Diagnostic-therapeutic approach to breast cancer associated with pregnancy: update 2010

Breast cancer associated with pregnancy (defined as the presence of breast cancer during gestation extending until a year after the resolution of the pregnancy) represents controversial ethical dilemmas and contradictions in its diagnostic and therapeutic approach. Diagnostic methods and the role of pregnancy interruption are controversial subjects for prognosis. Our objective was to discuss the recommendations for diagnosis and treatment for these patients using evidence-based medicine and to discuss controversial subjects such as the role of lymphatic mapping, pre-therapeutic studies and appropriate treatment schedule. Fortunately, the prevalence of breast cancer during pregnancy is low. It is generally considered, however, that this prevalence will slowly increase because of two factors: 1) breast cancer is showing an increasing prevalence and 2) in Western societies the age when a woman becomes pregnant for the first time has increased, also associated with the age when breast cancer shows a higher frequency. As in the general population, breast cancer is the most frequent neoplasm in pregnant women. When diagnostic questions arise that sometimes do not have an answer based on scientific evidence, therapeutic decisions are often made based on knowledge acquired in breast cancer treatment of nonpregnant women. To routinely apply new diagnostic/therapeutic technologies with the safety of protecting the pregnancy is a difficult decision to make. In the end, the main objective of treatment of a pregnant woman with breast cancer is to maintain the standard of the desired oncological results while preserving the integrity of the fetus.