Worse prognosis for breast cancer diagnosed in advanced pregnancy and shortly postpartum: an update of the Dutch pregnancy-associated breast cancer cohort.

Purpose: Breast cancer diagnosed during pregnancy (PrBC) or postpartum (PPBC) is associated with a poorer prognosis, and earlier research indicated that outcomes differ based on timing of diagnosis. We updated and expanded our Dutch nationwide pregnancy-associated breast cancer (PABC) cohort, now also including patients diagnosed within one year after an interrupted pregnancy (AABC), to compare disease characteristics and prognosis across PrBC-, PPBC- and AABC subgroups and to non-PABC patients.

Methods: All breast cancer pathology reports of women < 45 years in the Netherlands (1988-2022) were screened to identify patients diagnosed with PrBC, PPBC (< 12 months postpartum) or AABC (< 12 months after pregnancy interruption). PABC patients were 1:3 matched on age and year of diagnosis to non-PABC breast cancer patients.

Results: In our PABC cohort (N = 787), the majority was diagnosed during pregnancy (n = 471, 60%). Two distinct prognostic subgroups were observed: a favorable group including trimester 1 PrBC, PPBC 6-12 months postpartum and AABC, and an unfavorable group diagnosed later in pregnancy (trimesters 2 and 3) or shortly postpartum (< 6 months). PABC patients showed overall, in comparison to non-PABC controls, poorer histopathological characteristics (more grade III and triple negative tumors) and a significantly worse 5-year overall survival (77% vs. 85%), persisting in multivariable analysis (HR 1.6, 95% CI 1.06 - 2.33, P = 0.025).

Conclusions: PABC patients diagnosed in advanced pregnancy or shortly postpartum are most at risk for aggressive histopathology and an unfavorable prognosis. This highlights the need for in-depth analyses between specific PABC subgroups to elucidate the etiologic mechanisms involved.