Lidia Schapira, MD

There is concern and growing evidence that the supply of medical oncologists in the United States will be insufficient to meet the needs of future patients. With an aging population and increasing complexity of cancer therapies, it is clear there will be more patients and that they will live longer and require expert care. It is equally clear that the number of specialists trained in cancer medicine is not growing fast enough to meet projected needs, so new models of care will need to be designed and implemented. Innovation in practice models will require the integration of non-physician practitioners (nurse practitioners and physician assistants) into multidisciplinary teams, broader use of technology to allow virtual consultations and the secure exchange of vital health information, increased utilization of community services, and public acceptance.

The relationship between pregnancy and breast cancer is complex,and a paucity of available data further complicates decision-makingfor many women diagnosed with breast cancer during pregnancy ordesiring to become pregnant after such a diagnosis. Treatment of breastcancer during pregnancy requires a multidisciplinary care team andcareful consideration of the risk of the disease and gestational age ofthe fetus, in conjunction with the patient’s preferences. Chemotherapyshould be deferred beyond the first trimester. There is no evidence thatpregnancy in a breast cancer survivor will decrease long-term survival;in fact, studies suggest a potential protective effect of pregnancy afterbreast cancer in terms of the risk of recurrence. However, the availablestudies are limited by substantial potential biases, and concerns remainfor some women and their doctors about the risks of pregnancy afterbreast cancer. This article reviews what is known about the associationbetween pregnancy and breast cancer, discusses treatment options forwomen diagnosed with the disease during pregnancy, and summarizesevidence regarding the safety of pregnancy after breast cancer.