By Krystal Redman (KR), DrPH, MHA, (they/she), Executive Director
In the session titled Special Populations: Pregnancy, Male and Geriatric Patients, Kausar Suleman, MD, consultant in medical oncology at King Faisal Specialist Hospital and Research Center, Ar Riyadh, Saudi Arabia, provided a presentation titled Clinical Outcome and Patients’ Characteristics of Breast Cancer Diagnosed During Pregnancy: A Retrospective Single Institutional Study. During the discussion, Dr. Suleman presented findings from a single-institution retrospective cohort study on breast cancer diagnosed during pregnancy.
Dr. Suleman began by providing some background to the study, noting that breast cancer is recognized as the second most prevalent malignancy impacting pregnant women [Note: In the remainder of this blog, I am shifting language in an effort towards inclusivity in pregnant people from here on out. As there are other gender identities and people who do not identify as cis women who also have the ability to become pregnant]. Dr. Suleman continues by stating that managing breast cancer is intricate due to the potential risks it presents to both the pregnant person and the fetus. This study aimed to present findings on the occurrence, clinicopathological features, treatment approaches, and outcomes of individuals diagnosed with breast cancer during pregnancy at a tertiary care institution in Saudi Arabia.
In this study involving 173 breast cancer patients, the findings paint a detailed portrait of the disease landscape. With a median age at diagnosis of 34 years, the cohort exhibited diverse pathological characteristics. Dominantly, 58% of patients presented with invasive ductal carcinoma (IDC), while 24% had IDC coexisting with DCIS. Notably, 82% displayed pathological grades 2 and 3, indicative of a moderate-to-high degree of cell abnormality. Hormone receptor status varied, with 52% testing positive, 45.7% negative, and 2.3% unknown. Additionally, 26% of patients experienced triple-negative disease. Staging unveiled a spectrum of disease progression, ranging from stages I to IV. Treatment approaches were diverse, with 52% and 43% receiving neoadjuvant and adjuvant chemotherapy, respectively. The median overall survival reached 127 months, and univariate analysis underscored significant correlations between clinical stage, hormonal status, and overall survival. These insights contribute valuable nuances to our understanding of breast cancer dynamics and treatment outcomes.
Dr. Suleman concluded that the challenging prognosis associated with breast cancer diagnosed during pregnancy underscores the critical need for proactive measures. Prioritizing comprehensive breast cancer awareness and robust screening initiatives is imperative. By fostering early detection and implementing effective management strategies, we can significantly enhance outcomes and contribute to improved results in the complex intersection of breast cancer and pregnancy.
Initially, upon hearing the concluding thought focusing on the need for “awareness” as a means to early detection, my “BCAction ears” went up and I thought, “oh no, not more awareness talk.” But after pondering for some time, I came to agree that we do still need awareness around the prevalence of breast cancer in pregnancy and the importance of early detection. While there is far greater awareness about breast cancer today than there once was, conversations and education about breast cancer that is diagnosed during pregnancy remain limited. In this case, awareness would translate to equitable access to information around risk, prevalence, and early detection. A breast cancer diagnosis during any stage of pregnancy is typically associated with poor outcomes, hence, the need for more education and information around early detection which will allow pregnant people to have the information they need to make an informed decision on their treatment options and how or if they choose to carry out their pregnancy.
Early detection of breast cancer in people who are pregnant needs an intersectional approach as the disease is a health justice issue and we cannot attain health justice without reproductive justice. Reproductive justice is broader than just obtaining access to reproductive care. It connects reproductive rights with social justice issues and is grounded in four major principles: 1) the right to bodily autonomy, 2) the right to have children, 3) the right to not have children, and 4) the right to parent our children in safe and healthy environments.
The connection between breast cancer and reproductive justice involves examining how issues related to reproductive health, rights, and justice intersect with breast cancer prevention, early detection, diagnosis, and treatment. Reproductive justice is a framework that goes beyond reproductive rights to address systemic inequities. When considering breast cancer, several aspects of reproductive justice come into play:
Access to Screening and Early Detection
Cultural Humility in Healthcare
Understanding the intersection of breast cancer and reproductive justice involves recognizing the diverse needs and challenges faced by individuals and communities. It calls for a holistic approach that addresses systemic inequities and ensures that all individuals can make informed choices about their reproductive health, including breast cancer prevention, detection, and treatment.
The fact stands that breast cancer diagnosed during pregnancy is associated with poor outcomes. So, yes, awareness around early detection and screens for breast cancer prior to and during pregnancy are needed. As we know, the earlier people are aware of their diagnosis, the greater options they have around their treatment and their pregnancy. However, to address the increasing prevalence of breast cancer among pregnant people, we must take an intersectional approach that involves health justice, environmental justice, and reproductive justice.