Breast cancer, pregnancy, and breastfeeding.

摘要: OBJECTIVE: The primary objective of this guideline is to provide Canadian physicians up-to-date, accurate information and recommendations regarding: i) impact pregnancy lactation on risk breast cancer; ii) prognosis cancer diagnosed during lactation; iii) recurrence with the occurrence subsequent pregnancies; iv) feasibility breastfeeding its women cancer. OPTIONS: This reviews evidence whether change lifetime for in women, or has a different prognosis. It offers clinician advice diagnostic options help identify and/or lactation, evidence-based managing an ongoing when treatment being planned. also clinicians counselling their patients regarding future who have been treated cancer. OUTCOMES: These guidelines should counsel using recommendations. may improve those had are contemplating pregnancies. EVIDENCE: A Medline search was carried out all publications from 1990 through 2000, English language, related terms diagnosis, prognosis, treatment, as well breastfeeding, particular focus after lactation. authors submitted manuscript review members Breast Disease Committee, validated levels evidence. final SOGC Council approval dissemination. determined criteria described by Task Force Periodic Health Examination. BENEFITS, HARMS, AND COSTS: will be able woman's cancer. Physicians empowered decide how manage pregnancy, appreciate ramifications reproduction identifies areas where good lacking advocates research areas. RECOMMENDATIONS: Women counselled informed that: 1. There that there transient increase first three four years delivery singleton baby (II-2B). Subsequently, seems lower than remain nulliparous 2. premenopausal reduced (II-2A). protective effect best extended periods (ll-2B). familial risks could potentially benefit most (II-2C). Since milk ideal nutrient newborn, since modifiable factor, encouraged breastfeed children 3. All practice self-examination Clinicians screen pregnant thorough examination early (III-B). advised examine postpartum period if woman not breastfeeding. obstetrician at any time presents symptoms 4. use ultrasltrasonography, mammography, needle aspiration, biopsies assess suspicious masses same timely fashion non-pregnant non-lactating Interruption investigation necessary, nor it recommended unless nuclear studies entertained 5. Once diagnosed, multidisciplinary approach taken. includes obstetrician, surgeons, medical radiation oncologists, counsellors 6. In patient proposed therapy fetus overall maternal Termination discussed, but altered termination pregnancy. premature menopause result treatments, especially chemotherapy given past age 30. (II-2C) 7. Up until now, modified radical mastectomy cornerstone surgical Adjuvant and, required, administered without delay. reproductive potential third trimester, benefits versus continuation fetus, addressed undergoing tamoxifen 8. wish become possible does seem associated worse (II-3C). However, they made aware support such relatively poor. 9. recurrences appear within two initial postpone (III-C). If axillary node involvement, recommendation defer five years, based opinion only Prior attempting survivor referred full oncologic evaluation. 10. no increases recurring second developing, carries health child. previously cancer, do show residual tumour, (III-B). VALIDATION: Level evidence, quality recruited publications, ensuing were reviewed discussed Committee member Gynaecological Oncology Committee. External reviewers expertise area solicited comments criticism.