Outcomes of Pregnancy-Associated Breast Cancer: A Tertiary Care Cancer Hospital Experience

TL;DR

This study examines breast cancer outcomes during and after pregnancy at a hospital in Pakistan, finding that tumor recurrence is a major factor in poor survival rates.

Contribution

The paper provides insights into PABC outcomes in a low- and middle-income country setting, highlighting the impact of tumor recurrence on mortality.

Findings

Patients with early-stage PABC had an 82% three-year event-free survival rate.

Recurrence was the strongest predictor of mortality, with a 61.1% mortality rate in recurrent cases.

Non-recurrent PABC patients had a median survival of 62.5 months compared to 44.5 months in recurrent cases.

Abstract

Introduction

Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy or within one year postpartum. There is limited data on this, especially from low- and middle-income countries (LMICs), warranting further exploration. Factors such as restricted healthcare access and resources and cultural beliefs that influence awareness are the main barriers to LMICs.

Study design

This retrospective study included 44 adult patients aged 30 years and older. Only patients who received treatment and subsequent follow-up at our institution were included. The study was conducted at the Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. The data were extracted from the hospital records over a 10-year period from 2010 to 2020.

Patients and methods

A total of 44 patients were included, with a median age of 33 years. Eleven (25%) had triple-negative disease, 23 (52.3%) were hormone receptor (HR) positive and HER2 negative, three (6.8%) were HER2 positive and HR negative, and seven (15.9%) had triple-positive disease. A total of 81.8% presented with early-stage breast cancer (EBC) and received either neoadjuvant (n = 32) or adjuvant (n = 11) chemotherapy and surgery. Trastuzumab, tamoxifen, and radiotherapy were administered post-delivery. Factors associated with mortality were analyzed using chi-square statistics and the Mann-Whitney U test. Survival analysis for overall survival and disease-free survival was performed using Kaplan-Meier survival analysis.

Results

At a median follow-up of 27 months, the estimated three-year event-free survival for EBC and locally advanced breast cancer was 82% (95% CI: 65.2-100) and 56% (95% CI: 42-75.6%), respectively, and 24% (95% CI: 10.1%-58.5%) for metastatic breast cancer. Of the 44 patients, 14 had terminations, whereas 29 had full-term deliveries (FTDs). Patients with PABC showed a 92.6-month mean survival, but tumor recurrence significantly impacted outcomes, with a 61.1% mortality rate and a reduced median survival of 44.5 months compared to 62.5 months in non-recurrent cases. Recurrence emerged as the strongest predictor of mortality.

Conclusion

Future research should improve PABC patient outcomes by improving diagnostic methods, refining treatment protocols, investigating long-term effects, developing early detection tools, tailoring treatment plans, and evaluating treatment impact on fetal health. It is essential to establish guidelines for mother and child safety and address emotional and psychological needs.

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