CA: A Cancer Journal for Clinicians, Vol 15, 182-183, Copyright
© 1965 by American Cancer Society
Breast Cancer and Pregnancy
Arthur I. Holleb M.D.1
1 Associate Medical Director and Assistant Attending Surgeon, Memorial Hospital for Cancer and Allied Diseases, New York City.
On the basis of available information it may be noted that:
1. Breast cancer occurring during gestation or in the immediate postpartum period yields a poor prognosis when the axillary lymph nodes are involved, but one cannot state dogmatically that it is the pregnancy per se which accounts for unfavorable results of treatment, since the stage of disease is usually already advanced at the time of radical mastectomy.
2. There is no proof that interruption of pregnancy improves the 5-year clinical cure rate or increases the survival time.
3. Pregnancy subsequent to radical mastectomy does not alter the prognosis whether or not a therapeutic abortion is done. However, this group of patients is highly selected not only by the aggressiveness of the disease but also by the recommendation usually made to these patients to avoid pregnancy after radical mastectomy, especially in cases in which the axillary lymph nodes are involved.
4. Interruption of pregnancy in the early trimesters is indicated for the patient with inoperable breast cancer. Interruption should be combined with oophorectomy as a therapeutic measure. There is not sufficient justification to warrant therapeutic abortion for the patient who has breast cancer which is classified clinically as curable by radical mastectomy. Likewise, no proof exists of the value of therapeutic abortion for the patient who has had a radical mastectomy and demonstrates no evidence of locally recurrent disease or distant metastases.
5. The relative infrequency of concomitant breast cancer and pregnancy precludes the compilation of a large enough series for adequate statistical evaluation.
6. Until therapeutic standards are firmly established, the wisest policy is to treat cases individually, based on anticipated prognosis, possible risks involved, religious convictions, attitudes of husband and wife toward parenthood, current size of family, sociologic factors, and other aspects less easily described.
