OBJECTIVES. Despite the high incidence of breast cancer and multitude of breast cancer risk factors, there are limited guidelines for breast cancer screening in high-risk women during the pregnancy and breastfeeding period. The objective of this systematic review (SR) is to assess the available evidence on breast cancer screening in this population and to propose an evidence-based algorithm for screening high-risk pregnant or breastfeeding patients.

METHODS. We performed a systematic search of the literature using the electronic databases MEDLINE and Embase. Predetermined inclusion and exclusion criteria were used during the abstract screening phase and full-text data extraction phase.

RESULTS. 16 studies were included out of 2274 retrieved abstracts based on predetermined eligibility criteria. Clinical breast exam (CBE) was recommended by 12 studies in the pregnancy period and by 6 studies in the breastfeeding period. Mammography was recommended in the breastfeeding period by 2 studies. Ultrasound was limited as an adjunct for symptomatic patients with a palpable mass. Magnetic resonance imaging (MRI) was recommended in the breastfeeding period by 2 studies.

CONCLUSIONS. Based on our SR, we are proposing the first algorithm for screening high-risk women during pregnancy and breastfeeding. It is imperative to promptly identify patients at increased risk for developing breast cancer in this population. Ideally, necessary screening is completed prior to pregnancy. A CBE early in pregnancy is recommended to establish a baseline and repeated exams are recommended in women with high-risk genetic mutations. In the breastfeeding phase, breast cancer screening using imaging should be promptly resumed.

High-Risk Patients During Pregnancy and Breastfeeding: A Proposed Management Algorithm Based on A Systematic Review of the Literature