Carcinoma of the breast occurring during pregnancy

Abstract

1.- Seventy-four cases of breast cancer have been observed in the Tumor Clinic of Hospital San Juan de Dios, in San José, Costa Rica. Two of these were cases of mammary carcinoma occuring during pregnancy. Including one other private case, such cases form only 4.05 per cent of the total incidence of breast carcinoma. The authors present the clinical history o f two patients, and other some considerations on the development of the clinical picture and the palliative treatment given.

2.- The malignancy of gestational mammary carcinoma is considered by the authors as due in part to:

a) the normal histological modification of the mammary glands during preg­nancy, favoring karyokinesis of neoplastic elements;

b) the effect of the hormonal component formed by ovarian and placental hormones, the latter being especially important. The fact that patients are usually relatively young, in full hormonal activity, is also significant in this respect;

c) the increase in blood supply of the breast during pregnancy, increasing the possibility of circulatory metastasis as is shown by the frequency of bone metastasis at an early date. The increased blood supply, besídes, constitutes a greater pabulum vitae for malignant cells;

d) the difficulty of early diagnosis of the tumor, the latter being masked by the natural increase in the turgidity of the breast and to the dísregard of the observed changes by the patient, who relates them to her pregnant condition.

3.-In the light of BURT and CASTLEMAN'S report of pituitary cytolo­gical modifications in breast cancer patients the authors consider oophorectomy, of little value as a palliative treatment in cases of mammary carcinoma ocurring duríng pregnancy, because of the increased production of estrogens by the suprarenals caused by a corticohypophysiary compensatory stimulus. On the other hand, oophorectomy is considered advisable in cases of mammary carcinoma ocurring in young prerrienopausic women, in order to eliminate the danger of placental endocríne stimulation in the event of pregnancy after mastectomy.

4.- The presence of multiple follicular cysts in the ovaries of one patient suggests the need of further investigatíon of this condition, its occurence and sígnificance in cases of mammary carcinoma in general and particulary in ges­tational cases.