The diagnosis of breast cancer during pregnancy presents various complexities for patients and practitioners since the benefit of the patient´s treatment must be compatible with the well-being of the foetus. While cancer diagnosed during pregnancy is rare the number of cases have progressively increased over recent years due to a delay in first-time pregnancy among women in developed countries and a rise in cancer occurring in women aged between 30-45 years of age. Statistically, among women 25-29 years of age, one out of every five cases of this type of cancer is diagnosed in association with a pregnancy, either during pregnancy or in the year after giving birth.
These patients have the option of either interruption of continuation of pregnancy – naturally an almost impossible decision to make without the right guidance and up-to-the-minute information about the efficacy and safety of treatment options available.
In order to better support, inform and treat these women, Javier Cortés, the then Head of Vall d´Hebron´s Breast Cancer Unit and currently Associate Translational Investigator at VHIO and Head of Breast Cancer and Gynecological Tumors at the Ramón y Cajal University Hospital in Madrid, in collaboration with other leading specialists across the Vall d´Hebron Barcelona Hospital Campus – including its Breast Pathology Unit, set up a program to treat these patients in a holistic manner and make pregnancy compatible with effective and safe cancer treatment without harming the development of the foetus.
Since this program launched in 2006, more than 50 women diagnosed with breast cancer during pregnancy have been treated by a multidisciplinary expert team comprised of gynaecologists, obstetricians, foetal medicine specialists, oncologists, specialized surgeons and pathologists in breast cancer, and paediatricians at Vall d´Hebron. This integrated approach facilitates communication between the experts involved in decision-making as well as enhances the safety, flexibility and effectiveness of the management of these pregnant patients during treatment.
In parallel, pioneering research led by VHIO´s Cristina Saura, current Principal Investigator of VHIO´s Breast Cancer and Melanoma Group and Head of the Breast Cancer Unit of Medical Oncology Service at Vall d’Hebrón, who reported important findings today during her doctoral thesis defence directed by Javier Cortés, will further improve outcomes for these patients as well as finely tune protocols already in place.
Multidisciplinary research hand in hand with cancer care of excellence
Thanks to the connectivity of a truly dedicated and multidisciplinary team coupled with the close follow-up and monitoring of these patients, Cristina´s research has shown that these patients can undergo suitable treatment for their breast cancer while pregnant and that there is no need to interrupt pregnancy. With the appropriate selection of therapy, findings also evidenced that treatment does not jeopardize the neonate or suppose a worse prognosis for these patients, and that the decision to have an abortion when breast cancer is diagnosed during pregnancy does not improve the prognosis of these patients.
Cristina also stressed the importance of the purely multidisciplinary approach to treating and managing patients diagnosed with breast cancer during pregnancy. Through the necessary cross-talk between specialities complications are avoided and en force, thanks to exceptional teamwork, the mother receives optimal oncological treatment and care and the best paediatric outcomes are also achieved for the neonate. She also observed that the aggressive nature of breast cancer during pregnancy is consistent with that found in women diagnosed at a young age and shares similar characteristics.
Notably, Cristina´s findings also demonstrate that these patients should be treated as similarly as possible to non-pregnant patients. This includes surgery where necessary at any time during pregnancy, as well as chemotherapy with anthracyclines and/or taxanes as of the second trimester. Approaches and therapies that should on the other hand be discouraged are radiotherapy and those agents for which there is no information available with regards to potential interactions during pregnancy.
She concluded her thesis defence affirming that “according to our findings thus far, using chemotherapy does not result in any subsequent neuropsychological or cardiologic abnormalities in the baby with the foetus having been exposed to intrauterine therapy”. In addition, she revealed that preventing prematurity as much as possible helps to both reduce post-partum complications as well as achieve better long-term neuropsychological outcomes for the neonates. “As of week 34, however, we need to test whether any placental insufficiency has occurred. In which case, after this period of gestation, induction of labour should be indicated”, she concluded.
Vall d´Hebron´s established protocol: making pregnancy compatible with cancer treatment
It is thanks to this exceptional program and established protocol combining prenatal care and cancer treatment that Vall d´Hebron´s team of experts provide comprehensive care of excellence for these women with outcomes comparable to those of non-pregnant patients. The multidisciplinary management of this patient population is achieved through the coordination of the different specialists involved in the management of breast cancer and pregnancy.
In addition, thanks to the leading research directed by VHIO´s Cristina Saura, Vall d´Hebron is firmly establishing itself as a leading force in the treatment of women diagnosed with breast cancer during pregnancy. According to statistics to-date out of the patients diagnosed with breast cancer at Vall d´Hebron during their pregnancies, 30 foetus have been exposed to chemotherapy, and 43 babies have since been born.
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