Pregnancy

Sentinel node biopsy – Pregnant women

In pregnant women with breast cancer with no clinical or radiological evidence of axillary lymph node metastases at initial diagnosis, consider the use of radioactive tracers but do not use Patent Blue dye if undertaking sentinel node biopsy.

Systemic therapy planning considerations – Pregnancy avoidance

Advise women with breast cancer who are receiving chemotherapy, anti-HER2 therapy, or tamoxifen, to avoid pregnancy as these therapies are potentially teratogenic. 

Systemic therapy planning considerations – Pregnant women #1

In pregnant women with breast cancer, chemotherapy can be considered after 14 weeks of gestation. 

Systemic therapy planning considerations – Pregnant women #2

The dosage of chemotherapeutic agents should be the same for pregnant women as compared to non-pregnant women. A lower pre-pregnant weight should not be used. 

Systemic therapy – Breastfeeding

Breastfeeding is not recommended during chemotherapy or endocrine therapy.

Radiation therapy considerations – Pregnant women

In pregnant women with breast cancer with a high risk of recurrence, the multidisciplinary team should consider the risks and benefits of radiation therapy to the woman and the fetus, and these should be discussed with the woman.

MDT treatment planning – Pregnant women

Include obstetricians and perinatologists in the multidisciplinary team (MDT) for the treatment of patients with breast cancer during pregnancy. Particular attention should be paid to each woman’s preferences and psychosocial needs due to the higher likelihood of distress.

Radiation therapy timing – Pregnant women

In pregnant women with breast cancer with a low to intermediate risk of recurrence, delay radiation therapy until after delivery of the baby.