Analysis:Pregnancy and breast cancer

HOLLYWOOD, Fla., March 10 (UPI) -- Doctors announced Friday the first guidelines for the treatment of pregnant women who find that they also have breast cancer.

"We have been reluctant to tackle this guideline," said Robert Carlson, professor of medicine at Stanford University in California, "because we thought it would be an overwhelming task. However, when we got into it, we found that it was rather straightforward."

The guideline considers woman with early stage breast cancer - cancer that is believed to be confined to the breast. The guideline differentiates whether a woman is in the first, second or third trimester of her pregnancy when the cancer is discovered.

"If she is in the first trimester, we discuss the possibility of termination of the pregnancy," Carlson said. If the women decides to continue the pregnancy, she is then scheduled for surgery -- a lumpectomy and a dissection of the lymph nodes under the armpit in order to determine if the cancer is localized in the breast.

Following surgery, the treatment guidelines suggests beginning preventive chemotherapy in the second trimester. "We would absolutely wait until the baby is born before adding radiation therapy and endocrine therapy with drugs such as tamoxifen," Carlson told United Press International at the 11th annual conference of the National Comprehensive Cancer Network in Hollywood, Fla.

Chemotherapy, radiation and endocrine therapy are all designed to prevent recurrence of the cancer.

"Considerations and selection of optimal local therapy and systemic therapy are similar to that recommended in non-pregnancy associated breast cancer," noted Richard Theriault, professor of breast medical oncology at the University of Texas M.D. Anderson Cancer Center, Houston. Theriault was assigned to write the guidelines.

Carlson said that there is no clinical trial evidence that the recommendations are based upon. Lacking this so-called "Level 1" evidence, the breast cancer guideline-writing committee, which he heads, assigned Level 2A evidence to the treatment suggestions.

"That means that while we have no hard evidence for these recommendations, there was unanimous agreement among those of us on the committee that the guideline represents the best treatment for these women," Carlson said.

If cancer is discovered during the second trimester or in the early part of the third trimester, women are offered either a mastectomy or breast conserving therapy - a lumpectomy - along with lymph node dissection. The patient can also begin chemotherapy as well as undergoing surgery.

If the women selects breast conserving therapy, radiation is delayed until after delivery of the child, as is endocrine therapy.

Women in the last third trimester are offered mastectomy or lumpectomy along with lymph node dissection. Again radiation and endocrine therapy would follow post-partum.

"Chemotherapy should not be administered during the first trimester of pregnancy and radiation therapy should not be administered during any time of the pregnancy," Theriault wrote in preparing the guidelines.

He said that, after the child is delivered, standard chemotherapy can be offered. During pregnancy, patients have usually been treated with combinations of doxorubicin, cyclophosphamide and fluorouracil - potent anti-cancer drugs.