Objective: To determine the incidence, obstetric and cancer management, perinatal outcomes and health care experiences of women with gestational breast cancer (GBC).
Methods: Population study using AMOSS to identify women with GBC from January 2013-June 2014. Qualitative study of perceived quality of care among 17 survivors diagnosed with GBC from 2008-2013 was undertaken. GBC was defined as a first diagnosis of breast cancer based on pathological diagnosis or determined from medical record(s) during pregnancy or six weeks postpartum.
Results: 47 women in Australia and New Zealand aged 23-53 years were diagnosed with GBC (40 in pregnancy, 7 postpartum) giving an estimated incidence of 8.5 per 100,000 women giving birth (95% CI: 6.1–11.0 per 100,000). 76.6% experienced change(s) in the breast prior to diagnosis, 53.2% had unifocal and 25.5% multifocal GBC, 27.7% had metastatic cancer. 23 (57.5%) women diagnosed during pregnancy had surgery and 18 (45%) had systemic therapy. 72.5% of women diagnosed during pregnancy and 85.7% diagnosed postpartum received systemic therapy postpartum. 29 (61.7%) women were induced, cancer management was the indication for 21 of them. Most women (68.1%) had a vaginal birth. Of 47 liveborn singletons 16 were male and 31 female, 40.4% were born preterm (<37 weeks), 23.4% were low birthweight, and 32.0% required admission to higher care. There were no perinatal deaths.
Hallmarks of perceived quality of care included: being taken seriously when presenting with a lump; prompt referral; involvement in treatment planning; the provision of consistent information; well co-ordinated care between oncology and obstetric services; and access to breast care nurse.
Conclusion: The high rate of preterm birth but reassuring good neonatal outcomes reflects the effective use of induction for planned early delivery to support cancer management. Responsiveness to their psychological need is of particular importance for the emotional well-being of women diagnosed with GBC.
*Funding gratefully acknowledged from National Breast Cancer Foundation (NBCF) Novel Concept Award (2012-2014)