Pregnant women heeding breast cancer signs can turn to ultrasound

Ultrasound provides a safe and accurate method of detecting breast cancer and assessing response to chemotherapy in pregnant women, according to a study in the April issue of Radiology.

"We want young women to know that symptomatic breast cancer that occurs during pregnancy can be imaged, diagnosed, and treated while pregnant, so they should not wait to seek medical attention if they have suspicious symptoms," said Dr. Wei T. Yang, an associate professor of diagnostic radiology at the M.D. Anderson Cancer Center.

Breast changes related to hormonal activity during pregnancy and lactation can shroud lesions and impair mammographic detection. Moreover, safety concerns for the developing fetus may hinder the benefits of early diagnosis. Ultrasound could provide a way around these caveats in symptomatic pregnant women, Yang said.

Yang and colleagues enrolled 23 women diagnosed with 24 breast cancers. A combination of ultrasound and mammography helped diagnose 17 tumors. Ultrasound alone diagnosed four, and mammography alone diagnosed three.

The investigators detected 18 tumors in 20 women who underwent mammography. However, they found all the tumors (21) in every woman who underwent a sonographic exam. Ultrasound also depicted the spread of cancer in 15 of 18 women who had their lymph nodes evaluated. The report includes the largest group of women known to date diagnosed and treated for breast cancer during pregnancy, the researchers said.

Most patients (18) had invasive ductal carcinoma. Women diagnosed with stage II and stage III cancers made up 30% and 60% of the population group, respectively. Only two women had stage I or liver-metastasized stage IV breast cancer.

Sixteen patients underwent anthracycline-based chemotherapy in the second and third pregnancy trimesters in an attempt to shrink their advanced-stage lesions. This type of chemotherapy poses minimal risk to the developing fetus and is preferred over radiotherapy or surgery for pregnant women. Twelve of these women underwent ultrasound to assess tumor response to chemotherapy. Ultrasound accurately predicted treatment response in all of them.

"Not only can imaging help stage these cancers by assessing the lymph nodes in women who are candidates for chemotherapy, but it can also be used as a tool to assess response to chemotherapy, to determine if the treatment is effective or if a different treatment approach is necessary," Yang said.

Ultrasound should be the initial imaging modality in symptomatic pregnant women. Mammography, on the other hand, should be used in women diagnosed with invasive or in situ cancers, as it may demonstrate cancerous microcalcifications not visible with ultrasound, Yang said.

About one out of every 6000 pregnant women will develop breast cancer. Cancers in young women of child-bearing age usually appear as painless palpable masses. Symptoms, however, can include nipple discharge, skin changes, and persistent or progressive unilateral breast swelling or engorgement. Young women of child-bearing age do not typically have routine mammograms, so a growing cancer may not be found by the patient or her physician until it has progressed to a more serious stage.

For more information from the Diagnostic Imaging archives:

Elastography slashes biopsy rate for benign breast lesions

Study challenges value of ultrasound in breast cancer screening

Ultrasound BI-RADS brings consistency to lesion classification

Ultrasound accreditation efforts boost performance