Diagnosing breast cancer in pregnancy may often be difficult,
given the gestational physiologic modifications of the gland that cause a diagnosis delay of 1-2 months,
often when the disease has already spread. At presentation,
the disease is more frequently a palpable mass,
with thickening retractable skin,
rarely with blood secretions.
The first approach for diagnosis is ultrasound,
which shows high sensitivity and specificity,
being the right approach to discriminate between solid and cystic lesions.
Mammography may be used with appropriate radioprotection procedures in order to protect the fetus.
MRI can be performed after the 3rd trimester,
but only in case ultrasound/mammography result unsatisfactory for a proper diagnosis.
Microbiopsy is to prefer compared to cytologic exam,
for the early preliminary evaluation of hormonal/Her2 receptor pattern.
The surgical intervention can be executed following the 21st pregnancy week,
as there is no evidence of teratogenic effects of anesthesiology drugs.
Trastuzumab cannot be administered during pregnancy as potentially toxic for the fetus.
Monitoring of the fetus is performed every 3 weeks to evaluate the fetus growth.
It is furthermore necessary to execute a histologic exam of the placenta right after childbirth.
It is preferable to procrastinate childbirth after the 35th gestational week in case of neo-adjuvant CT.
CT drugs should not be administered after the 34th gestational week,
avoiding a NADIR phase for delivery.
In conclusion,
it is pivotal to have a multidisciplinary clinical approach to the management of PABC patients who,
more than others,
need to be guided by expert professionals,
able to establish the best therapeutic strategy with a special attention to empathy and emotional care.