In Mexico, there are no official statistics but it is estimated that 1,600 breast cancers are diagnosed each year during pregnancy.
Dr. Alvaro Cabrera to tell us about his diagnosis and more importantly the care for mother and child during breast cancer during pregnancy.
BREAST CANCER DURING PREGNANCY
Maternal death from indirect obstetric causes has emerged as the leading cause of maternal death for more than 10 years, even above haemorrhage and hypertensive disease.
every year a Mexico It is estimated that they occur between 2 thousand and 3 thousand cases of pregnant women with some kind of cancer, according to information from the International Network on Cancer, Infertility and Pregnancy (INCIP). The main reason for maternal death (RMM) in the country (28%) it is due to “indirect non-infectious causes”, where they are located cases of pregnant women and cancer.
THE RELATIONSHIP BETWEEN CANCER AND PREGNANCY
The association between cancer and pregnancy it’s very rare. There are patients diagnosed with Cancer during pregnancy or in the first year after pregnancy (which includes the breastfeeding period).
TYPES OF CANCER DURING PREGNANCY
The cancers most frequently associated with pregnancy are: breast cancer, cervical cancer, lymphoma and melanoma.
The incidence of breast cancer and pregnancy is 15 to 35 per 100,000 live births and could increase due to the current tendency for women to postpone pregnancy, whether for cultural, educational or professional reasons.
WHO ARE THE POPULATIONS AT RISK?
The median age for diagnosis is 39 years old and 6.6% are diagnosed during pregnancy. Establishing the diagnosis of cancer during pregnancy has large and important implications, since given the infrequency with which they coincide and the physiological alterations typical of pregnancy, it often leads to multiple challenges in cancer diagnosis, treatment, pregnancy surveillance, and ideally long-term follow-up.
In 2020, 1,629,211 births were reported, according to INEGI, which would suggest 1,630 cases of cancer and pregnancy across the country, but the official document is missing. In Mexico it is likely that every oncologist during his career faced 1 to 2 cases of pregnancy and cancer, which narrows down the best options for diagnostic approach and treatment.
Yes, OK pregnancy does not alter the biology or behavior of the cancer, secondary complications a Cancer treatment can influence the evolution of pregnancy.
WHY DOES BREAST CANCER DEVELOP DURING PREGNANCY?
Hormonal changes during pregnancy cause breast changes, can be increase in size, become more tender and/or have masses (lumps). This can make it difficult to notice a breast mass caused by cancer before it is significantly large.
This raises questions about the treatment of the patient in her particular physiological condition and the safety of the fetus. In that context, surgery and chemotherapy during pregnancy are not contraindicated, but some considerations must be made on some aspects such as:
- The appropriate times for a surgical process
- The fetal age required for exposure to some anticancer drugs
- Targeted therapies are constantly emerging.
WARNING SIGNS DURING PREGNANCY
If you find one mass or notice any changes in your breasts, you should not ignore it. Los mammography can find most breast cancers that start when a woman is pregnant, e it is generally considered safe perform a mammogram during pregnancy.
Around half of all breast cancer cases are in women with no identifiable risk factors, except for gender (female) and age (over 40). Certain factors increase the risk of suffering from this disease:
- aging
- obesity
- harmful use of alcohol
- family history of breast cancer
- history of radiation exposure
- reproductive history (such as age at the start of menstrual periods and age at first pregnancy)
- tobacco consumption
- postmenopausal hormone therapy
TREATMENT AFTER THE DIAGNOSIS
The treatment and surveillance of these patients should be performed with a multidisciplinary approach in centers specialized in oncology and obstetrics. although the chemotherapy in pregnancy it has been used since 1996, its standardization began in 2012 with precise indications in which the type of tumor and the gestational age must be identified.
Los drugs Used kill rapidly proliferating cells For this reason, in the face of a growing fetus, they have since been considered category D by the FDA (Food and Drug Administration). all drugs have the potential to cross the placenta. The amniotic fluid act like a “third space” which can delay the elimination of agents and increase their toxicity, which means it can present in intrauterine growth restriction, prematurity or low birth weight.
According to breastfeeding and family planning, Many cytotoxic drugs are excreted in breast milk so, as a general rule, Breastfeeding is contraindicated during chemotherapy or endocrine therapy.
According to the Directorate General of Epidemiology, from 2010 to 2016, the majority of pregnant patients who died of cancer (65.5%) were already in puerperiumwhich allows us to see that termination of pregnancy is frequent to proceed with initiation of cancer treatment.
Source: Álvaro Cabrera, hematologist and surgeon, specialist in the treatment and surveillance of cancer in women.
Spider’s web: www.unhematologoparami.com // T. 5536743947
