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    Awarded Grants
    The Relationship Between Breast Cancer and Pregnancy: A Study of the Diagnosis, Management and Outcomes in Young Breast Cancer Patients and Their Families

    Scientific Abstract:
    THE RELATIONSHIP BETWEEN BREAST CANCER AND PREGNANCY: A STUDY OF THE DIAGNOSIS, MANAGEMENT AND OUTCOMES IN YOUNG BREAST CANCER PATIENTS AND THEIR FAMILIES Gestational breast cancer is a devastating illness to the woman, her family and treating clinicians and health professionals. It is defined as breast cancer diagnosed during pregnancy or in the first twelve months post partum. Each year it affects 200 families in Australia and 3000 in the United States of America. Today, more women are delaying pregnancy until their 30’s or 40’s and at this age the incidence of breast cancer begins to rise. Therefore, the combination of pregnancy and cancer is likely to increase. In 2002, the Western Australian (WA) Gestational Breast Cancer Project was established to review the clinical epidemiology, management and outcomes of two groups of young women diagnosed with breast cancer in WA between 1982 and 2000: Group 1 - women diagnosed with gestational breast cancer (148 cases): and Group 2 - women treated for breast cancer and who subsequently conceived (98 cases). Cases for this population-based study of breast cancer and pregnancy were identified from the WA Data Linkage System. This health data linkage system, one of the most comprehensive in the world, links together all hospital admission records, death records and cancer registrations for all people living in the state of Western Australia, from 1982 onwards. Data linkage is a useful tool in identifying cases of rare diseases and conditions where clinical trials are unethical and it assists in investigating the treatment and outcome of these diseases. The present proposal aims to expand the knowledge-base established in the foundation study to further evaluate the relationship between pregnancy and breast cancer. From our original work, we have identified three themes that warrant further investigation, they are: ▪ Theme 1 will update the WA Gestational Breast Cancer Project dataset to investigate in more detail the management and outcomes of breast cancer and pregnancy in women diagnosed with gestational breast cancer and breast cancer survivors who subsequently conceive. The management and survival outcomes of women diagnosed with gestational breast cancer will be compared to all other women diagnosed with breast cancer at age 45 years or below in WA. This will establish what role the management of breast cancer and concurrent or subsequent pregnancy play in the survival outcomes for these women. ▪ Theme 2 will assess imaging and pathology in the diagnosis of gestational breast cancer. The utilization of breast imaging in the diagnosis of gestational breast cancer will be assessed, and the imaging examinations reviewed and compared to images from age comparable non-gestational breast cancer controls. Pathology specimens from our gestational breast cancer cohort will also be reviewed and compared with pathology specimens from age comparable non-gestational breast cancer controls, using conventional and molecular biological methods. Imaging and pathology will be examined and compared using current local reporting guidelines, to identify any imaging or pathological characteristics that are unique to gestational breast cancer and which can be related to the cancer outcome. ▪ Theme 3 will identify the specific psychological and social needs of gestational breast cancer survivors by comparing them to other young women who have been diagnosed with breast cancer and/or have been pregnant. Semi-structured interviews, supplemented with information from two validated questionnaires (Sexual Activity Questionnaire and the General Health Questionnaire) will be used and thematic assessment of the interviews will be undertaken using N-Vivo data management software to identify the unique needs of women diagnosed with gestational breast cancer. Outcomes and Benefits: The anticipated benefit of this project (locally, nationally and internationally) is that it will provide population-based knowledge on the complex relationship between breast cancer and pregnancy. This knowledge will fuel the evidence-base from which best practice guidelines can be developed for the management of gestational breast cancer and young breast cancer survivors considering pregnancy. These updated guidelines will give health professionals more confidence to manage these special women. It will also provide an information source for these women so that they may more fully participate in the decision-making processes surrounding the management of their breast cancer and pregnancy.

    Lay Abstract:
    THE RELATIONSHIP BETWEEN BREAST CANCER AND PREGNANCY: A STUDY OF THE DIAGNOSIS, MANAGEMENT AND OUTCOMES IN YOUNG BREAST CANCER PATIENTS AND THEIR FAMILIES Pregnancy-associated breast cancer, also known as gestational breast cancer, is a devastating illness to the woman, her family and the treating health professionals. It is defined as breast cancer diagnosed during pregnancy or in the first twelve months after delivery. In today's society, where more women are delaying pregnancy until their 30's or 40's when the risk of breast cancer begins to rise, the combination of pregnancy and breast cancer is likely to increase. Each year in Australia, 200 additional families are affected by gestational breast cancer, in the United States of America it will affect close to 3000 families a year. In 2002, the Western Australian Gestational Breast Cancer Project was established to identify two special groups of women diagnosed with breast cancer in Western Australia: 1. Women diagnosed with gestational breast cancer. 2. Breast cancer survivors who subsequently became pregnant. Cases were identified for the study using the Western Australian Data Linkage System. This health data linkage system, one of the most comprehensive in the world, links together all hospital admission records, death records and cancer registrations for all people living in the state of Western Australia, from 1982 onwards. Data linkage is a useful tool in identifying cases of rare diseases and conditions where clinical trials are unethical and it assists in investigating the treatment and outcomes of these diseases. This unique data linkage system has allowed the Western Australian Gestational Breast Cancer Project to identify all Western Australian women diagnosed with gestational breast cancer and breast cancer survivors who have become pregnant - making this one of the largest population studies of breast cancer and pregnancy in the world. The information collected on diagnosis, treatment and outcomes in this study will provide a much more accurate and detailed picture of these two special groups of women than in previous single hospital-based studies. The purpose of this application is to expand this important research program to further explore the relationship between breast cancer and pregnancy. Three themes will be used to do this: · Theme 1 will investigate in more detail the management and outcomes of gestational breast cancer and breast cancer in young women who subsequently conceive. We will also look at how the management and outcomes of these women differs from all other women in Western Australia diagnosed with breast cancer before the age of 45 years. · Theme 2 will review the role of imaging and pathology in women diagnosed with gestational breast cancer. We will compare their imaging and pathology with that of non-gestational breast cancers diagnosed in similar aged women. This will allow us to assess what effect pregnancy and breastfeeding has on the imaging and pathology of breast cancers, and how this may affect the diagnosis, treatment and outcomes of gestational breast cancer. · Theme 3 will investigate the psychosocial needs of women diagnosed with gestational breast cancer. This will involve interviewing and listening to how women themselves are affected by the disease - no study of gestational breast cancer has previously reported from the women’s point of view. This study will provide a new insight into how pregnancy and breastfeeding may affect breast cancer diagnosis, treatment and outcomes. The information provided by this study will assist in the development of best practice guidelines that health professionals can use when managing this group of special women. It will also enable women diagnosed with gestational breast cancer and those younger women diagnosed with breast cancer who may want to have children in the future, to make informed choices about the management of their breast cancer and pregnancy.