen levels during pregnancy that lead to a down-regulation (decrease) of the expression of estrogen receptors in some cell lines. On the contrary, other authors have described overexpression (too much HER2).\u003c\/p\u003e\n\n\u003cp\u003eAmong these, Bae et al. evaluated \u003cstrong\u003e2,810 cases of women under 40 years old with breast cancer\u003c\/strong\u003e, including 40 with PABC and 2,770 with breast cancer not associated with pregnancy. They found that PABC had higher HER2 overexpression (38.5% of cases). The possible explanation given by the authors is that this receptor plays an important role in embryogenesis (embryo development) and the development of some tissues such as lung, skin, gut, muscle, heart, and neural tissue. Two more studies found no differences in terms of HER2 overexpression between PABC patients and the control group. However, in one study, there was no difference in terms of breast-cancer-related family history between the two groups, while in the other study, only 8 out of 41 non-PABC patients were nulliparous, and 33 were diagnosed more than 1 year after delivery. The differences among PABC patients and the control group of each study could probably explain this finding.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eWT1 and p63 — emerging biomarkers:\u003c\/strong\u003e Wilms' tumor 1 (WT1) is a tumor suppressor gene initially identified in Wilms tumors (a type of kidney cancer in children). It participates in the embryogenesis of many organs by regulating multiple target genes and signaling pathways. Moreover, it was detected in some tumors, suggesting that WT1 could also function as an oncogene (cancer-promoting gene). In breast cancer patients, the expression of WT1 is associated with high histological grade, estrogen receptor negativity, and HER2 subtype. In PABC, WT1 expression was found substantially increased in vascular structures (blood vessels) of the invasive cancer component, in comparison with that of non-PABC.\u003c\/p\u003e\n\n\u003cp\u003eP63 is a member of the p53 family (a family of tumor suppressor proteins). It is expressed on ductal myoepithelial cells (cells surrounding the milk ducts) and lobules and is necessary for the development of the mammary gland. A study has shown that epithelial cells with aberrant WT-1 and p63 expression did not express estrogen receptors or progesterone receptors and had a higher proliferation index (meaning the cells were dividing more rapidly — a sign of more aggressive cancer).\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eKi-67:\u003c\/strong\u003e Ki-67 is a nuclear protein and a biomarker of cellular proliferation — it tells doctors how fast cancer cells are dividing. A high Ki-67 index (such as 50% in the example above) indicates a rapidly growing tumor, which has implications for treatment decisions and prognosis.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eClinical Implications for Patients\u003c\/h2\u003e\n\u003cp\u003eFor women diagnosed with PABC, this review carries several important messages. First, a diagnosis of breast cancer during pregnancy does not mean treatment must wait until after delivery. The authors are clear that postponing management until delivery or after the end of lactation should be avoided, as delay is associated with poor prognosis.\u003c\/p\u003e\n\n\u003cp\u003eSecond, the diagnostic pathway is well established. Ultrasound should be the first test performed for any suspicious breast symptom during pregnancy or lactation. If the ultrasound is inconclusive or suspicious, mammography can be safely performed with abdominal shielding. The radiation exposure is minimal — equivalent to about 7 weeks of background radiation.\u003c\/p\u003e\n\n\u003cp\u003eThird, patients should be reassured that modern imaging techniques can accurately detect breast cancer during pregnancy. The key is not to dismiss symptoms. A persistent breast mass, skin changes, or nipple discharge should never be automatically attributed to normal pregnancy changes.\u003c\/p\u003e\n\n\u003cp\u003eFinally, multidisciplinary management is essential. The review emphasizes the need for a team approach involving radiologists, surgeons, oncologists, pathologists, and obstetricians working together to optimize outcomes for both mother and child. Women with PABC should expect coordinated care that addresses not only the cancer but also the psychological aspects of facing a cancer diagnosis during such a vulnerable time in life.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations of Current Knowledge\u003c\/h2\u003e\n\u003cp\u003eThis is a review article, meaning it synthesizes existing research rather than presenting new study data. The authors note that several aspects of PABC remain poorly understood:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eThe molecular nature of PABC remains partially unexplained, and more studies are required to formulate conclusions and recommendations regarding diagnosis, prognosis, and possible treatment\u003c\/li\u003e\n  \u003cli\u003eHER2 expression patterns in PABC are inconsistent across studies — some show overexpression, others show no difference from non-PABC, and still others show negative expression during pregnancy with positive expression after delivery\u003c\/li\u003e\n  \u003cli\u003eThe exact reasons for the aggressiveness of PABC are not fully established, though multiple contributing factors have been identified\u003c\/li\u003e\n  \u003cli\u003eResearch on MRI in pregnancy is limited; current experiences are restricted to examinations before elected abortion or using unenhanced protocols\u003c\/li\u003e\n  \u003cli\u003eStudies on DWI as a stand-alone modality in pregnancy are limited, though promising\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003ePatients should also understand that while the statistics show PABC is aggressive, these are population-level findings. Every individual case is different, and treatment decisions should be personalized based on the specific characteristics of the tumor (its receptor status, grade, stage) and the stage of pregnancy.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\u003cp\u003eBased on the review's findings, here are actionable recommendations for patients and their families:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDo not ignore symptoms.\u003c\/strong\u003e If you feel a persistent breast lump, notice skin changes, or have nipple discharge (especially bloody or pus-like) during pregnancy or while breastfeeding, seek medical evaluation promptly. Do not assume it is just a blocked milk duct or a normal pregnancy change.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRequest appropriate imaging.\u003c\/strong\u003e Ask your doctor about breast ultrasound as the first test. If ultrasound is inconclusive or suspicious, discuss whether mammography with abdominal shielding is appropriate. It is safe — the radiation dose is minimal and equivalent to about 7 weeks of natural background radiation.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNurse or pump before imaging.\u003c\/strong\u003e If you are breastfeeding and need a mammogram, empty your breasts immediately beforehand. This reduces breast density from milk and improves image quality.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eUnderstand that biopsy is essential.\u003c\/strong\u003e If a suspicious mass is found, tissue sampling (biopsy) is needed to confirm or rule out cancer. A complex cystic mass during pregnancy should not be dismissed as benign without sampling.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSeek a multidisciplinary team.\u003c\/strong\u003e Ideally, your care should involve a team of specialists — a breast radiologist, breast surgeon, medical oncologist, pathologist, and high-risk obstetrician — who have experience with PABC and can coordinate your treatment plan.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAsk about MRI options.\u003c\/strong\u003e If you are pregnant or breastfeeding, discuss with your radiologist whether unenhanced MRI techniques like diffusion-weighted imaging (DWI) might be appropriate in your case. Standard contrast-enhanced MRI is generally avoided during pregnancy due to gadolinium concerns.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf breastfeeding, discuss timing.\u003c\/strong\u003e If MRI is needed, breastfeeding discontinuation for 1–2 weeks is usually sufficient to decrease background parenchymal enhancement and improve diagnostic accuracy. Your healthcare team can help you weigh the benefits of continued breastfeeding against the need for accurate imaging.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDo not delay treatment.\u003c\/strong\u003e If cancer is diagnosed, the review emphasizes that delaying treatment until after delivery or after lactation ends is associated with poorer outcomes. Modern treatment protocols can be adapted to protect the fetus while effectively treating the mother.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eConsider genetic counseling.\u003c\/strong\u003e While most patients with PABC have no family history of breast cancer, BRCA mutation carriers are at high risk. Genetic counseling may be appropriate, especially for younger patients.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThe authors' concluding message is clear: the presence of palpable breast lumps, skin changes, or non-dairy nipple discharge in pregnant or lactating patients should never be automatically attributed to the pregnancy or breastfeeding itself. These findings require a thorough clinical examination and imaging work-up to reduce the delay in PABC diagnosis and treatment.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is pregnancy-associated breast cancer (PABC)?\u003c\/h3\u003e\n\u003cp\u003ePABC is breast cancer diagnosed during pregnancy, within the first year after delivery, or while breastfeeding. It is rare, affecting about 1 in 3,000 pregnant women, but it is one of the most common cancers during pregnancy and its incidence is increasing.\u003c\/p\u003e\n\u003ch3\u003eWhat symptoms of breast cancer should pregnant or breastfeeding women not ignore?\u003c\/h3\u003e\n\u003cp\u003eA persistent breast lump is the most common symptom, seen in nearly all cases. Other warning signs include skin thickening, bloody or pus-like nipple discharge, swollen armpit lymph nodes, and redness or warmth. These should not be assumed to be normal pregnancy changes or a blocked milk duct.\u003c\/p\u003e\n\u003ch3\u003eWhich imaging test is the first choice for evaluating a breast lump during pregnancy?\u003c\/h3\u003e\n\u003cp\u003eUltrasound is the first-line imaging tool for suspected pregnancy-associated breast cancer. It has high sensitivity and reliably rules out cancer when negative. Ultrasound can also guide biopsy and check lymph nodes. Mammography is used as a complementary test when ultrasound is inconclusive or suspicious.\u003c\/p\u003e\n\u003ch3\u003eCan breast MRI be used during pregnancy or while breastfeeding?\u003c\/h3\u003e\n\u003cp\u003eStandard contrast-enhanced MRI is generally avoided in pregnancy due to concerns about gadolinium crossing the placenta. However, newer unenhanced MRI techniques like diffusion-weighted imaging (DWI) show promise and are being studied. In breastfeeding women, stopping breastfeeding for 1–2 weeks improves MRI accuracy.\u003c\/p\u003e\n\u003ch3\u003eWhy is pregnancy-associated breast cancer often aggressive?\u003c\/h3\u003e\n\u003cp\u003ePABC tends to be diagnosed at a younger age and more advanced stage. It is often estrogen- and progesterone-receptor negative, more frequently HER2 positive, and more likely to involve lymph nodes and blood vessels. These features contribute to poorer outcomes compared with breast cancer in women who have never given birth.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eOriginal Article Title:\u003c\/strong\u003e Pregnancy-Associated Breast Cancer- A Diagnostic and Therapeutic Challenge RADIOLOGY\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e \u003ca href=\"https:\/\/doi.org\/10.3390\/diagnostics13040604\" target=\"_blank\" rel=\"noopener\"\u003e10.3390\/diagnostics13040604\u003c\/a\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Francesca Galati, Valentina Magri, Paula Andrea Arias-Cadena, Giuliana Moffa, Veronica Rizzo, Marcella Pasculli, Andrea Botticelli, and Federica Pediconi\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e Diagnostics, 2023, Volume 13, Article 604\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e 10.3390\/diagnostics13040604\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitution:\u003c\/strong\u003e Department of Radiological, Oncological and Pathological Sciences, Sapienza-University of Rome, Italy, and Clinica Imbanaco, Cali, Colombia\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication Date:\u003c\/strong\u003e Published 7 February 2023 (Received 3 January 2023; Revised 31 January 2023; Accepted 3 February 2023)\u003c\/p\u003e\n\u003cp\u003eThis patient-friendly article is based on peer-reviewed research published in an open-access journal under the Creative Commons Attribution (CC BY) license.\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47432356724892,"sku":null,"price":0.0,"currency_code":"EUR","in_stock":true}],"url":"https:\/\/diagnosticdetectives.cn\/products\/pregnancy-associated-breast-cancer-understanding-diagnosis-and-treatment-during-pregnancy-and-postpartum","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}