информационное письмо
Американский Научный Журнал BREAST CANCER AND PREGNANCY — HOW TO SOLVE IT
t we have tried to explain and answer in our work.
Abstract
Every year, more than 1 million new cases of breast cancer are detected in the world, predicting an increase
in the number of cases by 2010 to 1.5 million. In Russia, breast cancer (BC) takes 1st place in the frequency of all
malignant neoplasms in women: 19.8 % Mortality from breast cancer continues to occupy the first place in the
structure of female mortality from cancer and is 17.1% while continuing to grow steadily [8,10]. Despite the last
5 years, indicating the stabilization of the incidence of breast cancer in the age group from 20 to 49 years (51:
100.000), since 2000, there is a global trend towards an increase in the incidence of breast cancer in the group of
young women under the age of 35, cancer is “younger” [2, 6]. At the same time, there is a tendency to increase the
birth rate among women over 30 years old. Consequently, every year there will be an increase in the number of
women in whom breast cancer will be diagnosed during pregnancy or lactation. Today, the incidence of breast
cancer is 1 case per 3,000 pregnant women. Mostly women aged between 32 and 38 are affected [4,9]. Скачать в формате PDF
16 American Scientific Journal № ( 25 ) / 20 19
МЕДИЦИНА И СТОМАТОЛОГИЯ
BREAST CANCER AND PREGNANCY - HOW TO SOLVE IT
Dilfuzahon Mamarasulova
Dr of science, Head of chair Oncology and Medical Radiology
Andijan state medical institute
Andijan
Khusniddin Muratov
Medical oncology at the Andijan branch center of oncology and radiology
Yuri Azizov
Dr of science, head of chair microbiology
Devrat Muradov
Student at the Andi jan state medical instate
Gulmirakhon Iminjonova
Student 4 th courseat the medical instate
Resume
The topic of “breast cancer and pregnancy” is a combination of a number of unsolved problems and questions
that we have tried to explain and answer in our wo rk.
Abstract
Every year, more than 1 million new cases of breast cancer are detected in the world, predicting an increase
in the number of cases by 2010 to 1.5 million. In Russia, breast cancer (BC) takes 1st place in the frequency of all
malignant neoplasms in women: 19.8 % Mortality from breast cancer continues to occupy the first place in the
structure of female mortality from cancer and is 17.1% while continuing to grow steadily [8,10]. Despite the last
5 years, indicating the stabilization of th e incidence of breast cancer in the age group from 20 to 49 years (51:
100.000), since 2000, there is a global trend towards an increase in the incidence of breast cancer in the group of
young women under the age of 35, cancer is “younger” [2, 6]. At the s ame time, there is a tendency to increase the
birth rate among women over 30 years old. Consequently, every year there will be an increase in the number of
women in whom breast cancer will be diagnosed during pregnancy or lactation. Today, the incidence of breast
cancer is 1 case per 3,000 pregnant women. Mostly women aged between 32 and 38 are affected [4,9].
Key words : Breast cancer , pregnancy and frequency of occurrence
Difficulties in diagnosing the objective (increas-
ing th e volume and changing the consistency of the
mammary glands, the incidence of complications dur-
ing lactation) and the subjective nature (psychological
"unavailability" for the diagnosis of a malignant tumor
in the patient and the doctor) lead to late detec tion of
the tumor in pregnant women, treatment begins at more
common stages disease than in the general population
of patients.
A set of diagnostic measures for suspected breast
cancer during pregnancy is limited. Due to the danger
of radiation exposure to the fetus, radionuclide methods
are excluded. And the hyperplasia of the breast tissue,
its hypervascularization, the changed consistency re-
duces the information content of the X -ray method of
mammography by up to 25%. Thus, the diagnosis, the
determina tion of the stage and the final verification of
the diagnosis is based on ultrasound, the study of cyto-
logical and biopsy material [1, 6, 8]. Hyperplastic
changes in the breast tissue during pregnancy and lac-
tation can potentially lead to false positive or false -neg-
ative cytological diagnosis of breast cancer [5]. Tradi-
tionally used biochemical and immunohistochemical
methods for examining the receptor status of a tumor in
this group of patients often give a negative This results
in a search for more “subtl e” methods for assessing the
true state of the receptor status. At the moment, there
are no clear recommendations in terms of timely and
reliable diagnosis of tumor masses during pregnancy.
Therapeutic tactics are also not defined and de-
pend on a number o f factors: on the patient's desire to
save the pregnancy, on the timing of gestation, on the
stage and prevalence of the disease. Often, a different
combination of these options in one patient makes us
consider each clinical case individually. Nevertheless ,
the determination of the sequence of diagnostic and
therapeutic measures, taking into account all the ac-
companying factors, is extremely relevant. In the past,
in the few clinical observations of this group of pa-
tients, some authors identified them as “i noperable”, re-
gardless of the prevalence of the disease at the time of
diagnosis. However, in recent years, the point of view
of the expediency of radical treatment has become more
and more reasonable. There is no consensus on discuss-
ing the possibility of performing organ -sparing opera-
tions in such cases, there is no unity of views on the
feasibility of and modes of radiation and drug therapy
in terms of combined and complex treatment, the indi-
cations for hormone therapy and the latter are unclear.
The pro gnostic factors that determine the course of the
disease in patients of this group remain inadequate. A
number of researchers argue that even within the same
stages of breast cancer, the prognosis makes pregnancy
[3], - others believe that the worst progno sis is only due
to the greater prevalence of the disease at the time of
diagnosis [7]. The study of such factors as: tumor size,
number of affected regional lymph nodes, tumor inva-
sion into surrounding tissues, expression of the Her -2 /
neu gene, receptor status, in relation to the prognosis of
the disease, will allow defining new approaches to
treatment individualization. Thus, summarizing the
above data, it can be stated that at present there is no
American Scientific Journal № (25 ) / 201 9 17
single concept in the implementation of diagnostic and
therapeutic programs in the group of breast cancer pa-
tients associated with pregnancy [3].
Cases of diagnosis of breast cancer on the back-
ground of pregnancy in patients participating in an in
vitro fertilization program require close examination.
Such obse rvations suggest the absence of “oncological
vigilance” in obstetrician -gynecologists, who observe
(sometimes for years) women and conduct the next cy-
cle of extracorporeal fertilization in case of already ex-
isting cancer [2].
Pregnancy completed childbirt h is considered by
many authors as an important preventive measure in re-
lation to the development of breast tumors. It is of sci-
entific interest to study the relationship of the term of a
previous pregnancy in a patient and the corresponding
effect on the prognosis of the disease. A number of re-
searchers have noted an increase in the relative risk of
developing breast cancer and a deterioration in the
prognosis of the disease with a decrease in the time in-
terval to a previous pregnancy and childbirth [5].
The question of the possibility of pregnancy after
treatment for breast cancer has not yet been resolved.
Currently, in the literature, there is almost no infor-
mation on the increased risk of recurrence and progres-
sion of breast cancer associated with a po ssible subse-
quent pregnancy. There is no clear definition of the
minimum “safe” interval between the end of breast can-
cer treatment and subsequent pregnancy [8,9].
According to preliminary data obtained on the ba-
sis of an analysis of pregnancy after suffe ring cancer,
during the initial stages of the disease and the absence
of adverse prognostic factors, the patient may have a
pregnancy as early as 2 years after treatment. However,
this issue requires further study.
Various combinations of anticancer treat ment of
breast cancer, including radiation therapy, chemother-
apy, directly affect the patient's ovarian function, caus-
ing a decrease in oocyte reserves and ovarian reserve.
On the one hand, the need to control ovarian function
is determined by the general tasks of treating hormone -
dependent tumors. On the other hand, the increasing in-
terest of cancer patients to the possible preservation and
restoration of reproductive function with subsequent
pregnancy is determined.
A number of international conferences under the
general title “Cancer and pregnancy”, held in Europe
and in America, are devoted to studying the problem of
reproduction in cancer patients. In 2006, officially an-
nounced the opening of two specialized cente rs for the
study of reproductive capacity in cancer patients (Va-
lencia -Spain, Lyon -France). In Russia, however, in our
opinion, insufficient attention is paid to the preserva-
tion of reproduction. There are no recommendations on
chemotherapy planning, takin g into account the possi-
ble loss of fertility in patients with breast cancer, and
there are no ways to restore reproduction using modern
methods of assisted reproductive technology. The pos-
sibility of preserving reproductive function, the use of
new reprod uctive technologies that allow one to have a
pregnancy after undergoing treatment for cancer, and
conducting prospective studies of preimplantation ge-
netic diagnosis in cancer patients are extremely rele-
vant today [1,2,5,8,9].
References
1. Полевая Е.Б., Пор тной С.М. Рак молочной
железы и беременность // Материалы V Ежегодной
российской онкологической конференции. —
Москва, 27 —29 ноября 2011 г. 36 -38 с.
2. Amant F, Vandenbroucke T, Verheecke M,
Fumagalli M, Halaska MJ, Boere I, Han S, Gziri MM,
Peccatori F, Rob L et al (2015) Pediatric outcome af-
ter maternal cancer diagnosed during pregnancy.
N Engl J Med 373:1824 –
1834 CrossRef PubMed Google Scholar
3. Bamdad S, Bamdad M, Khanlari M, Danesh-
bod Y, Khademi B (2017) Terat ogenic effects of In-
travitreal injection of bevacizumab in a pregnant rat
model. Iran J Pharm Res 16:670 –
676 PubMed PubMedCentral Google Scholar
4. Cardonick E, Bhat A, Gilmandyar D, Somer
R (2012) Mat ernal and fetal outcomes of taxane chem-
otherapy in breast and ovarian cancer during preg-
nancy: case series and review of the literature. Ann
Oncol 23:3016 –3023 CrossRef PubMed Google
Scholar
5. Cardonick E, Dougherty R, Grana G, Gil-
mandyar D, Ghaffar S, Usmani A (2010) Breast can-
cer during pregnancy: maternal Cardonick E, Gilman-
dyar D, Somer RA (2012) Maternal and fetal out-
comes. Cancer J 16:76 –82 CrossRef PubMed Google
Scholar and neonatal outcomes of dose -dense chemo-
therapy for breast cancer in pregnancy. Obstet Gyne-
col 120:1267 –1272 CrossRef PubMed Google Scholar
6. Etwel F, Faught LH, Rieder MJ, Koren G
(2017) The risk of adverse pregn ancy outcome after
first trimester exposure to H1 antihistamines: a sys-
tematic review and meta -analysis. Drug Saf 40:121 –
132 CrossRef PubMed Google Scholar
7. Han SN, Amant F, Cardonick EH, Loi bl S,
Peccatori FA, Gheysens O, Sangalli CA, Nekljudova
V, Steffensen KD, Mhallem Gziri M et al (2017d) Ax-
illary staging for breast cancer during pregnancy: fea-
sibility and safety of sentinel lymph node biopsy.
Breast Cancer Res Treat 2017.
https://doi.org/10.1007/s10549 -017 -4611 -
zPubMedCentral CrossRef PubMed Google Scholar
8. Loibl S, Han SN, von Minckwitz G, Bonten-
bal M, Ring A, Giermek J, Fehm T, Van Calsteren K,
Linn SC, Schlehe B et al (2012) Treatment of breast
cancer during pregnancy: an observational study. Lan-
cet Oncol 13:887 –896 CrossRef PubMed Google
Scholar
9. Murphy CG, Mallam D, Stein S, Patil S,
Howard J, Sklarin N, Hudis CA, Gemignani ML,
Seidman AD (2012) Current or recent pregnancy is
associated with adverse pathologic features but not
impaired survival in early breast cancer. Cancer
118:3254 –3259 CrossRef PubMed Google Scholar
МЕДИЦИНА И СТОМАТОЛОГИЯ
BREAST CANCER AND PREGNANCY - HOW TO SOLVE IT
Dilfuzahon Mamarasulova
Dr of science, Head of chair Oncology and Medical Radiology
Andijan state medical institute
Andijan
Khusniddin Muratov
Medical oncology at the Andijan branch center of oncology and radiology
Yuri Azizov
Dr of science, head of chair microbiology
Devrat Muradov
Student at the Andi jan state medical instate
Gulmirakhon Iminjonova
Student 4 th courseat the medical instate
Resume
The topic of “breast cancer and pregnancy” is a combination of a number of unsolved problems and questions
that we have tried to explain and answer in our wo rk.
Abstract
Every year, more than 1 million new cases of breast cancer are detected in the world, predicting an increase
in the number of cases by 2010 to 1.5 million. In Russia, breast cancer (BC) takes 1st place in the frequency of all
malignant neoplasms in women: 19.8 % Mortality from breast cancer continues to occupy the first place in the
structure of female mortality from cancer and is 17.1% while continuing to grow steadily [8,10]. Despite the last
5 years, indicating the stabilization of th e incidence of breast cancer in the age group from 20 to 49 years (51:
100.000), since 2000, there is a global trend towards an increase in the incidence of breast cancer in the group of
young women under the age of 35, cancer is “younger” [2, 6]. At the s ame time, there is a tendency to increase the
birth rate among women over 30 years old. Consequently, every year there will be an increase in the number of
women in whom breast cancer will be diagnosed during pregnancy or lactation. Today, the incidence of breast
cancer is 1 case per 3,000 pregnant women. Mostly women aged between 32 and 38 are affected [4,9].
Key words : Breast cancer , pregnancy and frequency of occurrence
Difficulties in diagnosing the objective (increas-
ing th e volume and changing the consistency of the
mammary glands, the incidence of complications dur-
ing lactation) and the subjective nature (psychological
"unavailability" for the diagnosis of a malignant tumor
in the patient and the doctor) lead to late detec tion of
the tumor in pregnant women, treatment begins at more
common stages disease than in the general population
of patients.
A set of diagnostic measures for suspected breast
cancer during pregnancy is limited. Due to the danger
of radiation exposure to the fetus, radionuclide methods
are excluded. And the hyperplasia of the breast tissue,
its hypervascularization, the changed consistency re-
duces the information content of the X -ray method of
mammography by up to 25%. Thus, the diagnosis, the
determina tion of the stage and the final verification of
the diagnosis is based on ultrasound, the study of cyto-
logical and biopsy material [1, 6, 8]. Hyperplastic
changes in the breast tissue during pregnancy and lac-
tation can potentially lead to false positive or false -neg-
ative cytological diagnosis of breast cancer [5]. Tradi-
tionally used biochemical and immunohistochemical
methods for examining the receptor status of a tumor in
this group of patients often give a negative This results
in a search for more “subtl e” methods for assessing the
true state of the receptor status. At the moment, there
are no clear recommendations in terms of timely and
reliable diagnosis of tumor masses during pregnancy.
Therapeutic tactics are also not defined and de-
pend on a number o f factors: on the patient's desire to
save the pregnancy, on the timing of gestation, on the
stage and prevalence of the disease. Often, a different
combination of these options in one patient makes us
consider each clinical case individually. Nevertheless ,
the determination of the sequence of diagnostic and
therapeutic measures, taking into account all the ac-
companying factors, is extremely relevant. In the past,
in the few clinical observations of this group of pa-
tients, some authors identified them as “i noperable”, re-
gardless of the prevalence of the disease at the time of
diagnosis. However, in recent years, the point of view
of the expediency of radical treatment has become more
and more reasonable. There is no consensus on discuss-
ing the possibility of performing organ -sparing opera-
tions in such cases, there is no unity of views on the
feasibility of and modes of radiation and drug therapy
in terms of combined and complex treatment, the indi-
cations for hormone therapy and the latter are unclear.
The pro gnostic factors that determine the course of the
disease in patients of this group remain inadequate. A
number of researchers argue that even within the same
stages of breast cancer, the prognosis makes pregnancy
[3], - others believe that the worst progno sis is only due
to the greater prevalence of the disease at the time of
diagnosis [7]. The study of such factors as: tumor size,
number of affected regional lymph nodes, tumor inva-
sion into surrounding tissues, expression of the Her -2 /
neu gene, receptor status, in relation to the prognosis of
the disease, will allow defining new approaches to
treatment individualization. Thus, summarizing the
above data, it can be stated that at present there is no
American Scientific Journal № (25 ) / 201 9 17
single concept in the implementation of diagnostic and
therapeutic programs in the group of breast cancer pa-
tients associated with pregnancy [3].
Cases of diagnosis of breast cancer on the back-
ground of pregnancy in patients participating in an in
vitro fertilization program require close examination.
Such obse rvations suggest the absence of “oncological
vigilance” in obstetrician -gynecologists, who observe
(sometimes for years) women and conduct the next cy-
cle of extracorporeal fertilization in case of already ex-
isting cancer [2].
Pregnancy completed childbirt h is considered by
many authors as an important preventive measure in re-
lation to the development of breast tumors. It is of sci-
entific interest to study the relationship of the term of a
previous pregnancy in a patient and the corresponding
effect on the prognosis of the disease. A number of re-
searchers have noted an increase in the relative risk of
developing breast cancer and a deterioration in the
prognosis of the disease with a decrease in the time in-
terval to a previous pregnancy and childbirth [5].
The question of the possibility of pregnancy after
treatment for breast cancer has not yet been resolved.
Currently, in the literature, there is almost no infor-
mation on the increased risk of recurrence and progres-
sion of breast cancer associated with a po ssible subse-
quent pregnancy. There is no clear definition of the
minimum “safe” interval between the end of breast can-
cer treatment and subsequent pregnancy [8,9].
According to preliminary data obtained on the ba-
sis of an analysis of pregnancy after suffe ring cancer,
during the initial stages of the disease and the absence
of adverse prognostic factors, the patient may have a
pregnancy as early as 2 years after treatment. However,
this issue requires further study.
Various combinations of anticancer treat ment of
breast cancer, including radiation therapy, chemother-
apy, directly affect the patient's ovarian function, caus-
ing a decrease in oocyte reserves and ovarian reserve.
On the one hand, the need to control ovarian function
is determined by the general tasks of treating hormone -
dependent tumors. On the other hand, the increasing in-
terest of cancer patients to the possible preservation and
restoration of reproductive function with subsequent
pregnancy is determined.
A number of international conferences under the
general title “Cancer and pregnancy”, held in Europe
and in America, are devoted to studying the problem of
reproduction in cancer patients. In 2006, officially an-
nounced the opening of two specialized cente rs for the
study of reproductive capacity in cancer patients (Va-
lencia -Spain, Lyon -France). In Russia, however, in our
opinion, insufficient attention is paid to the preserva-
tion of reproduction. There are no recommendations on
chemotherapy planning, takin g into account the possi-
ble loss of fertility in patients with breast cancer, and
there are no ways to restore reproduction using modern
methods of assisted reproductive technology. The pos-
sibility of preserving reproductive function, the use of
new reprod uctive technologies that allow one to have a
pregnancy after undergoing treatment for cancer, and
conducting prospective studies of preimplantation ge-
netic diagnosis in cancer patients are extremely rele-
vant today [1,2,5,8,9].
References
1. Полевая Е.Б., Пор тной С.М. Рак молочной
железы и беременность // Материалы V Ежегодной
российской онкологической конференции. —
Москва, 27 —29 ноября 2011 г. 36 -38 с.
2. Amant F, Vandenbroucke T, Verheecke M,
Fumagalli M, Halaska MJ, Boere I, Han S, Gziri MM,
Peccatori F, Rob L et al (2015) Pediatric outcome af-
ter maternal cancer diagnosed during pregnancy.
N Engl J Med 373:1824 –
1834 CrossRef PubMed Google Scholar
3. Bamdad S, Bamdad M, Khanlari M, Danesh-
bod Y, Khademi B (2017) Terat ogenic effects of In-
travitreal injection of bevacizumab in a pregnant rat
model. Iran J Pharm Res 16:670 –
676 PubMed PubMedCentral Google Scholar
4. Cardonick E, Bhat A, Gilmandyar D, Somer
R (2012) Mat ernal and fetal outcomes of taxane chem-
otherapy in breast and ovarian cancer during preg-
nancy: case series and review of the literature. Ann
Oncol 23:3016 –3023 CrossRef PubMed Google
Scholar
5. Cardonick E, Dougherty R, Grana G, Gil-
mandyar D, Ghaffar S, Usmani A (2010) Breast can-
cer during pregnancy: maternal Cardonick E, Gilman-
dyar D, Somer RA (2012) Maternal and fetal out-
comes. Cancer J 16:76 –82 CrossRef PubMed Google
Scholar and neonatal outcomes of dose -dense chemo-
therapy for breast cancer in pregnancy. Obstet Gyne-
col 120:1267 –1272 CrossRef PubMed Google Scholar
6. Etwel F, Faught LH, Rieder MJ, Koren G
(2017) The risk of adverse pregn ancy outcome after
first trimester exposure to H1 antihistamines: a sys-
tematic review and meta -analysis. Drug Saf 40:121 –
132 CrossRef PubMed Google Scholar
7. Han SN, Amant F, Cardonick EH, Loi bl S,
Peccatori FA, Gheysens O, Sangalli CA, Nekljudova
V, Steffensen KD, Mhallem Gziri M et al (2017d) Ax-
illary staging for breast cancer during pregnancy: fea-
sibility and safety of sentinel lymph node biopsy.
Breast Cancer Res Treat 2017.
https://doi.org/10.1007/s10549 -017 -4611 -
zPubMedCentral CrossRef PubMed Google Scholar
8. Loibl S, Han SN, von Minckwitz G, Bonten-
bal M, Ring A, Giermek J, Fehm T, Van Calsteren K,
Linn SC, Schlehe B et al (2012) Treatment of breast
cancer during pregnancy: an observational study. Lan-
cet Oncol 13:887 –896 CrossRef PubMed Google
Scholar
9. Murphy CG, Mallam D, Stein S, Patil S,
Howard J, Sklarin N, Hudis CA, Gemignani ML,
Seidman AD (2012) Current or recent pregnancy is
associated with adverse pathologic features but not
impaired survival in early breast cancer. Cancer
118:3254 –3259 CrossRef PubMed Google Scholar