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Gestational breast cancer

[Data collection for this study is complete. Analysis in progress]

Background

Breast cancer is the most common cancer in pregnant women. Although the overall incidence is low1; this is expected to rise. Pregnancy-associated breast cancers carry a similar prognosis to other breast cancers when matched for stage and age, yet due to pregnancy related physiological changes, delays in diagnosis are common. This often results in later stage presentation, and is associated with increased morbidity and mortality2. Women diagnosed with breast cancer during pregnancy pose a diagnostic and therapeutic dilemma, with doctors needing to assess whether the benefits of treatment for the mother outweigh the risks to her unborn child. Currently, there is limited experience in treating this group of breast cancer patients, with the published research from Europe suggesting that doctors sometimes advise patients to delay treatment or recommend premature delivery or termination of the pregnancy3. These inconsistencies pose challenges for the management of young women with breast cancer, and therefore may compromise the quality of care they receive.

In addition, there is currently limited information available to consumers, which is concerning given the evidence that information surrounding fertility and motherhood is crucial in reducing psychosocial distress and maximising quality of life for young women with breast cancer4,5. There has been no national study on the diagnosis, management and outcomes of gestational breast cancer in Australia or New Zealand.

Key points

  • Gestational breast cancer is managed with specific drugs, radiotherapy or surgery, but it is not known how these affect the mother, the fetus or the neonate.
  • This study will investigate the current incidence of Gestational breast cancer. It will describe their current management and the associated outcomes for women and their infants and develop guidelines for their optimal management.

Surveillance period

January 2013 - June 2014

Objectives

  • To use the Australasian Maternity Outcomes Surveillance System (AMOSS) to describe the incidence, management and outcomes of gestational breast cancer in Australia and New Zealand.
  • To use this information to develop guidelines for their optimal management.

Research questions

  1. What is the current incidence of gestational breast cancer in Australia and New Zealand?
  2. What are the outcomes for women and their babies?
  3. How is the condition managed in Australia and New Zealand?
  4. What is the role of the timing of surgery to remove the tumours and what are the complications compared to non-pregnant women in Australia and New Zealand?

Case definition

All pregnant women in Australia and New Zealand with first diagnosis of breast cancer during current pregnancy or during the 6 weeks of giving birth.

Inclusion criteria

  • Pathological diagnosis of breast cancer during pregnancy or in the 6 weeks postpartum
  • Confirmed diagnosis of breast cancer during pregnancy or in the 6 weeks postpartum, determined from medical record

Investigators

Professor Elizabeth Sullivan, Principal Investigator AMOSS, Professor of Public Health, Assistant Deputy Vice Chancellor, University of Technology Sydney and Conjoint Professor, UNSW Medicine, New South Wales

Winthrop Professor Christobel Saunders, Deputy Head of School, School of Surgery, University of Western Australia, Western Australia

Professor Jan Dickinson, Maternal Fetal Medicine, School of Women’s and Infant’s Health, University of Western Australia, Western Australia

Professor Frances Boyle, Medical Oncology and Director of Patricia Richie Centre for Cancer Care and Research, Mater Hospital, New South Wales

Dr. Angela Ives, Research Assistant Professor, Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Western Australia

Dr. Greg Duncombe, Co-Director of Queensland Ultrasound for Women and Staff Specialist in Maternal Fetal Medicine, Royal Brisbane Women’s Hospital, Queensland

Professor Jane Fisher, Jean Hailes Professor of Women’s Health and Director Jean Hailes Research Unit, Monash University

Dr Karin Hammberg, Postdoctoral Research Fellow, Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University

Funding and other support

We gratefully acknowledge our funding partners and participating AMOSS sites.

The study is funded by National Breast Cancer Foundation.

The University of New South Wales provided support to redevelop the AMOSS site with a Major Research Equipment and Infrastructure Initiative (MREII) Grant in 2013.

Other funding support has been provided through the University of Technology Sydney.

Data collection is supported by AMOSS participating sites.

References

  1. Ives, A., Saunders, C., Semmens, J. (2005). The Western Australian gestational breast cancer project: A population-based study of the incidence, management and outcomes. The Breast, 14(4), 276-282.
  2. Ulery, M., Carter, L., McFarlin, B.L. & Giurgescu, C. (2009). Pregnancy- associated breast cancer: significance of early detection. Journal of Midwifery & Women‟s Health, 54(5), 357 -363
  3. Amant, F., Deckers, S., Van Calsteren, K., Loibl, S., Halaska, M., Brepoels, L., Beijen, J. et al. (2010). Breast cancer in pregnancy: Recommendations of an international consensus meeting. European Journal of Cancer, 46, 3158-3168.
  4. Puckridge, P., Saunders, C., Ives, A., Semmens, J. (2003). Breast Cancer in Pregnancy: a Diagnostic and Management Dilemma. Australian & New Zealand Journal of Surgery, 73, 500-503.
  5. Peate, M., Meiser, B., Hickey, M. & Friedlander, M. (2009). The fertility-related concerns, needs and preferences of younger women with breast cancer: a systematic review. Breast Cancer Treatment & Research, 116, 215-223.
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