Abstract
Introduction: Breast carcinoma is the most commonly reported neoplasm during pregnancy and represents a diagnostic challenge since, as a rare pathology associated with the physiological changes of the mammary glands during gestation, a high index of suspicion is required. It tends to be diagnosed in advanced stages of gestation, delaying treatment and increasing maternal-perinatal morbidity and mortality. Case Description: A 34-year-old patient, 29 weeks pregnant, with a rapidly growing breast tumor, in whom, after analyzing the risk-benefit at a bioethical level through a dialogical approach focused on the patient with the multidisciplinary medical team, patient, and family, the initiation of prioritized neoadjuvant chemotherapy plus dose-dense carboplatin was decided, and based on current literature, it was agreed to end the pregnancy via cesarean section at week 36, awaiting greater fetal maturity. Discussion: There are clinical cases like this where complex bioethical questions arise in the management of pregnant patients with invasive breast carcinoma in settings with limited resources. The multidisciplinary approach is an important foundation for optimizing maternal-fetal and neonatal outcomes according to the risk-benefit assessment, especially in cases where future fertility is at risk. Bioethical dilemmas regarding maternal-fetal well-being, breast cancer survival, and options in regions with limited resources were discussed.
References
Global cancer observatory. GLOBOCAN. 2022 [cited 2024 Apr 1]. BREAST. Available from: https://gco.iarc.who.int/media/globocan/factsheets/cancers/20-breast-fact-sheet.pdf
Global Cancer Observatory. GLOBOCAN. 2022 [cited 2024 Apr 1]. CANCER TODAY - COLOMBIA. Available from: https://gco.iarc.who.int/media/globocan/factsheets/populations/170-colombia-fact-sheet.pdf
Corte Constitucional de Colombia. Corte constitucional de la República de Colombia. 2009. Sentencia T-732/09. Derechos sexuales y reproductivos. Bogotá D.C. Available from: https://www.corteconstitucional.gov.co/relatoria/2009/t-732-09.htm#:~:text=T-732-09 Corte Constitucional de Colombia&text=En virtud de la autodeterminación,cuándo y con qué frecuencia.
AJ. ZC. El bioderecho como instrumento en la determinación de los límites a la libertad de investigación. Especial referencia a la eugenesia positiva en la genética humana. Madrid: Universidad Complutense de Madrid; 2014.
Fajdić J, Gotovac N, Hrgović Z, Fassbender W. Diagnosis and Therapy of Gestational Breast Cancer: A Review. Adv Med Sci [Internet]. 2008 Jan 1;53(2). Available from: http://www.degruyter.com/view/j/ams.2008.53.issue-2/v10039-008-0037-5/v10039-008-0037-5.xml
Cordeiro CN, Gemignani ML. Breast Cancer in Pregnancy: Avoiding Fetal Harm When Maternal Treatment Is Necessary. Breast J [Internet]. 2017 Mar;23(2):200–5. Available from: https://onlinelibrary.wiley.com/doi/10.1111/tbj.12780
Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, et al. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Annals of Oncology [Internet]. 2019 Oct;30(10):1601–12. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0923753419609737
Basro S, Apffelstaedt JP. Breast Cancer in Young Women in a Limited-Resource Environment. World J Surg [Internet]. 2010 Jul 9;34(7):1427–33. Available from: http://link.springer.com/10.1007/s00268-009-0299-5
Martínez-Ramos D, Ferraris C, Greco M, Grosso I, Rudy Conti A. Carcinoma de mama durante el embarazo. Cir Esp [Internet]. 2007 Nov;82(5):305–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0009739X0771730X
Meisel JL, Economy KE, Calvillo KZ, Schapira L, Tung NM, Gelber S, et al. Contemporary multidisciplinary treatment of pregnancy-associated breast cancer. Springerplus [Internet]. 2013 Dec 3;2(1):297. Available from: https://springerplus.springeropen.com/articles/10.1186/2193-1801-2-297
Zagouri F, Sergentanis TN, Chrysikos D, Papadimitriou CA, Dimopoulos MA, Bartsch R. Trastuzumab administration during pregnancy: a systematic review and meta-analysis. Breast Cancer Res Treat [Internet]. 2013 Jan 15;137(2):349–57. Available from: http://link.springer.com/10.1007/s10549-012-2368-y
de Haan J, Verheecke M, Van Calsteren K, Van Calster B, Shmakov RG, Mhallem Gziri M, et al. Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol [Internet]. 2018 Mar;19(3):337–46. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1470204518300597
Salani R, Billingsley CC, Crafton SM. Cancer and pregnancy: an overview for obstetricians and gynecologists. Am J Obstet Gynecol [Internet]. 2014 Jul;211(1):7–14. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002937813021601.