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Pregnancy-associated breast cancer (PABC): Demographics and outcome analysis from a lower and middle income country (LMIC)

In Annals of Oncology
By: Bajpai J.
Contributor(s): Dandekar S | Simha V | Shylasree T | Sarin R | Bansal V | Ghosh J | Rath S | Nair N | Gulia S | Patil A | Gupta S.
Material type: materialTypeLabelArticlePublisher: 2020Description: .Subject(s): Pregnancy | Llower - middle income country | Breast cancer In: Annals of OncologySummary: Background PABC is defined as breast cancer diagnosed during pregnancy or one year post-partum. It poses a unique challenge to safeguard oncologic outcome and fetal safety. This is an unmet need especially in LMICs and merits exploration. Methods A prospective and retrospective registry study of PABC was carried out from May 2013-Feb 2020 at Tata Memorial Center in India. Results There were 100 patients with a median age of 31 (20-42) years; 33 diagnosed during pregnancy while 67 postpartum; 79 had delayed diagnosis. 23 had family history, 1 was positive for BRCA mutation (185DelAG). Of these, 96% had IDC grade III tumours, 50 were triple-negative and 35 were Her2-positive. 84 patients received anthracyclines and taxanes; grade III/IV complications occurred as: 12 febrile-neutropenias, 3 mucositis, 1 hypersensitivity. Of 72 non-metastatic patients, 52 received neoadjuvant-chemotherapy, 28 underwent breast-conservations and 4 had pathological complete remission. Of the total, 33 patients were diagnosed during pregnancy (14-first, 12 -second, 7-third trimester). There were 16 medical terminations (MTP) (5 metastatic), 15 full term, and 2 premature deliveries with average birth -weight of 2.48kg (1.7-4kg). One neonate had hydrouretronephrosis and another two required ventilator support due to prematurity. Trastuzumab, tamoxifen and radiotherapy were administered post-delivery. 65 patients were diagnosed postpartum. There were 2 MTPs (1 metastatic), 15 full term, 1 premature delivery with average birth weight of 2.9kg (1.7-4kg). There was no congenital abnormality but two infants succumbed at 18 days (unknown cause) and 6 months after birth (severe diarrhea). Of the rest, all 78 (17/33 and 61/65) babies are alive with normal milestones. At median follow up of 18 (11-25) months, 2 years overall and event free survival in early (100%, 92%), locally advanced (76%, 54%) and metastatic breast cancer is (77%,32%), p values of 0.019 and 0.001. Conclusions PABC is associated with delayed, advanced presentation and aggressive biology. Outcomes deteriorated as stage is advanced. However, stage-matched outcomes are comparable if adequately treated. International collaboration and consensus are highly warranted to optimize outcomes.
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Articles Articles Tata Memorial Hospital
Available AR20577

Abstract Book of ESMO Breast Cancer Virtual Meeting 2020 23-24 May 2020

Background
PABC is defined as breast cancer diagnosed during pregnancy or one year post-partum. It poses a unique challenge to safeguard oncologic outcome and fetal safety. This is an unmet need especially in LMICs and merits exploration.

Methods
A prospective and retrospective registry study of PABC was carried out from May 2013-Feb 2020 at Tata Memorial Center in India.

Results
There were 100 patients with a median age of 31 (20-42) years; 33 diagnosed during pregnancy while 67 postpartum; 79 had delayed diagnosis. 23 had family history, 1 was positive for BRCA mutation (185DelAG). Of these, 96% had IDC grade III tumours, 50 were triple-negative and 35 were Her2-positive. 84 patients received anthracyclines and taxanes; grade III/IV complications occurred as: 12 febrile-neutropenias, 3 mucositis, 1 hypersensitivity. Of 72 non-metastatic patients, 52 received neoadjuvant-chemotherapy, 28 underwent breast-conservations and 4 had pathological complete remission. Of the total, 33 patients were diagnosed during pregnancy (14-first, 12 -second, 7-third trimester). There were 16 medical terminations (MTP) (5 metastatic), 15 full term, and 2 premature deliveries with average birth -weight of 2.48kg (1.7-4kg). One neonate had hydrouretronephrosis and another two required ventilator support due to prematurity. Trastuzumab, tamoxifen and radiotherapy were administered post-delivery. 65 patients were diagnosed postpartum. There were 2 MTPs (1 metastatic), 15 full term, 1 premature delivery with average birth weight of 2.9kg (1.7-4kg). There was no congenital abnormality but two infants succumbed at 18 days (unknown cause) and 6 months after birth (severe diarrhea). Of the rest, all 78 (17/33 and 61/65) babies are alive with normal milestones. At median follow up of 18 (11-25) months, 2 years overall and event free survival in early (100%, 92%), locally advanced (76%, 54%) and metastatic breast cancer is (77%,32%), p values of 0.019 and 0.001.

Conclusions
PABC is associated with delayed, advanced presentation and aggressive biology. Outcomes deteriorated as stage is advanced. However, stage-matched outcomes are comparable if adequately treated. International collaboration and consensus are highly warranted to optimize outcomes.

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