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Geburtshilfe Frauenheilkd 2003; 63(5): 417-425
DOI: 10.1055/s-2003-39635
Übersicht

Georg Thieme Verlag Stuttgart · New York

Schwangerschaft und Mammakarzinom - ein Überblick

Pregnancy and Breast Cancer: A ReviewI. Bauerfeind 1 , M. Untch 1
  • 1Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Ludwig-Maximilians-Universität München, Klinikum Großhadern
Further Information

Publication History

Eingang Manuskript: 18. März 2002

Publication Date:
02 June 2003 (online)

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Zusammenfassung

Die Inzidenz eines Mammakarzinoms während der Schwangerschaft oder bis zu einem Jahr post partum ist gering. Hormonelle Einflüsse spielen eine wesentliche Rolle in der Karzinogenese des Mammakarzinoms, dennoch scheint die Prognose für Frauen in und außerhalb der Schwangerschaft identisch zu sein. Die Diagnose ist aufgrund vielfältiger Veränderungen der Brustdrüse intra graviditatem deutlich erschwert. Die sehr häufig verspätete Diagnosestellung erklärt zu einem gewissen Teil die schlechten Überlebensdaten. Die Therapie darf sich nicht nur an den möglichen Nebenwirkungen für die Mutter ausrichten, sondern muss ebenso die Kurz- und Langzeittoxizität für das ungeborene Leben berücksichtigen. Die operative Therapie folgt den bekannten Empfehlungen. Die adjuvante Bestrahlung sollte nach der Geburt erfolgen. Eine (neo-)adjuvante, anthrazyklinhaltige Chemotherapie scheint im zweiten und dritten Trimenon für Mutter und Kind ohne wesentliche Nebenwirkungen möglich zu sein. Die angewandten Therapien können einen negativen Einfluss auf die Fertilität der jungen Frauen haben. Eine Schwangerschaft nach einem behandelten Mammakarzinom verändert die Prognose der Patientinnen nicht.

Abstract

Breast cancer during pregnancy or the first year postpartum is rare. While hormonal factors play an important role in the carcinogenesis of breast cancer, the prognosis of pregnant patients appears to be identical to that of nonpregnant women. The physiologic changes the breast undergoes with pregnancy can make it difficult to diagnose cancer and delayed diagnosis may contribute to unfavorable survival. Treatment plans need to consider potential immediate and long-term toxicity for the fetus. Surgical treatment should be the same as for nonpregnant women. Adjuvant radiation should be deferred until after delivery. Neoadjuvant anthracycline-based chemotherapy in the second and third trimester appears to be without significant side effects for mother or fetus. Certain treatment modalities can impair future fertility. Pregnancy after breast cancer does not affect the prognosis.

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Dr. Ingo Bauerfeind

Oberarzt der Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der LMU München, Klinikum Großhadern

Marchioninistraße 15

81377 München

Email: ingo.bauerfeind@med.uni-muenchen.de

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