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AddYourCompanySloganBreastCancerDiagnosedDuringPregnancy天津市肿瘤医院乳腺一科陈祖锦11EpidemiologyTheMotheriskguidetocancerinpregnancyandlactation.2nded.Toronto,Canada:MotheriskProgram;2005.EpidemiologyBCPbecomemorefrequent:delaychildbearingBreastcarcinomaduringpregnancy.Internationalrecommendationsfromanexpertmeeting.Cancer2006;106(2):237–46.History：Positivefamilyhistory:48%BRCA1orBRCA2mutations:9%FamilyhistoryofbreastandovariancancersandBRCA1andBRCA2mutationsinapopulation-basedseriesofearly-onsetbreastcancer.JNatlCancerInst2001;93(16):1215–23.DiagnoseClinicalexaminationGlandularandductalhyperplasias:palpationcannotdiscriminatemalignantfrombenignlumpsofasimilarsizediagnosiscanbedelayedDiagnoseDiagnosticRadiologyExceedingadoseof0.05Gymaycausemalformations,microcephaly,intrauterinegrowthretardation,andmentalretardationDiagnosticClinicalstageIIorhigherbreastcancer：metastasesbone,liver,andlung•Chestx-raywithabdominalshielding;•Ultrasoundoftheliver•noncontrastMRIexclude:livermetastasesthoracicandlumbarspinebonemetastases.•CTscansandbonescansarenotrecommendedforroutineuse•Echocardiogram:anthracycline-basedchemotherapyregimenDiagnosticStagingevaluationTreatmentimplantation(0-2weeks),organogenesis(2-10weeks),fetalphase(>10weeks)Treatment:LocoregionalTherapySurgeryandAnesthesia•Breastsurgerycanbesafelyperformedinalltrimestersofpregnancy•afterthe12thweekofgestationwhentheriskofspontaneousabortionmaybelower•MultiplestudiesevaluatingtherisksofanesthesiaduringpregnancyhavenotshownanincreaseinfetalabnormalitiesSLNB•Estimatedradiationexposuretothefetusislowandcalculatedtoamaximumof4.3mGy•Bluedyeshouldnotbeused：anaphylaxisbeharmfulforthefoetus---SensitivitydecreasedThesensitivityandspecificityofSLNPhasnotbeenwellestablishednotthetechnicalaspectsaccuracyPregnancy-associatedbreastcancerpatientscansafelyundergolymphaticmapping.BreastJ2008;14(3):250–4.Treatment•RadiationtherapyduringpregnancyisrarelyindicatedinBCP.Ingeneral,itisrecommendedtopostponeRTuntilafterdelivery•Duringthefirstmonthsofpregnancy,theuterusdoesnotextendoutsidethetruepelvisTreatment:RadiationtherapyMostchemotherapeuticagentsareCategoryDTreatment:SystemicTherapyThefirsttrimester(thefetusisespeciallyvulnerable):increasestheriskofspontaneousabortion,fetaldeath,andmajormalformationsThesecondandthirdtrimesters:increasestheriskofintrauterinegrowthrestriction(IUGR)andlowbirthweightfetalmalformationsriskfirsttrimester14%to19%secondandthirdtrimester1.3%long-termfollowuphavenotshownimpairmentsinlearningbehaviourorhaematologicalorimmunologicalabnormalities.Antineoplasticagentsinpregnancy.Seminoncol1989;16:337–346Antifolates：methotrexate•teratogenesis（畸形）•aknownabortifactant（坠胎药）CMFnotgivenPrognosisJClinOncol31:2532-2539.AddYourCompanySloganThankyou