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Jullien Brady · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 39

Here is the answer for the first essay of the week on breast cancer:

A woman has had a breast cancer a year previously. She is considering pregnancy. She has consulted you for pre-pregnancy counselling.
What factors would you need to ascertain to assess the severity of her disease status? (4 marks)
What are the implications of her diagnosis on pregnancy? (5 marks)
If the patient decided to embark upon pregnancy, what modifications would you suggest to her care? (11 marks)

What do we know?
Had treated breast cancer 1 year previously.
Is considering pregnancy, so not yet pregnant.

What do we not know?
How breast cancer was treated and was it successful?
Has treatment finished?
Age of patient.
Previous obstetric history etc.

Category.
Obstetrics, medical disorder.

Approach.
Counselling, modified management.

Impact.
Obstetricians likely to see more cases, due to increased incidence but falling mortality of breast cancer.

Concept.
Patient should be counselled in light of information on previous treatment and bearing on possible pregnancy.

What factors would you need to ascertain to assess the severity of her disease status? (4 marks)
If the patient is still undergoing treatment for her breast cancer pregnancy is contra-indicated.
The treatments used on any treated breast cancer should be established.
Chemotherapy treatment may have caused a premature menopause.
Regular menstruation and ovulation should be investigated if indicated, but resumption of menstruation following chemotherapy does not confirm restoration of fertility.

What are the implications of her diagnosis on pregnancy? (5 marks)
Long term survival rates after breast cancer do not appear to be affected by subsequent pregnancies.
Fertility may have been compromised by chemotherapy.
There appears to be an increased chance of pregnancy loss and miscarriage following treatment for breast cancer.
There is no evidence that cytotoxic drugs used in the treatment of breast cancer prior to pregnancy produce any adverse effects on fetal development or the neonate.

If the patient decided to embark upon pregnancy, what modifications would you suggest to her care? (11 marks)
Deferring pregnancy.
It is recommended that pregnancy be deferred until 2 years after treatment, to allow differentiation of those patients with a better chance of long term survival from those with more aggressive disease. Younger women have significantly lower survival rates, and higher local and distal relapse rates, so those women under the age of 33 are advised to defer pregnancy for 3 years to reduce the risk of relapse.
The final decision on deferring pregnancy should be the patients.
Ante-natal care.
Standard pre-conceptual advice regarding diet, exercise, smoking, folic acid, and rubella status should be given.
Normal ante-natal screening should be offered.
Intra-partum care.
Vaginal delivery is not contra-indicated, and decisions for delivery should be conducted on obstetric grounds.
Post-partum care.
There is no evidence to contra-indicate breast feeding from the unaffected breast. With regard to the affected breast, conserving surgery may allow for feeding, but irradiation causes fibrosis and makes lactation unlikely.
Suitable contraceptive advice should be given, with the avoidance of oestrogen containing methods that may compromise breast feeding and increase recurrent breast disease risk.
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Jullien Brady B.Sc. MB.BS. MRCOG.
Teale Fenning Administrator

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

totally agree with section II and III

Jullien Brady · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 39

Those are all valid points, but perhaps a little to detailed for something that is only worth 4 marks.

The marking scheme reflects a more wide reaching approach.
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Jullien Brady B.Sc. MB.BS. MRCOG.
Teale Fenning Administrator

Nick Raine-Fenning · Posted: Wed Feb 28, 2007 4:31 pm Post subject:

I'm closing this as we have transferred the above posts into the original Essay post which can be found by clicking here

Better to have everything in one place

Wink

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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997