Abstract
The diagnosis of breast cancer (BC) during pregnancy is uncommon. It has varied among
different studies from 1:10,000 to 1:3000 of all pregnancies, with a median age of
33 years. Pregnancy-associated BC represents a challenge in terms of clinical management
to guarantee both maternal and fetal security in choosing the right treatment. This
situation is complex and requires a multidisciplinary approach, including the surgeon,
anesthesiologist, oncologist, radiotherapist, psychologist, and maternal–fetal medicine
specialist. In the present review, we examined the management of pregnancy-associated
BC, focusing on pathophysiologic background, risk factors, diagnosis, staging procedures,
anesthesia, surgical management, and systemic treatment.
Keywords
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Article info
Publication history
Published online: July 19, 2020
Accepted:
July 14,
2020
Received in revised form:
July 7,
2020
Received:
April 6,
2020
Footnotes
I.P., D.D.G. and L.C. share first co-authorship.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.