A retrospective clinical study of patients with pregnancy-associated breast cancer among multiple centers in China (CSBrS-008)

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A retrospective clinical study of patients with pregnancy-associated breast cancer among multiple centers in China (CSBrS-008)

As more women in China delay their first childbirth—driven by social shifts and policy changes—the need to understand pregnancy-associated breast cancer (PABC) has never been greater. PABC, a rare form of breast cancer that develops during pregnancy or within 12 months of giving birth, is expected to become more common as maternal age rises. Until recently, there was little large-scale data on how PABC affects women in China. A new multicenter study from 27 hospitals across the country offers critical insights into this condition—from diagnosis to treatment and long-term outcomes.

What the Study Did

Led by researchers from Fudan University’s Obstetrics and Gynecology Hospital and Zhongshan Hospital, the study reviewed medical records of 164 women diagnosed with PABC between 2016 and 2018. Half the patients were diagnosed during pregnancy (83 women, split into early, mid, and late stages) and half during lactation (81 women). Researchers tracked their care—including surgery, chemotherapy, and pregnancy choices—and followed up for a median of 36 months (range: 3 to 59 months) to see how they fared.

Key Findings About PABC in China

The study uncovered several important trends about who gets PABC and how it presents:

1. Who Is Affected?

The median age of patients was 33 years (range: 24–47), aligning with global data on PABC. Only 5.4% had a family history of breast cancer—similar to the general population—suggesting family history may not raise PABC risk.

2. How Advanced Is the Cancer?

Most patients were diagnosed at stage II (55%), while 24% were stage III and 2% stage IV. Delayed diagnosis is a major factor here: Breast tissue thickens during pregnancy and lactation, making lumps harder to feel. Plus, doctors often avoid X-rays (to protect the fetus), delaying imaging. A 1-month treatment delay can increase lymph node spread by nearly 1%, according to prior research.

3. What Types of PABC Are Most Common?

Invasive ductal carcinoma (the most common breast cancer type) accounted for 71% of cases. Most tumors were high-grade (61% G2 or G3), and hormone receptor (ER/PR) positivity was low (52% ER+, 43% PR+). The most common molecular subtype was luminal B (43%), followed by triple-negative (19%) and HER2-positive (15%)—consistent with global studies showing PABC tends to be more aggressive.

How Do Doctors Treat PABC in China?

Treating PABC is tricky: Doctors must balance the mother’s health with the fetus’s safety. Here’s what the study found:

  • Surgery during pregnancy: 36% of pregnant patients had surgery (8 breast-conserving, 22 modified radical mastectomy) with no major complications for mom or baby.
  • Chemotherapy during pregnancy: 20% received chemo—mostly in mid-pregnancy (15 patients) or late pregnancy (2). Regimens like epirubicin + cyclophosphamide or weekly paclitaxel were used (these drugs cross the placenta minimally). All neonates were healthy.
  • Pregnancy termination: 31% chose to end their pregnancy—all in early pregnancy (<12 weeks). For mid- and late-pregnancy patients, most (26 of 38 mid-pregnancy, 31 of 31 late-pregnancy) delivered successfully.

How Did Patients Fare?

After 3 years of follow-up:

  • 11% (18 patients) had local recurrence or distant metastasis (e.g., liver, bone, brain).
  • 3% (5 patients) died.
  • Survival rates were similar for patients diagnosed during pregnancy vs. lactation (no statistically significant difference in disease-free or overall survival).
  • Children of PABC patients who received chemo or surgery during pregnancy showed normal growth and development (85 kids followed up had no major issues).

What This Means for PABC Care

The study’s biggest takeaway: Standardized surgery and chemotherapy for PABC are safe for both mothers and babies. This aligns with global guidelines that support timely treatment—even during pregnancy—rather than delaying care.

Delayed diagnosis remains a challenge, though. Doctors emphasize the need for early detection: Women should report any new breast lumps immediately, even during pregnancy. Ultrasound (safe for fetuses) is the first-line imaging tool, and biopsy should be done if a lump is suspicious.

The study also suggests pregnancy termination isn’t always necessary. Most women who continued their pregnancy (57 of 83) had good outcomes, with survival rates similar to those who ended their pregnancy. Termination is only recommended if chemo is needed in early pregnancy (when it can harm the fetus).

Final Thoughts

As PABC becomes more common in China, this study provides a much-needed roadmap for care. Early detection, timely surgery, and safe chemotherapy are key to improving outcomes. For women, the message is clear: Don’t ignore breast changes during pregnancy or lactation—talk to your doctor right away.

For doctors, the study reinforces that PABC can be managed without sacrificing the mother’s or baby’s health. More research is needed to confirm long-term outcomes, but this multicenter data is a critical first step.

The study was published in the Chinese Medical Journal in 2021 by Yu-Chun Jin, Jun-Xian Du, and colleagues from Fudan University. You can access the original paper at doi.org/10.1097/CM9.0000000000001697.

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