Breast cancer and pregnancy: Challenges of chemotherapy

Background: Breast cancer is the second most frequently occurring malignancy during pregnancy. As evidence-based data on diagnostics and treatment is lacking, current recommendations mostly derive from nonrandomized experiences. We reviewed the current literature with focus on chemotherapy during pregnancy and lactation. Results: The diagnosis of pregnancy associated breast cancer implies the challenge to balance between a life-saving therapy for the mother's breast cancer and a potentially life-threatening therapy for the fetus. With few limitations, surgery and chemotherapy can be performed during pregnancy, preferably in the second and third trimester, whereas radiotherapy and endocrine or antibody treatment should be postponed until after delivery. Conclusion: Breast cancer during pregnancy and lactation remains a therapeutic and ethical multidisciplinary challenge. Close cooperation between all disciplines is inevitable to find an optimal treatment strategy for the mother and her unborn child. (C) 2008 Elsevier Ireland Ltd. All rights reserved.