Breast Cancer and Pregnancy

Breast Cancer and Pregnancy is a topic covered in the 5-Minute Clinical Consult.

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Basics

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.

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