Review Article Clinical Decision Making in the Management of Breast Cancer Diagnosed During Pregnancy: A Review and Case Series Analysis Nadom Safi, MPH, 1,2 Christobel Saunders, AO, FRCS, FRACS, FAAHMS, 3 Antoinette Anazodo, MSC, PhD, MRCPCH, FRACP, 4–6 Jan E. Dickinson, FRANZCOG, MD, 7 Frances Boyle, FRACP, PhD, 8,9 Angela Ives, PhD, 10 Alex Wang, PhD, 1 Zhuoyang Li, PhD, 2 and Elizabeth Sullivan, MPH, MD, MMed, FAFPHM 1,2 Purpose: To highlight the various options available for the management of breast cancer diagnosed during preg- nancy by describing the investigations, treatment, and outcomes in relation to these women. Methods: This is a narrative review of the literature to describe the issues related to pregnancy and obstetric management in patients with breast cancer. It incorporates a description of six cases of women (aged 29–39 years) with a first-time diagnosis of breast cancer during pregnancy to illustrate a number of issues that need to be considered during different trimesters. Results: Of the six cases, two were diagnosed in each pregnancy trimester. A painless breast mass was the pre- senting symptom in five cases (83%). In all cases, breast ultrasound was the primary diagnostic imaging pro- cedure. Chest X-ray was performed in 3 (50%) and computed tomography in 2 (33%). A core needle biopsy was performed in all cases, and sentinel lymph node biopsy in 3 (50%) cases. Four women had grade 3 tumor; five had estrogen receptor-positive tumors. Four women had breast surgery during pregnancy. Five women gave birth after the induction of labor and/or cesarean section. In all six cases, a multidisciplinary team was involved in the delivery of health care. Conclusion: Regular breast examinations are needed for all pregnant woman during prenatal visits. Breast ultrasonography should be offered if a breast lump or other symptoms are detected. Breast surgery can be safely performed during all pregnancy trimesters, and some systemic therapeutic agents can be administered safely in the second and third trimesters. Keywords: breast cancer, clinical decision making, gestational breast cancer, management, pregnancy Introduction B reast cancer is one of the most common malignancies diagnosed in women during pregnancy, with an inci- dence in Australia of 23 per 100,000 pregnancies. 1 The most common presenting symptom is a painless breast lump. 2 This can present diagnostic difficulties, as normal physiological changes during pregnancy can lead to the development of benign transient lumps in the breast of a pregnant woman, thereby masking breast cancer symptoms. 2–4 This problem is compounded by physician reluctance to request imaging studies during pregnancy using ionizing radiation such as 1 School of Public Health, University of Technology Sydney, Broadway, New South Wales, Australia. 2 Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. 3 Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia. 4 School of Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia. 5 The Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Randwick, New South Wales, Australia. 6 Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia. 7 Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia. 8 Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia. 9 Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, North Sydney, New South Wales, Australia. 10 Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia. JOURNAL OF ADOLESCENT AND YOUNG ADULT ONCOLOGY Volume 11, Number 3, 2022 ª Mary Ann Liebert, Inc. DOI: 10.1089/jayao.2021.0054 245 Downloaded by 34.238.161.82 from www.liebertpub.com at 02/28/24. For personal use only.