Inflammatory breast cancer in pregnancy and lactation

Samantha Linhares, Tamrah Alrammah, Hattan A. Alghamdi, Mecker G. Möller

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Inflammatory breast cancer (IBC) represents only 1% to 5% of all breast malignancies and is an extremely aggressive subtype. At time of diagnosis, up to 85% of patients will present with regional nodal metastases and up to 30 % will have metastasis to distant organs. There is limited medical literature describing treatment guidelines for IBC during gestation. The best diagnostic tools are core needle and full-thickness skin punch biopsies to assess presence of dermal lymphatic invasion. Breast Ultrasound is preferred to mammogram, but mammography could still be done with proper fetal shielding. Ultrasound and Magnetic resonance imaging are used for staging. Pregnant patients should be managed with special attention to the health of the fetus by a multidisciplinary team. Treatment based on current guidelines consist of a sequence of systemic chemotherapy followed by mastectomy with axillary dissection (modified radical mastectomy), and even if good clinical nodal response to neoadjuvant therapy is obtained, sentinel node biopsy is not recommended. Radiation therapy is to be given once the baby has been delivered. Chemotherapy is not recommended in the first trimester, and anti-estrogen hormonal therapy, as well as targeted Her2-neu therapies are contraindicated during the length of the pregnancy. There is no evidence that early termination improves the outcome. However, given the poor prognosis of IBC, patients should be fully counseled on the risks and benefits of continuing or terminating an early pregnancy.

Original languageEnglish (US)
Title of host publicationAdvances in Experimental Medicine and Biology
PublisherSpringer
Pages143-151
Number of pages9
DOIs
StatePublished - 2020
Externally publishedYes

Publication series

NameAdvances in Experimental Medicine and Biology
Volume1252
ISSN (Print)0065-2598
ISSN (Electronic)2214-8019

Keywords

  • Axillary dissection
  • Inflammatory breast cancer
  • Mastectomy
  • Neoadjuvant chemotherapy
  • Pregnancy

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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