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Imaging Pregnancy Associated Breast Cancer

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Abstract

Purpose of Review

Pregnancy associated breast cancer (PABC) distinguishes itself as a different diagnosis due to its unique presentation, diagnostic timetable, and risk factors. The extended duration of treatment and the unfavorable prognosis linked to PABC can be attributed to the delay in diagnosis and treatment. The delay results from the difficulty in interpreting gravid breast examinations and clinicians' hesitancy to perform imaging and treatment procedures on expectant patients. To prevent unnecessary stress on the patient and to mitigate harm to the fetus, accurate and expeditious imaging is necessary.

Recent Findings

As the number of women delaying childbirth continues to increase, it is projected that number of PABC diagnoses will also increase. The most common symptom associated with PABC is a palpable mass.

Summary

This review provides a comprehensive discussion of the epidemiology and risk factors, clinical presentation, diagnostic challenges, and imaging evaluation of pregnancy associated breast cancer.

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Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hou N, Ogundiran T, Ojengbede O, Morhason-Bello I, Zheng Y, Fackenthal J, et al. Risk factors for pregnancy-associated breast cancer: a report from the Nigerian breast cancer study. Ann Epidemiol. 2013;23(9):551–7. https://doi.org/10.1016/j.annepidem.2013.06.008.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ayyappan AP, Kulkarni S, Crystal P. Pregnancy-associated breast cancer: spectrum of imaging appearances. Br J Radiol. 2010;83(990):529–34. https://doi.org/10.1259/bjr/17982822.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. •• Langer A, Mohallen M, Stevens D, Rouzier R, Lerebours F, Cherel P. A single-institution study of 117 pregnancy-associated breast cancers (PABC): presentation, imaging, clinicopathological data and outcome. 2014;95(4):435–441. https://doi.org/10.1016/j.diii.2013.12.021. This article provides a patient-centered analysis to identify unique characteristics of patients with PABC including presentation, imaging, and outcomes.

  4. Keyser EA, Staat BC, Fausett MB, Shields AD. Pregnancy-associated breast cancer. Rev Obstet Gynecol. 2012;5(2):94–9.

    PubMed  PubMed Central  Google Scholar 

  5. Expert Panel on Breast Imaging, di Florio-Alexander RM, Slanetz PJ, Moy L, Baron P, Didwania AD, et al. ACR Appropriateness Criteria® Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol. 2018;15(11S):S263–75. https://doi.org/10.1016/j.jacr.2018.09.013.

    Article  Google Scholar 

  6. Sabate JM, Clotet M, Torrubia S, Gomez A, Guerrero R, de las Heras P, et al. Radiologic evaluation of breast disorders related to pregnancy and lactation. Radiographics. 2007;27 Suppl 1:S101–24. https://doi.org/10.1148/rg.27si075505.

  7. Smith LH, Danielsen B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gyncecol. 2003;189(4):1128. https://doi.org/10.1067/s0002-9378(03)00537-4.

    Article  Google Scholar 

  8. Andersson TM, Johansson AL, Hsieh C, Cnattingius S, Lambe M. Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol. 2009;114(3):568–72. https://doi.org/10.1097/AOG.0b013e3181b19154.

    Article  PubMed  Google Scholar 

  9. Woo JC, Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Arch Surg. 2003;138(1):91. https://doi.org/10.1001/archsurg.138.1.91.

    Article  PubMed  Google Scholar 

  10. Galati F, Magri V, Arias-Cadena PA, Moffa G, Rizzo V, Pasculli M, Botticelli A, Pediconi F. Pregnancy-associated breast cancer: a diagnostic and therapeutic challenge. Diagnostics (Basel). 2023;13(4):604. https://doi.org/10.3390/diagnostics13040604.

    Article  CAS  PubMed  Google Scholar 

  11. Soto-Trujillo D, Aragon LN, Kimura Y. Pregnancy-associated breast cancer: what radiologists must know. Cureus. 2020;12(9):e10343. https://doi.org/10.7759/cureus.10343.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lyons TR, Schedin PJ, Borges VF. Pregnancy and breast cancer: when they collide. J Mammary Gland Biol Neoplasia. 2009;14:87–9. https://doi.org/10.1007/s10911-009-9119-7.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ruiz R, Herrero C, Strasser-Weippl K, Touya D, St Louis J, Bukowski A, Goss PE. Epidemiology and pathophysiology of pregnancy-associated breast cancer: a review. Breast. 2017;35:136–41. https://doi.org/10.1016/j.breast.2017.07.008.

    Article  PubMed  Google Scholar 

  14. Albrektsen G, Heuch I, Hansen S, Kvåle G. Breast cancer risk by age at birth, time since birth and time intervals between births: exploring interaction effects. Br J Cancer. 2005;92(1):167–75. https://doi.org/10.1038/sj.bjc.6602302.

    Article  CAS  PubMed  Google Scholar 

  15. Albrektsen G, Heuch I, Tretli S, Kvåle G. Breast cancer incidence before age 55 in relation to parity and age at first and last births: a prospective study of one million Norwegian women. Epidemiology. 1994;5(6):604–11. https://doi.org/10.1097/00001648-199411000-00008.

    Article  CAS  PubMed  Google Scholar 

  16. Johannsson O, Loman N, Borg A, Olsson H. Pregnancy-associated breast cancer in BRCA1 and BRCA2 germline mutation carriers. Lancet. 1998;352(9137):1359–60. https://doi.org/10.1016/S0140-6736(05)60750-7.

    Article  CAS  PubMed  Google Scholar 

  17. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with BC and 96973 without the disease. Lancet. 2002;360(9328):187–95. https://doi.org/10.1016/S0140-6736(02)09454-0.

    Article  Google Scholar 

  18. Proussaloglou EM, Blanco LZ, Siziopikou KP. Updates in the pathology of pregnancy associated breast cancer (PABC). Pathol Res Pract. 2023;244:154413. https://doi.org/10.1016/j.prp.2023.154413.

    Article  PubMed  Google Scholar 

  19. Middleton LP, Amin M, Gwyn K, Theriault R, Sahin A. Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features. Cancer. 2003;98(5):1055–60. https://doi.org/10.1002/cncr.11614.

    Article  PubMed  Google Scholar 

  20. Reed W, Hannisdal E, Skovlund E, Thoresen S, Lilleng P, Nesland JM. Pregnancy and breast cancer: a population-based study. Virchows Arch. 2003;443(1):44–50. https://doi.org/10.1007/s00428-003-0817-z.

    Article  CAS  PubMed  Google Scholar 

  21. Yang WT, Dryden MJ, Gwyn K, Whitman GJ, Theriault R. Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology. 2006;239(1):52–60. https://doi.org/10.1148/radiol.2391050083.

    Article  PubMed  Google Scholar 

  22. Espinosa LA, Daniel BL, Vidarsson L, Zakhour M, Ikeda DM, Herfkens RJ. The lactating breast: contrast-enhanced MR imaging of normal tissue and cancer. Radiology. 2005;237(2):429–36. https://doi.org/10.1148/radiol.2372040837.

    Article  PubMed  Google Scholar 

  23. Vashi R, Hooley R, Butler R, Geisel J, Philpotts L. Breast imaging of the pregnant lactating patient: imaging modalities and pregnancy-associated breast cancer. Am J Roentgenol. 2013;200(2):321–8. https://doi.org/10.2214/ajr.12.9814.

    Article  Google Scholar 

  24. Liberman L, Giess CS, Dershaw DD, Deutch BM, Petrek JA. Imaging of pregnancy-associated breast cancer. Radiology. 1994;191(1):245–8. https://doi.org/10.1148/radiology.191.1.8134581.

    Article  CAS  PubMed  Google Scholar 

  25. Ahn BY, Kim HH, Moon WK, Pisano ED, Kim HS, Cha ES, et al. Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings. J Ultrasound Med. 2003;22(5):491–7; quiz 8–9.

  26. Taylor D, Lazberger J, Ives A, Wylie E, Saunders C. Reducing delay in the diagnosis of pregnancy-associated breast cancer: how imaging can help us. J Med Imaging Radiat Oncol. 2011;55(1):33–42. https://doi.org/10.1111/j.1754-9485.2010.02227.x.

    Article  PubMed  Google Scholar 

  27. Myers KS, Green LA, Lebron L, Morris EA. Imaging appearance and clinical impact of preoperative breast MRI in pregnancy-associated breast cancer. Am J Roentgenol. 2017;209(3). https://doi.org/10.2214/AJR.16.17124.

  28. Oh SW, Lim HS, Moon SM, Kim JW, Shin SS, Heo SH, et al. MR imaging characteristics of breast cancer diagnosed during lactation. Br J Radiol. 2017;90(1078):20170203. https://doi.org/10.1259/bjr.20170203.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Taron J, Fleischer S, Preibsch H, Nikolaou K, Gruber I, Bahrs S. Background parenchymal enhancement in pregnancy-associated breast cancer: a hindrance to diagnosis? Eur Radiol. 2019;29(3):1187–93. https://doi.org/10.1007/s00330-018-5721-7.

    Article  PubMed  Google Scholar 

  30. Taskin F, Polat Y, Erdogdu IH, Soyder A. Pregnancy-associated breast cancer: a review of 47 women. Clin Imaging. 2019;58:182–6. https://doi.org/10.1016/j.clinimag.2019.07.012.

    Article  PubMed  Google Scholar 

  31. Joshi S, Dialani V, Marotti J, Mehta TS, Slanetz PJ. Breast disease in the pregnant and lactating patient: radiological-pathological correlation. Insights Imaging. 2013;4(5):527–38. https://doi.org/10.1007/s13244-012-0211-y.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Candelaria RP, Huang ML, Adrada BE, Bassett R, Hunt KK, Kuerer HM, et al. Incremental cancer detection of locoregional restaging with diagnostic mammography combined with whole-breast and regional nodal ultrasound in women with newly diagnosed breast cancer. Acad Radiol. 2017;24(2):191–9. https://doi.org/10.1016/j.acra.2016.11.015.

    Article  PubMed  Google Scholar 

  33. Xu K, Chung M, Hayward JH, Kelil T, Lee AY, Ray KM. MRI of the Lactating Breast. Radiographics. 2024;44(2):e230129. https://doi.org/10.1148/rg.230129.

    Article  PubMed  Google Scholar 

  34. •• Kieturakis AJ, Wahab RA, Vijapura C, Mahoney MC. Current Recommendations for Breast Imaging of the Pregnant and Lactating Patient. AJR Am J Roentgenol. 2021;216(6):1462–75. https://doi.org/10.2214/AJR.20.23905. This article is a 2021 update to the recommendations for imaging in the pregnancy and postpartum patient. Imaging plays a critical role in both screening and treatment; thus this article helps guide clinicians on up-to-date recommendations.

    Article  PubMed  Google Scholar 

  35. Peterson MS, Gegios AR, Elezaby MA, Salkowski LR, Woods RW, Narayan AK, et al. Breast Imaging and Intervention during Pregnancy and Lactation. Radiographics. 2023;43(10):e230014. https://doi.org/10.1148/rg.230014.

    Article  PubMed  Google Scholar 

  36. McCormick A, Peterson E. Cancer in pregnancy. Obstet Gynecol Clin North Am. 2018;45(2):187–200. https://doi.org/10.1016/j.ogc.2018.01.009.

    Article  PubMed  Google Scholar 

  37. Loibl S, von Minckwitz G, Gwyn K, Ellis P, Blohmer JU, Schlegelberger B, et al. Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer. 2006;106(2):237–46. https://doi.org/10.1002/cncr.21610.

    Article  PubMed  Google Scholar 

  38. National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Breast Cancer (Version 2.2024). https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (2024). Accessed Mar 24 2024.

  39. Litton JK, Theriault RL, Gonzalez-Angulo AM. Breast cancer diagnosis during pregnancy. Womens Health (Lond). 2009;5(3):243–9. https://doi.org/10.2217/whe.09.2.

    Article  PubMed  Google Scholar 

  40. Amant F, Deckers S, Van Calsteren K, Loibl S, Halaska M, Brepoels L, et al. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer. 2010;46(18):3158–68. https://doi.org/10.1016/j.ejca.2010.09.010.

    Article  PubMed  Google Scholar 

  41. American College of Radiology: ACR Manual on Contrast Media. https://www.acr.org/Clinical-Resources/Contrast-Manual (2023). Accessed 03/18/2024 2024.

  42. Little JT, Bookwalter CA. Magnetic Resonance Safety: Pregnancy and Lactation. Magn Reson Imaging Clin N Am. 2020;28(4):509–16. https://doi.org/10.1016/j.mric.2020.06.002.

    Article  PubMed  Google Scholar 

  43. Schackmuth EM, Harlow CL, Norton LW. Milk fistula: a complication after core breast biopsy. AJR Am J Roentgenol. 1993;161(5):961–2. https://doi.org/10.2214/ajr.161.5.8273635.

    Article  CAS  PubMed  Google Scholar 

  44. Vinatier E, Merlot B, Poncelet E, Collinet P, Vinatier D. Breast cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2009;147(1):9–14. https://doi.org/10.1016/j.ejogrb.2009.06.030.

    Article  PubMed  Google Scholar 

  45. Son EJ, Oh KK, Kim EK. Pregnancy-associated breast disease: radiologic features and diagnostic dilemmas. Yonsei Med J. 2006;47(1):34–42. https://doi.org/10.3349/ymj.2006.47.1.34.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Amant F, Loibl S, Neven P, Van Calsteren K. Breast cancer in pregnancy. Lancet. 2012;379(9815):570–9. https://doi.org/10.1016/S0140-6736(11)61092-1.

    Article  PubMed  Google Scholar 

  47. Gegios AR, Peterson MS, Fowler AM. Breast cancer screening and diagnosis. PET Clin. 2023;18(4):459–71. https://doi.org/10.1016/j.cpet.2023.04.003.

    Article  PubMed  Google Scholar 

  48. Peccatori FA, Codacci-Pisanelli G, Del Grande M, Scarfone G, Zugni F, Petralia G. Whole body MRI for systemic staging of breast cancer in pregnant women. Breast. 2017;35:177–81. https://doi.org/10.1016/j.breast.2017.07.014.

    Article  PubMed  Google Scholar 

  49. Nissan N, Furman-Haran E, Allweis T, Menes T, Golan O, Kent V, et al. Noncontrast Breast MRI During Pregnancy Using Diffusion Tensor Imaging: A Feasibility Study. J Magn Reson Imaging. 2019;49(2):508–17. https://doi.org/10.1002/jmri.26228.

    Article  PubMed  Google Scholar 

  50. Nissan N, Allweis T, Menes T, Brodsky A, Paluch-Shimon S, Haas I, et al. Breast MRI during lactation: effects on tumor conspicuity using dynamic contrast-enhanced (DCE) in comparison with diffusion tensor imaging (DTI) parametric maps. Eur Radiol. 2020;30(2):767–77. https://doi.org/10.1007/s00330-019-06435-x.

    Article  PubMed  Google Scholar 

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Author information

Author notes

  1. Lindsay Telles and Logan Blackney contributed equally to this work

Authors and Affiliations

  1. Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA

    Lindsay Telles & Logan Blackney

  2. University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Tanya W. Moseley

  3. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Marion E. Scoggins

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  1. Lindsay Telles
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  2. Logan Blackney
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  4. Marion E. Scoggins
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Contributions

All authors contributed to the conception and design of this review. All authors gave final approval of the version of the review to be published, and all authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Tanya W. Moseley.

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Ms. Telles, Mr. Blackney, and Dr. Scoggins declare that they have no conflict of interest. Dr. Moseley is a medical imaging consultant for Merit Medical, Hologic, GE, and Siemens Medical.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Telles, L., Blackney, L., Moseley, T.W. et al. Imaging Pregnancy Associated Breast Cancer. Curr Breast Cancer Rep (2024). https://doi.org/10.1007/s12609-024-00553-2

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