Breast cancer and pregnancy: the ultimate challenge.

An update on a series of 413 patients with carcinoma of the breast associated with pregnancy and referred to The Princess Margaret Hospital between 1931 and 1985 is presented. Coincident pregnancy is seriously detrimental to survival and, to a lesser degree, lactation. Subsequent pregnancies do not affect survival provided the pregnancy occurs at least one year after treatment for breast cancer, and preferably two years. Subsequent pregnancy may confer an improved prognosis. Interference in terms of a therapeutic abortion in breast cancer with coincident, lactational and subsequent pregnancies, is associated with decreased survival and ovarian ablation confers no benefit. Investigation and local treatment for coincident pregnancies should be limited to the absolute minimum necessary to achieve local control. Aggressive management should be reserved for acute life-threatening situations and then only after frank discussion with the patient. Adjuvant therapy is recommended after delivery and for lactational presentations, even if nodes are negative, due to the poor prognosis.