Breast cancer during pregnancy: results of maternal and perinatal outcomes in a single institution and systematic review of the literature.

To compare the maternal and the perinatal variables of the patients with pregnancy associated breast cancer (PABC) and the pregnant patients without breast cancer (PNABC), we retrospectively included 13 PABC cases and 66.265 PNABC patients. The PABC patients presented a lower mean gestational age at their delivery and had higher induction of labour and prematurity rates. A diagnosis was performed before stage III in 77% of the cases. The overall survival was 90%; moreover, we collected 16 manuscripts when gathering data from 1581 patients with PABC. The mean follow-up time was 70 ± 8 months. The mean maternal age at diagnosis was 34 years old. Most of the patients were at their second trimester of pregnancy. The gestational age at delivery was 35 weeks. A mastectomy was the most frequently used surgical approach. PABC should be managed by a multidisciplinary team, ensuring there is a rigorous oncological treatment, with foetal well-being. IMPACT STATEMENT What is already known on this subject? The malignant breast tumours diagnosed during pregnancy, or 1 year after a delivery are increasing, there is evidence supporting the treatment during a pregnancy with maternal and foetal safety. A PABC should be managed by a multidisciplinary team in a referral centre, ensuring that there is a rigorous oncological treatment with foetal well-being. What do the results of this study add? Our results show that the PABC patients in our centre had a mean maternal age older than the PNABC women, as well as a higher percentage of the induction of labour and prematurity. 48 Cancer was usually diagnosed in early stages, and the most common type was ductal infiltrating, with positive hormonal receptors. For those patients continuing their pregnancies, a mastectomy plus a lymphadenectomy was the most frequent chemotherapy, and was usually administered in the third trimester of pregnancy. What are the implications of these findings for future clinical practice and/or further research? Moreover, the number of publications concerning PABC has grown, series are still scarce. We understand the limitations of the low number of the cases on our population, but this study is the first which compare the PABC with the PNABC patients, allowing to describe and compare the obstetrical and perinatal variables. Finally, we consider it is of a paramount importance to create an international database to register in a prospective way all of the cases of PABC to increase our knowledge in this field.

Maternal and perinatal outcomes in pregnancy-associated melanoma. Report of two cases and a systematic literature review.

OBJETIVES: Melanoma is one of the most frequent malignancies during gestation. However, oncological and perinatal management is still challenging. Our first objective is to describe the cases of pregnancy-associated melanoma (PAM) diagnosed in our centre between January-2004 and May-2015. Secondly, to perform a systematic review of the published articles analysing the maternal-perinatal outcomes of patients diagnosed with PAM. DESIGN, POPULATION AND METHODS: Obstetrical, oncological and perinatal variables were recorded in the case series. For the systematic review we include all published articles assessing the obstetric and neonatal outcomes in PAM cases in Pubmed, Web of Knowledge and Cochrane Library. The search was restricted to articles published in English, between January-2004 and May-2015. Study characteristics, oncological and maternal-perinatal variables were recorded in the systematic review. RESULTS: Two patients were found: the first case presents a newly diagnosed metastatic melanoma at 26-weeks of gestation with fatal maternal and neonatal outcome. The second case presents a patient with metastatic melanoma who got pregnant during her treatment. For the systematic review we found 25 articles, providing data from 489 patients. Maternal-perinatal outcomes, including termination of pregnancy rates, vary depending on the country, gestational age and tumour stage at diagnosis. PAM is usually detected at advanced stages, even with metastasis affecting the placenta and the foetus. CONCLUSIONS: When diagnosed at early stages, melanoma does not seem to alter the evolution of gestation, whereas patients with advanced stages of melanoma frequently deliver prematurely, by caesarean section, with lower neonatal weight, higher neonatal morbidity and mortality rates.