Breast Cancer and Pregnancy

Description

Breast cancer in pregnancy is defined as breast cancer that is diagnosed during pregnancy, during lactation, and up to 12 months postpartum.

Epidemiology

Incidence

• Gestational breast cancer is one of the most common pregnancy-associated malignancies as well as cervical cancer.
• Breast cancer in pregnancy has an incidence of approximately 0.3/1,000 deliveries (1).

Etiology and Pathophysiology

Genetics

• BRCA1 and BRCA2 mutation carriers have greatly increased risk of breast cancer overall and may be more likely to develop breast cancer during pregnancy.
• Multiparity appears protective in BRCA1 carriers but is associated with increased risk in BRCA2 carriers.
• Other significant mutations include p53 (Li-Fraumeni syndrome) and PTEN (Cowden syndrome).

Risk Factors

• Age
  • Increased risk with advanced age
  • First pregnancy after age 35 years increases risk.
• Early menarche and late menopause
• Family history
  • Breast cancer in first-degree relatives
  • First-degree relatives with premenopausal breast cancer further increase risk.
• Nulliparity
• Exposure to radiation
• Social
  • Increased consumption of alcohol
  • Obesity
  • Sedentary lifestyle (2)

General Prevention

• Reduce the risk of breast cancer by maintaining a healthy weight.
• The benefits with moderate exercise such as brisk walking are seen at all age groups including postmenopausal women.

Commonly Associated Conditions

• Women with gestational diabetes mellitus (GDM) are at 1.5 times greater risk of breast cancer as compared with women who do not have GDM.
• Lower risk of breast cancer is observed in women who have pregnancy-related hypertensive disorders such as preeclampsia.