There are several viable treatment options for patients with PABC considered un-harmful to fetal development. Trastusumab, or Herceptin, targets HER2 protein and successfully combats aggressive breast cancer. In standard doses, it appears to be safe to the fetus even when administered during the first trimester. A likely side effect of Herceptin is anhydramnios, which can be monitored for throughout the stages of a pregnancy (Shrim et al. 2008). Anthracyclines, commonly used in chemotherapy, appear to be non-toxic, and have been used to successfully cure PABC patients in their second and third trimester. However, first trimester spontaneous abortions are documented to increase dramatically in anthracycline receiving PABC patients (Ring A. E. et al. 2005). Taxanes, such as paclitaxel, docetaxel, and vinorelbine, are microtubule agents that are highly active against breast cancer. As cytotoxic drugs they can possibly disrupt organogenesis and their administration should therefore be delayed until after the first trimester. Taxanes as well as anthracycline treatments should also be halted three weeks prior to delivery to prevent the occurrence of neutropenia, a decrease in white blood cells (neutrophil) that raises the risk of infection, and allow for regeneration of platelet count in the bloodstream (Mir O. et al 2008). Breast surgery can be safely performed at any point of a pregnancy although it is recommended to be postponed until after the first trimester. External beam radiation and hormone therapy are both documented to have negative effects on a developing fetus and therefore should not be considered as possible treatment options for PABC patients. In diagnosing and assessing PABC, ionizing radiation should be replaced by chest x-rays accompanied with proper shielding to protect the fetus. Sonograms appear to be more effective in diagnosing breast cancer than mammograms, because of the changes in pregnancy related breast density. Although PABC treatment is more complicated than standard breast cancer treatment, treatment during pregnancy has been proven to be a feasible and recommended option (Loibl S. et al. 2005)
