Human error causing inappropriate management of pregnancy associated breast cancer, literature review and experience in Niger delta university teaching hospital, Okolobiri, Bayelsa state, Nigeria

Breast cancer is the commonest cancer in women in Nigeria. Pregnancy Associated Breast Cancer (PABC) is breast cancer occurring in pregnancy up to one year after delivery. Due to some misconceptions, mistakes occur in the management of these patients leading to poor outcomes. There may be difficulties in the diagnosis of PABC due to the clinical features being mistaken for the normal physiologic changes of pregnancy. The physiologic changes may interfere with radiological and pathological interpretations. Fine needle aspiration cytology (FNAC) or a trucut biopsy confirms the diagnosis. There have been debates on maternal versus foetal wellbeing in PABC. Chemotherapy is safe after 10 weeks of pregnancy when organogenesis is complete. Delaying chemotherapy till after pregnancy worsens the prognosis. Hormonal treatment is contraindicated in PABC. Method: This is a retrospective observational study of cases of PABC at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria, from January 2019 to January 2021. Results: Seven cases were seen with ages ranging from 28 to 37. All patients presented with breast lumps. Diagnosis was by FNAC and trucut biopsy. None of the patients received care for the cancer during pregnancy as they were advised by their doctors not to and to present after delivery due to the percermived haful effects of treatment on the foetus. All seven patients presented with advanced stage disease after delivery. They all received chemotherapy and hormonal therapy. Eventually all patients were lost to follow up. Conclusion: Patients diagnosed with PABC in peripheral hospitals should be referred for specialist care. Treatment modalities like surgery and chemotherapy are feasible in PABC and should not be unduly delayed. Continuing education on the topic and feedback to colleagues at peripheral hospitals should be ensured

Case Reports of Two Patients with Pregnancy-associated Breast Cancer and Related Literature Review / 中国药房

OBJECTIVE：To provide reference for the early diagnosis and selection of treatment regimens of pregnancy- associated breast cancer （PABC）. METHODS ：The disease characteristics ，treatment process and prognosis of 2 cases of PABC were analyzed in our hospital. The relevant literature published from Jan. 1986 to Apr. 2019 in PubMed database was retrieved. The case reports that the title ，keywords or abstracts involved “Breast cancer and pregnancy ”“Pregnancy-associated breast cancer ” “Breast cancer during pregnancy ”“Breast carcinoma during pregnancy ”“Case reports ”were included. Cases which didn ’t meet the definition of PABC were excluded. The general information ，tumor clinical characteristics ，drug treatment plan ，maternal/fetal prognosis and other information of patients were extracted for summary and descriptive statistical analysis. RESULTS & CONCLUSIONS：Two patients were both diagnosed during lactation. The prognosis was good after neoadjuvant chemotherapy and surgical resection. A total of 36 case reports were obtained through literature search and screening ，as well asclinical data of 45 patients（39 diagnosed during pregnancy and 6 diagnosed during lactation ）.Neoadjuvant chemotherapy AC regimen （doxorubicin+ cyclophosphamide）was used in 35.0％（14/40）of cases after excluding the cases without relevant information ；elective caesarean section was performed in 59.5％（22/37）of cases ，37.8％（14/37）of cases were delivered ，and 1 case chose to terminate pregnancy；survival rate of patients was 80.8％（21/26），and the average weight of newborns was 2 407 g（1 015-3 830 g）. Six patients each received taxanes during pregnancy and 9 patients during postpartum. The determination of chemotherapy for PABC should comprehensively consider a variety of factors. It is necessary to comprehensively weigh the benefit risks of the mother and child，try to avoid chemotherapy in early pregnancy ，and especially consider the impact of chemotherapy on the fetus. The chemotherapy regimen is still dominated by anthracyclines. Based on this ，an individualized regimen is formulated and close monitoring should be performed when using paclitaxel.

Two Cases of Pregnancy-associated Breast Cancer / 대한산부인과학회잡지

Pregnancy-associated breast cancer is defined as that occurring during pregnancy or within 1 year after delivery. The incidence of pregnancy-associated breast cancer is 0.2% to 3.8%. Tenderness, engorgement, increased size and increased prominence of the glandular tissue during pregnancy and lactation make mammography and clinical breast examination uncomfortable for the patient and less accurate for the detection of an abnormal breast mass. Pregnancy-associated breast cancer tends to be diagnosed at a more advanced stage, with an attendant adverse prognosis, than in women who are not pregnant or lactating. So physicians should perform a thorough breast examination at the first prenatal visit and maintain a high index of suspicion for cancer. We experienced 2 cases of pregnancy-associated breast cancer patients and reported these cases with a brief review of literature.

Diagnosis and multidisciplinary treatment of 9 cases of pregnancy-associated breast cancer / 中国癌症杂志

Purpose: To analyze and study the characteristics of diagnosis, multidisciplinary treatment including surgery, chemotherapy and radiotherapy of pregnancy-associated breast cancer. Methods: 9 cases of pregnancy-associated breast cancer were diagnosed and treated in the Department of radiotherapy of Henri Mondor Hospital, the Xllth University of Paris, from December 1992 to June 1999. 3 cases were diagnosed during pregnancy, while the other 6 were diagnosed within one year following pregnancy. 5 cases were treated with breast conservative therapy, 4 cases with modified radical mastectomy. Post-operative radiotherapy was delivered to all of the 9 cases, and 7 cases accepted chemotherapy. Results: 7 of the 9 mammographies and all the 5 breast ultrasonographies revealed tumor images. The stage at the diagnosis was generally late, the proportion of stage I , II and fT was 11 % , 44% and 44% respectively. The median follow-up time was 60 months (9-89 months), disease-free survival was observed in 6 cases, 3 cases had local recurrence or distant metastasis at 14 months to 48 months after the completion of treatment. Conclusions: Delay of diagnosis is frequently observed in pregnancy-associated breast cancer, especially in these cases diagnosed after delivery. Attention should be paid to the physical examination and ultrasonography of the breast during pregnancy and lactation. The principal of treatment is to take into account both the urgency of the disease and the safety of the fetus. Under the condition that the chemotherapy and radiotherapy could be delivered without delay, breast conservative treatment is feasible in early stage pregnancy associated breast cancer