Epidemiological, Clinical, Paraclinical and Therapeutic Characteristics of Pregnancy-Associated Breast Cancer: Experience of the Medical Oncology Department of Hassan II University Hospital, Fez

Abstract

Intro duction: Breast cancer represents a major public health problem and is the most common cancer among women worldwide. Its occurrence during pregnancy is rare and is defined as breast cancer diagnosed during gestation or within one year postpartum. Pregnancy-associated breast cancer (PABC) is often described as more aggressive, mainly due to delayed diagnosis compared to breast cancer occurring outside pregnancy. The coexistence of these two clinical conditions poses significant diagnostic, therapeutic, and prognostic challenges. The aim of this study was to describe the epidemiological, clinical, paraclinical, and therapeutic characteristics of breast cancer diagnosed during pregnancy in patients managed at Hassan II University Hospital in Fez. Methods: This was a retrospective descriptive study including pregnant patients diagnosed with breast cancer and treated at the Medical Oncology Department of Hassan II University Hospital, Fez, between January 1, 2021, and December 31, 2024. Epidemiological, clinical, radiological, histopathological, and therapeutic data were collected and analyzed descriptively. Results: Twelve patients were included, representing 3.1% of all breast cancer cases. The mean age was 35 years, and 57% of patients were multiparous. Breast cancer was diagnosed during pregnancy in all cases, with a mean gestational age of 20 weeks. The main presenting symptom was self-detection of a breast lump (70%), with a mean consultation delay of 4 months. The mean tumor size was 30 mm. Local inflammatory signs were observed in 50% of cases, and suspicious axillary lymphadenopathy in 33%. Metastatic disease at diagnosis was present in 16.7% of cases, mainly involving bone metastases. Invasive carcinoma of no special type accounted for 95% of cases, with SBR grade II - III tumors in 85%. Hormone receptors were negative in 50% of patients, HER2 overexpression was observed in 25%, and the triple-negative subtype in 16.7%. All patients received chemotherapy, and surgery was performed in 83% of cases. Disease evolution was marked by recurrence in 50% of patients. Conclusion: Pregnancy-associated breast cancer remains a complex clinical entity, often characterized by delayed diagnosis and aggressive histopathological features. Through this monocentric series, one of the few reported in our setting, our study highlights the epidemiological, clinical, paraclinical, and therapeutic characteristics of PABC within a Moroccan university hospital. It emphasizes the importance of early, guideline-based multidisciplinary management to allow appropriate oncological treatment during pregnancy and underlines the need to strengthen awareness and early diagnosis in order to improve maternal outcomes.