The Breast (2006) 15(S2) S53–S59 www.elsevier.com/locate/breast Psychological management of pregnancy-related breast cancer Rosanna Zanetti-D¨allenbach, Sibil Tschudin, Olav Lapaire, Wolfgang Holzgreve, Edward Wight, Johannes Bitzer* Department of Obstetrics and Gynaecology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland KEYWORDS Breast cancer; Pregnancy; Breaking bad news; Communicating risk; Shared decision- making Summary The comprehensive care of a pregnant patient in whom breast cancer is diagnosed presents a challenge to the biomedical and psychological competence of the medical team. Illustrated by a case presentation the different phases of psychological care are delineated and discussed: the confrontation with the diagnosis of a life-threatening disease in a situation in which the beginning of a future life is celebrated. Special attention is given to breaking bad news, the establishment of a stable and trustful physician–patient relationship, communicating risk and to the extremely difficult decision-making process regarding termination or continuation of pregnancy (shared decision-making). The delicate balance between oncological care for the mother with a high-risk disease and a high-risk pregnancy and neonatal care for the foetus is outlined, including regular talks about emotions and concerns. © 2006 Elsevier Ltd. All rights reserved. Introduction Breast cancer remains the most frequent cancer in women. One woman out of ten will be diagnosed with breast cancer. Reproductive factors,such as menarche,menopause,parity, lactation and others are strongly linked to the risk of breast cancer. Cancer complicates0.07% ofall deliveriesin California and the mostfrequently documented primary cancer in this population was breast cancer (0.13 per 1000 deliveries) 1 . As women delay childbearing to a later age, the incidence of pregnancy-associated breast cancer is likely to increase over time 1,2 . The physiologicalchanges in the breast during pregnancy limit the utility * Corresponding author. Johannes Bitzer, Department of Obstetrics and Gynaecology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland. Tel.: +41 61 265 90 43; fax: +41 61 265 90 35. E-mail: jbitzer@uhbs.ch (J. Bitzer). of mammography and physical examination. This may contribute to a delay in diagnosis of 1–2 months. Therefore, breast lumps should undergo immediate evaluation – also during pregnancy or lactation 1,3 -6 . Breast cancer in young women below the age of 35 often shows a poorer differ- entiation and oestrogen-receptor negativity. They are associated with more aggressive behaviour and a worse outcome, but the prognosisfor pregnant and non-pregnant woman is similar when adjusted for stage and age 5,7,8 . The available data on treating pregnant women with breast cancer are very limited. Because of the lack of randomised trials, treatment recommendations are based on case reports and matched historical cohorts 9 -12 . Termination ofpregnancy brings no additional benefit to cancer therapy and does not improve survival 4,6,9,13 . During chemotherapy breastfeedingis contraindicated.Even though for most agents no breastfeeding information is 0960-9776/$ - see front matter © 2006 Elsevier Ltd. All rights reserved.