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Invited Critique
January 2003

Breast Cancer in Pregnancy—Invited Critique

Arch Surg. 2003;138(1):99. doi:10.1001/archsurg.138.1.99

Although breast cancer is the most common nongynecological malignancy during pregnancy, surgeons diagnose few women with breast cancer while they are pregnant. This article provides a thorough review of all of the issues that surgeons must understand and consider in the pregnant woman with breast cancer. Although not explicitly stated, the review makes it clear that termination of the pregnancy is not necessary to adequately treat these women.

The recommendation for a thorough breast examination in pregnant women should be strengthened to include examinations at the beginning of each trimester, particularly in high-risk women. Women with a genetic predisposition, who have had a previous breast cancer or premalignant abnormality such as atypical ductal hyperplasia and lobular carcinoma in situ, who are older than 40 years, and who have new breast complaints should be considered at higher risk than the average pregnant women. Although implicit in the data, the need to accurately diagnose a localized breast mass in a pregnant woman is essential. Women rarely get cysts during pregnancy. Fine-needle aspiration and, for that matter, core biopsy are of minimal morbidity during pregnancy. Although both ultrasonography and mammography have a role in the assessment of breast masses, a tissue diagnosis is still the gold standard.