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Original Research

Open Access

Pregnancy-associated breast malignancy mostly presents with an aggressive type of breast cancer

  • Ilkin Acar1
  • Leman Damla Ercan1
  • Selman Emiroglu1
  • Mustafa Tukenmez1
  • Baris Emiroglu1
  • Mahmut Muslumanoglu1
  • Abdullah Igci1,2
  • Vahit Ozmen1,3
  • Ahmet Sait Dinccag1
  • Neslihan Cabioglu1,*,

1Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, 34390 Istanbul, Turkey

2Department of Surgery, American Hospital, 34365 Istanbul, Turkey

3Department of Surgery, Istanbul Florence Nightingale Hospital, 34381 Istanbul, Turkey

DOI: 10.22514/ejgo.2023.069 Vol.44,Issue 5,October 2023 pp.1-10

Submitted: 29 November 2022 Accepted: 20 March 2023

Published: 15 October 2023

*Corresponding Author(s): Neslihan Cabioglu E-mail:;


Published reports on the prognosis of pregnancy-associated breast cancer are controversial. This study aims to determine the histopathological features of pregnancy-associated breast carcinoma (PABC) and the outcomes of patients with breast cancer during pregnancy and lactation among Turkish women. The study retrospectively analyzed 29 patients diagnosed with pregnancy-associated breast malignancies who underwent surgery between January 1989 and March 2021. Demographic and pathological data were obtained to evaluate the clinicopathological and prognostic characteristics of the patients. The median age was 36 years (range: 26–42 years). Of the 29 patients with breast cancer, 13 (44.8%) were diagnosed during pregnancy, and the remaining 16 (55.2%) were diagnosed during lactation. Most patients had clinical tumor stage (cT) cT2–3 (n = 20, 69%) disease, and 15 patients had clinically node (cN)-positive disease (N1 and N2, 51.7%). The majority (n = 19, 65.5%) had invasive ductal carcinoma with high Ki-67 scores (>20%). Patients with lactation-associated breast cancer were more likely to have a family history of breast cancer (44% vs. 8%, p = 0.04) than those with pregnancy-associated breast cancer. Notably, symptom duration ≥6 months and presenting with cT3–4 or cN(+) disease were associated with poor disease-free and disease-specific survival. However, no difference could be found in outcome among patients with pregnancy- and lactation-associated breast cancer. PABC mostly presents with aggressive tumor molecular subtypes with high Ki-67 scores and more advanced stages associated with poor outcome, possibly due to delayed diagnosis. Therefore, prompt early diagnosis and awareness of this disease might improve survival.


Breast cancer; Lactation; Pregnancy; Ki-67; Early diagnosis

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Ilkin Acar,Leman Damla Ercan,Selman Emiroglu,Mustafa Tukenmez,Baris Emiroglu,Mahmut Muslumanoglu,Abdullah Igci,Vahit Ozmen,Ahmet Sait Dinccag,Neslihan Cabioglu. Pregnancy-associated breast malignancy mostly presents with an aggressive type of breast cancer. European Journal of Gynaecological Oncology. 2023. 44(5);1-10.


[1] 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. The Lancet Oncology. 2018; 19: 337–346.

[2] Wang B, Yang Y, Jiang Z, Zhao J, Mao Y, Liu J, et al. Clinicopathological characteristics, diagnosis, and prognosis of pregnancy‐associated breast cancer. Thoracic Cancer. 2019; 10: 1060–1068.

[3] Choi M, Han J, Yang BR, Jang M, Kim M, Kim T, et al. Prognostic impact of pregnancy in Korean patients with breast cancer. The Oncologist. 2019; 24: e1268–e1276.

[4] Jerzak KJ, Lipton N, Nofech-Mozes S, Boles D, Slodkowska E, Pond GR, et al. Clinical outcomes and prognostic biomarkers among pregnant, post-partum and nulliparous women with breast cancer: a prospective cohort study. Breast Cancer Research and Treatment. 2021; 189: 797–806.

[5] Taylor D, Lazberger J, Ives A, Wylie E, Saunders C. Reducing delay in the diagnosis of pregnancy-associated breast cancer: how imaging can help us. Journal of Medical Imaging and Radiation Oncology. 2011; 55: 33–42.

[6] Silverstein J, Post AL, Chien AJ, Olin R, Tsai KK, Ngo Z, et al. Multidisciplinary management of cancer during pregnancy. JCO Oncology Practice. 2020; 16: 545–557.

[7] Amant F, von Minckwitz G, Han SN, Bontenbal M, Ring AE, Giermek J, et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. Journal of Clinical Oncology. 2013; 31: 2532–2539.

[8] Woo JC. Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Archives of Surgery. 2003; 138: 91–98; discussion 99.

[9] Crown A, McCartan D, Curry MA, Patil S, Kamer S, Goldfarb S, et al. Pregnancy-associated breast cancer: does timing of presentation affect outcome? Breast Cancer Research and Treatment. 2023; 198: 283–294.

[10] Loibl S, Schmidt A, Gentilini O, Kaufman B, Kuhl C, Denkert C, et al. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA Oncology. 2015; 1: 1145–1153.

[11] Tan QT, Alcantara VS, Sultana R, Loh KW, Go AL, Wong FY. Pregnancy-associated breast cancer: a multicenter study comparing clinicopathological factors, diagnosis and treatment outcomes with nonpregnant patients. Breast Cancer Research and Treatment. 2023; 198: 53–66.

[12] Gwak H, Woo SS, Lee E, Park MH, Lee S, Youn HJ, et al. Survival of women with pregnancy-associated breast cancer according to clinical characteristics: a propensity score matching study. Medicine. 2022; 101: e30831.

[13] Middleton LP, Amin M, Gwyn K, Theriault R, Sahin A. Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features. Cancer. 2003; 98: 1055–1060.

[14] Lefrère H, Floris G, Schmidt MK, Neven P, Warner E, Cardonick E, et al. Data describing the poor outcome associated with a breast cancer diagnosis in the post-weaning period. Data in Brief. 2021; 38: 107354.

[15] Kataoka A, Ueno T, Yamauchi H, Uehiro N, Takahata C, Takahashi Y, et al. Characteristics, treatment trends, and long-term outcomes of Japanese patients with pregnancy-associated breast cancer (PABC). Breast Cancer. 2022; 29: 825–834.

[16] Suelmann BBM, Bakhuis CFJ, van Dooijeweert C, Verloop J, Zweemer R, Linn S, et al. Prognosis of pregnancy-associated breast cancer: inferior outcome in patients diagnosed during second and third gestational trimesters and lactation. Breast Cancer Research and Treatment. 2022; 192: 175–189.

[17] Hartman EK, Eslick GD. The prognosis of women diagnosed with breast cancer before, during and after pregnancy: a meta-analysis. Breast Cancer Research and Treatment. 2016; 160: 347–360.

[18] Asztalos S, Pham TN, Gann PH, Hayes MK, Deaton R, Wiley EL, et al. High incidence of triple negative breast cancers following pregnancy and an associated gene expression signature. SpringerPlus. 2015; 4: 710.

[19] Nimbalkar VP, Snijesh VP, Rajarajan S, Alexander A, Kaluve R, Ramesh R, et al. Premenopausal women with breast cancer in the early post-partum period show molecular profiles of invasion and are associated with poor prognosis. Breast Cancer Research and Treatment. 2023; 200: 139–149.

[20] Jindal S, Pennock ND, Sun D, Horton W, Ozaki MK, Narasimhan J, et al. Postpartum breast cancer has a distinct molecular profile that predicts poor outcomes. Nature Communications. 2021; 12: 6341.

[21] Azim Jr HA, Botteri E, Renne G, Dell’Orto P, Rotmensz N, Gentilini O, et al. The biological features and prognosis of breast cancer diagnosed during pregnancy: a case-control study. Acta Oncologica. 2012; 51: 653–661.

[22] Li Y, Wang Y, Sun Q, Shen S. Clinicopathologic features, treatment, and prognosis of pregnancy-associated breast cancer. Frontiers in Oncology. 2022; 12: 978671.

[23] Johansson ALV, Andersson TM, Hsieh C, Jirström K, Cnattingius S, Fredriksson I, et al. Tumor characteristics and prognosis in women with pregnancy-associated breast cancer. International Journal of Cancer. 2018; 142: 1343–1354.

[24] Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, et al. Preoperative chemotherapy: updates of national surgical adjuvant breast and bowel project protocols B-18 and B-27. Journal of Clinical Oncology. 2008; 26: 778–785.

[25] Schmid P, Cortes J, Dent R, Pusztai L, McArthur H, Kümmel S, et al. Event-free survival with pembrolizumab in early triple-negative breast cancer. The New England Journal of Medicine. 2022; 386: 556–567.

[26] NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Breast cancer version 4. 2023. Available at: (Accessed: 23 March 2023).

[27] Ditsch N, Kolberg-Liedtke C, Friedrich M, Jackisch C, Albert U, Banys-Paluchowski M, et al. AGO recommendations for the diagnosis and treatment of patients with early breast cancer: update 2021. Breast Care. 2021; 16: 214–227.

[28] Poggio F, Tagliamento M, Pirrone C, Soldato D, Conte B, Molinelli C, et al. Update on the management of breast cancer during pregnancy. Cancers. 2020; 12: 3616.

[29] Han SN, Amant F, Cardonick EH, Loibl S, Peccatori FA, Gheysens O, et al. Axillary staging for breast cancer during pregnancy: feasibility and safety of sentinel lymph node biopsy. Breast Cancer Research and Treatment. 2018; 168: 551–557.

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