First-trimester pregnancy-associated breast cancer managed without pregnancy termination: a report with long-term follow-up.

Abstract

Pregnancy-associated breast cancer (PABC) presents unique challenges requiring a multidisciplinary approach to balance maternal treatment efficacy with fetal safety. This case describes a first-trimester breast cancer diagnosis, managed with a total mastectomy and axillary lymph node dissection, followed by a specialised adjuvant chemotherapy plan. Chemotherapy was initiated after the first trimester, with additional chemotherapy administered post partum. Although the National Comprehensive Cancer Network guidelines suggest considering early termination for first-trimester PABC, the patient opted to continue the pregnancy. A multidisciplinary team carefully planned the treatment sequence to minimise fetal risks while ensuring oncologic efficacy, considering the patient's concerns. A 9-year follow-up demonstrated no cancer recurrence and normal child development. This case underscores the importance of individualised treatment strategies in PABC, considering maternal prognosis, gestational age, treatment timing and patient preferences. With a multidisciplinary and patient-centred approach, pregnancy can safely continue alongside cancer treatment, achieving positive outcomes.