Breast Cancer and Pregnancy: Challenges for Maternal and Newborn Successful Outcomes

Cancer during pregnancy, particularly breast cancer, poses intricate challenges requiring a multidisciplinary approach. This chapter delves into the complexities of pregnancy-related breast cancer (PrBC), emphasizing its rising incidence amid delayed pregnancies and advancements in prenatal testing. Key aspects highlighted include diagnostic ambiguities, staging intricacies, and the imperative balance between effective oncological care and fetal safety. We aim to elucidate the landscape of PrBC, emphasizing its prevalence among younger women and the evolving terminology distinguishing cancer diagnosed during pregnancy (PrBC) from postpartum occurrences. While risk factors align with age-adjusted breast cancer, genetic predispositions, notably BRCA1 mutations, emphasize the need for genetic counseling. Diagnostic challenges stem from physiological changes hindering symptom detection and necessitate an initiative-taking approach for investigating suspicious masses. Balancing diagnostic accuracy with fetal safety involves careful consideration of imaging modalities, favoring ultrasound while minimizing ionizing radiation-based techniques. Treatment complexities arise from the individualized approach necessitated by gestational age, cancer stage, and patient preferences regarding pregnancy continuation. Chemotherapy during the second and third trimesters, excluding certain agents, stands as a viable option, while surgery, if clinically indicated, is considered safe, excluding the first trimester if radiotherapy is contraindicated. Radiotherapy remains generally contraindicated due to fetal risks, and endocrine therapy considerations are cautious. This chapter also outlines a comprehensive protocol across prenatal care, additional workup, childbirth, breastfeeding, and surgery during pregnancy. It underscores the importance of a specialized multidisciplinary team to navigate the intricate decision-making required to optimize maternal oncological care while safeguarding fetal well-being at every stage. Our main objective was to provide a comprehensive guide for managing PrBC, navigating diagnostic, staging, and treatment challenges, underscoring the imperative balance between effective cancer management and fetal safety within the realm of cancer during pregnancy.