pregnancy associated breast cancer
DESCRIPTION
PRESENTATION ABOUT PREGNANCY ASSOCIATED BREAST CANCERTRANSCRIPT
![Page 1: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/1.jpg)
� الر�ح�يم الر�ح�من� الل ه� � �س�م ب
العظيم الله صدق
� �وا � ق�ال ال �ك� �ح�ان �م� س�ب ل � ع� �ال إ �ا �ا ل�ن �ن �م�ت ع�ل م�ا�ح�ك�يم� ال �يم� �ع�ل ال �نت� أ �ك� �ن إ
![Page 2: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/2.jpg)
![Page 3: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/3.jpg)
![Page 4: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/4.jpg)
BREAST CANCER
![Page 5: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/5.jpg)
Breast cancer is the commonest of all cancers in women.
Worldwide, it comprises 22.9% of invasive
cancers in females.
One woman in nine will develop breast cancer during her lifetime, making it the leading cause of death from cancer after lung cancer I n Western women.
![Page 6: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/6.jpg)
25% of all breast cancers occur in women of childbearing age.
Only five percent of patients with breast cancer are less than 40 year old and 1.8% less than 35 years
![Page 7: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/7.jpg)
Age-specific incidence of
breast cancer.
![Page 8: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/8.jpg)
![Page 9: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/9.jpg)
Age : Over 75% of cases in women above 50 years old Family History Proliferative breast diseases : especially when
associated with atypia Enviromental factors:exposure to ionizing radiation
especially at a young age. Obesity: especially in post menopausal. Paersonal history of malignancy: Breast,
endometrial, ovarian. Dietary Factors: high fat diets
Risk Factors
![Page 10: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/10.jpg)
Hormonal factors:
Risk Factors
Endogeous exposure:NulliparityEarly menarcheLate menopause
Exogenous exposure:Hormonal replacement therapyOral contraceptive bills
![Page 11: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/11.jpg)
PREGNANCY ASSOCIATEDBREAST CANCER
![Page 12: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/12.jpg)
Definition:
Pregnancy associated breast cancer (PABC) is defined as any breast carcinoma diagnosed during pregnancy or during the first postpartum year.
![Page 13: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/13.jpg)
Role of pregnancy in Breast Ca. protection
There is a known solid association between parity and a lifetime reduction in breast cancer risk.
Many theories were intoduced, one of which relate the cause to the cellular differentiation associated with pregnancy changes, thus epithelial cells are less liable to proliferate and less susceptible to carcinogenic stimulus.
![Page 14: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/14.jpg)
Dual effect of pregnancy
However, studies of breast cancer incidence in young women demonstrate a clinically underrecognized transient increase in breast cancer risk in the years immediately following pregnancy where all parous women have higher incidence of breast cancer compared with nulliparous women.
This increase in risk has been shown to persist for at least 10 and up to 15 years after birth .
![Page 15: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/15.jpg)
Dual effect of pregnancy
The main contributers to this risk are: 1- Maternal age at 1st full term pregnancy:
35
30
25
40
45
full-term pregnancy offers women some degree of protection
pregnancy is assocIat-ed with a permanent increase in breast cancer risk.
![Page 16: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/16.jpg)
Dual effect of pregnancy
Age and parity appear to act synergistically: with high parity [≥5] and young age [≤20] at first birth associated with the greatest ultimate reduction in lifetime breast cancer risk
2 -Total number of pregnancies:
![Page 17: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/17.jpg)
Dual effect of pregnancy
advanced maternal age and family history act synergistically to increase risk. Women 30 years of age or older at first birth with a family history have a three-fold increased risk over those with no family history, and this risk persists longer, for 20–30 years post-partum.
3 -Family history:
![Page 18: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/18.jpg)
Epidemiology of PABC :
The incidence of PABC is estimated to be about 1 in 3000 pregnancies.
up to 3% of breast cancers are diagnosed in pregnant or lactating women.
10% of women under the age of 40 who develop breast cancer are pregnant when it is diagnosed.
At present, breast cancer is the second most common malignancy in pregnancy (after cervical cancer).
Once thought to be rare,it is expected to increase in frequency as women delay childbearing until later in life .
![Page 19: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/19.jpg)
DIAGNOSIS AND WORK UP
P A B C
![Page 20: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/20.jpg)
PABC usually come with an average delay of 5-7 months as breast changes are mistakenly related to pregnancy.
The average age of patients with breast carcinoma in pregnancy is between 35 and 38 years
History
![Page 21: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/21.jpg)
Most women diagnosed with pregnancy-associated breast cancer will present with a painless mass in the breast .
80% of breast masses presenting during pregnancy are benign.
Clinical presentation
![Page 22: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/22.jpg)
Two categories of radiation related effects in humans:
Imaging
Deterministic effects
Stochastic effects
![Page 23: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/23.jpg)
Imaging
In general, a fetal exposure of less than 100 mGy is considered to provoke no deterministic effects and has an associated risk of stochastical effects of <1% which does not justify termination of pregnancy, according to the recommendations of the International Commission on Radiological Protection (ICRP-84) .
![Page 24: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/24.jpg)
Imaging
Is the standard method for the evaluation of a palpable breast mass during pregnancy.
Ultrasonography
![Page 25: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/25.jpg)
Imaging
Ultrasonography
can usually distinguish cystic lesions from solid lesions, and it is used to guide core biopsy or fine needle aspiration of suspicious breast lesions.
![Page 26: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/26.jpg)
Imaging
Ultrasonography
Breast ultrasound has a high sensitivity and specificity for the diagnosis of PABC.
![Page 27: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/27.jpg)
Imaging
With adequate abdominal shielding, a mammography presents little risk to the fetus all during the tree trimesters .
Mammography
![Page 28: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/28.jpg)
Imaging
The increased water content, higher density and loss of contrasting fat in the proliferating mammary glands of young pregnant women may make mammographic diagnosis difficult (sensitivity less than 70%)
Mammography
![Page 29: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/29.jpg)
Imaging
Digital mammography (DM) is as safe as film-screen mamorgraphy (FM) but more accurate in detecting breast cancer in women aged under 50 years , those who are pre- or perimenopausal, and those with heterogeneously dense.
Mammography
![Page 30: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/30.jpg)
Imaging
MRI is not recommended during the first trimester because the developing embryo is susceptible to injury from various physical agents
MRI
![Page 31: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/31.jpg)
Imaging
Chest radiography is used mainly in staging work up.
It can be carried out safely during pregnancy with proper using of abdominal shielding.
Chest X-ray
![Page 32: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/32.jpg)
Imaging
CT of the abdomen and pelvis are by far the examinations with the highest radiation exposure to the fetus.
CT is used only in staging , however where possible, it should be replaced by ultrasound or MRI.
Computed Tomography
![Page 33: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/33.jpg)
![Page 34: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/34.jpg)
Approximate fetal doses from common radiological diagnostic procedures in the United Kingdom
![Page 35: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/35.jpg)
Pathology
Biopsy of a suspicious mass is the gold standard for the diagnosis of breast cancer.
A core needle biopsy is the technique of choice. The sensitivity of core needle biopsy is around 90%.
Fine Needle aspiration cytology (FNAC) may be misleading and should not be performed during pregnancy.
![Page 36: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/36.jpg)
Pathology
Breast cancers in pregnant women are histologically similar to those in non-pregnant women, with 75% to 90% being ductal cancers.
The incidence of inflammatory tumors probably lies between 1.5% and 4%.
![Page 37: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/37.jpg)
Pathology
pathological lymph node involvement (56–67%)
Lymphovascular invasion
HER-2/Neu overexpression 36% to 58%
ER –PR negative tumors :54% and 80%
High grade
![Page 38: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/38.jpg)
Staging The following points should be taken into
consideration:Staging of PABC is the same as TNM staging of
breast canerIf this risk is low, distance disease staging should be postponed to after delivery. Chest radiography with abdominal shielding to detect pulmonary metastasis .Ultrasound is the best to detect liver metastasis.
MRI is preferred to detect bone metastasis .Bone scan is only recommended in cases of uncertain MRI findings, or when MRI is unavailable.
![Page 39: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/39.jpg)
Staging
Alkaline phosphatase levels may be falsely elevated. Ultrasound is the best to detect liver metastasis.
Echocardiogram prior to anthracycline- based regiments , and is safe.Sites concerning for metastatic disease should be biopsied whenever possible and safe
![Page 40: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/40.jpg)
How to deal with a lady having PABC?
From the psychological point of view
![Page 41: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/41.jpg)
Cancer during pregnancy puts the mother in a difficult situation. A new life is growing inside her and at the same time her own life is threatened.
Also, for the medical team it is a complex setting, because two individuals are involved: the mother and her unborn child.
![Page 42: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/42.jpg)
This difficult situation cannot be helped by a standardised
treatment.
![Page 43: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/43.jpg)
Should be performed by persons skilled in communication skills.
The whole situation should be clear: diagnosis , prognosis , risks and options of treatment.
The information should be given in pieces at several different appointments in a simple , clear and not a blunt language.
Breaking bad news
![Page 44: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/44.jpg)
Communicating risk means confrontation with important uncertainties.
Shared decision-making means that patient with another person ; eg the partener, share in decision making based on the information they gained. It seems to be of benefits like improved patient satisfaction and clinical outcome .
Communicating risks and shared decision-making
![Page 45: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/45.jpg)
As physicians, we have legal obligations , and moral obligations.
This creates a conflict between what we have to do according to medicine rules and the patient autonomy that takes into consideration her opinion and her fears respect.
It is a matter of balance and the art of tailoring.
Understanding the ethical framework
![Page 46: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/46.jpg)
The patients should feel. that all medical stuff are caring for the mother–baby unit as a whole, the problem shouldn’t be considered as a matter of a breast and a uterus.
Inevitably, there will be phases of crisis during the pregnancy, which have to be responded to by psychologically trained members of staff
Bio- psychosocial care
![Page 47: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/47.jpg)
TreatmentPABC
![Page 48: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/48.jpg)
The protocol of treatment should be as close as possible to that offered to non-pregnant women.
Multidisciplinary approach is essential
![Page 49: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/49.jpg)
Termination of pregnancy is indicated in:
Termination of pregnanacy
Advanced disease with dismal prognosis. Poor general patient condition. fetal exposure to more than 100 mGy during
the first trimester. Reluctancy of the parents to accept the risks.
![Page 50: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/50.jpg)
Breast surgery can be offered safely during pregnancy.
Surgery:
Mastectomy
Conservative
The question is: or
![Page 51: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/51.jpg)
The answer depends mainly on “when the diagnosis is made”
surgery:
Is write option at any time of pregnancy .
Here , radiotherapy can be delayed after delivery
Mastectomy
At the end of second and at the third trimester . Radiotherapy again is delayed until after childbirth.
Conservative
![Page 52: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/52.jpg)
So it seems that radiotherapy derives the choice of the type of surgery
?Is there a role for radiotherapy in PABC ?
![Page 53: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/53.jpg)
Radiation doses used in cancer therapy are usually within the range of 4000–7000 cGy which is more than 1000-fold the level in diagnostic radiology.
Radiotherapy
Definitly , radiotherapy is contraindicated in pregnancy
Fetal exposure > 100 mGy can result in abortion or major fetal malformation in the 1st trimester. while exposur to > 250 m Gy in late pregnancy increase incidence of childhood cancer.
![Page 54: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/54.jpg)
Radiotherapy
The only role for RT is in a woman who has a diagnosis of breast cancer made during the first, or early in the second trimester, and insist on preserving her breast.
Here , radiotherapy option should be well discusssed with the patient and her family. RT is given in the 1st or early 2nd trimester with peoper shielding.
![Page 55: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/55.jpg)
Due to their relatively low molecular weight, most cytotoxic agents can cross the placenta.
Chemotherapy
In pregnancy, most chemotherapy are classified as a class D category.
![Page 56: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/56.jpg)
Anthracyclines-based regimens are the most widely used In PABC and has been shown to be associated with favorable safety profile
Chemotherapy
In the metastatic setting, anthracycline-based regimens remain the best choice as well. For patients who are not good candidates for anthracycline-based regimens, single agent taxane would be a preferred option.
![Page 57: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/57.jpg)
Chemotherapy is contraindicated during the first trimester “period of organogenesis”, and should be postponed till the second and third trimester.
Chemotherapy
Chemotherapy should not be given after 34-35 weeks of gestation as spontaneous delivery can occur before bone marrow recovery and before the baby eleminates the chemotherapt by the placenta.
![Page 58: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/58.jpg)
PABC is definitly associated with poor prognosis
Prognosis..
Delayed diagnosis Late stage Young age
![Page 59: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/59.jpg)
Prognosis..
Non PABC PABC TUMOR
38–54% 56–89% LN Metastases
2 cm 3.5 cm Tumor size
The pregnant women had a 2.5-fold higher risk
Diagnosis. at II and III stage
45–66% 65–90% Diagnosed as metastatic
![Page 60: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/60.jpg)
Prognosis..
However, many studies were done to investigate the role of pregnancy itself as an independent predictor of worse survival.
These studies suggesting a similar stage-for-stage prognosis as breast cancer in age matched non- pregnant women.
Therefore, pregnancy itself should not be regarded as a poor prognostic indicator
![Page 61: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/61.jpg)
BREAST CANCER &BREAST FEEDING
![Page 62: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/62.jpg)
Breast cancer diagnosed during Breastfeeding is also included under the term:
PABC
![Page 63: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/63.jpg)
Ultrasound....DD: galactoceleMammography....Dense breast
MRI
Biopsy
Treatment
![Page 64: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/64.jpg)
women undergoing active chemotherapy should not breastfeed. Cytotoxic agents can be detected in small quantities in breast milk and are potentially toxic for the baby.
There should be a time interval of 14 days or more from the last chemotherapy session to resume breastfeeding.
![Page 65: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/65.jpg)
Women taking tamoxifen should not breastfeed.
![Page 66: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/66.jpg)
?Can I breastfeed my baby?
Breast cancer survivors who becomePregnant…
![Page 67: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/67.jpg)
Breast cancer survivors who becomepregnant should be encouraged to breastfeed.
YES
![Page 68: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/68.jpg)
A history of breast surgery and radiation may affect milk supply. Mothers who have undergone mastectomy but no radiation to the remaining breast can often develop a full supply for one infant
Some researchers believe that breastfeeding after breast cancer will have a protective effect on the contralateral breast
![Page 69: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/69.jpg)
Subsequent pregnancy after breast cancer
![Page 70: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/70.jpg)
Amenorrhea is a common problem following adjuvant chemotherapy given to premenopausal women with breast cancer.
Regiments containing Cylophosphamide or taxanes are associated with high level of ovarian failure.
![Page 71: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/71.jpg)
Fertility preservation options:
Gonadotropin releasing-hormone (GnRH) agonist for ovarian protection
Ovarian cortex cryopreservation
oocyte cryopreservation
Embryo cryopreservation
![Page 72: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/72.jpg)
Patients are generally advised to wait at least two years after diagnosis before becoming pregnant.
For women receiving TAM it is better to wait untill the end of the 5 year treatment time before getting a pregnancy.
![Page 73: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/73.jpg)
Thank YOU
![Page 74: PREGNANCY ASSOCIATED BREAST CANCER](https://reader035.vdocument.in/reader035/viewer/2022062705/556e683ed8b42a6a248b4fe0/html5/thumbnails/74.jpg)