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Pregnant patients lose out in breast cancer treatment; a new approach is needed

April 16, 2008

Berlin, Germany: Pregnant breast cancer patients can be treated as closely as possible to existing guidelines for non-pregnant patients, with few ill effects, a scientist told the 6th European Breast Cancer Conference (EBCC-6) today (Wednesday 16 April).

Dr. Sibylle Loibl, Assistant Professor in Obstetrics and Gynaecology at University of Frankfurt, Germany, and a member of the German Breast Group, said that until now, evidence upon which decisions on treatment for pregnant patients could be made was limited, and that a cautious approach by doctors meant that many women did not get the best treatment for their cancer. "We realised that there are hardly any data on this subject," she said, "and therefore set out to collect information from patients in Germany and throughout Europe."

The German Breast Group launched a data-collection exercise in 2003. Information on 122 pregnant patients diagnosed with breast cancer between April 2003 and December 2007 was analysed for a number of factors - foetal outcome four weeks after delivery, maternal outcome of pregnancy, stage and biological characteristics of the breast cancer, breast cancer therapy, sensitivity and specificity of diagnostic procedures, outcome of the child five years later, and outcome of the breast cancer five years after diagnosis.

The median gestational age at the time of diagnosis was 21 weeks, and the median age of the women 33 years. Some patients chose not to continue the pregnancy on learning of their diagnosis, but of those who did, 33.3% received surgery only, 43.2% were treated by surgery and chemotherapy, 5.4% by chemotherapy alone, and 2.7% had no treatment at all. The median time for delivery was 36 weeks, slightly earlier than that which is normal in healthy women. Although there were some health problems among the newborn babies, they were generally minor, and the foetal outcome in babies whose mothers received chemotherapy was not different to those whose mothers did not.

"We are still analysing some of the data," said Dr. Loibl, "but in terms of our primary endpoint, foetal outcome four weeks after delivery, we are able to say that this shows that pregnant patients can benefit from the same breast cancer treatment that is given to non-pregnant women, and that this should be done in standardised multidisciplinary teams. Later this year we hope to have collected 200 patients in the dataset. This will be the largest ever data collection concerning breast cancer during pregnancy, and we intend to follow up these women and their children over a long period of time to produce further information. We are grateful to all collaborating doctors in Germany and neighbouring countries who are helping us to gain data on this important issue."

The training of doctors to deal with pregnant breast cancer patients and the centralisation of information on such patients will help raise awareness of the issues involved, says Dr. Loibl. "We hope that in the future we may be able to conduct trials in such patients and gain further important data. Treatments are improving all the time, and new drugs are on the horizon waiting to be implemented into the adjuvant therapy of breast cancer."

However, in order to conduct trials in such a group there are considerable difficulties, said Dr. Loibl. "Insurance for a study in pregnant patients is almost impossible to get, and, additionally, because the group to be studied will be small, it would be necessary to enrol patients from several hundred clinics in order to achieve a statistically valid result. We need some kind of fast-tracking to be able to get such a trial underway, but, in the meantime, pregnant patients should not lose out just because the data on their treatment are limited," she said.

ECCO-the European CanCer Organisation