Balancing treatment and reproductive rights in primary and recurrent phases of breast cancer diagnosed as hereditary breast and ovarian cancer syndrome: a case report

Abstract

　We herein report a case of hereditary breast and ovarian cancer syndrome (HBOC) wherein treatment during the perioperative and recurrent phases of breast cancer was conducted with respect for the patient’s reproductive rights. A 35-year-old woman with a desire for childbearing underwent embryo cryopreservation followed by breast-conserving surgery and sentinel lymph node biopsy for treatment of right primary breast cancer. Postoperatively, she was diagnosed with HBOC (BRCA1 pathogenic variant-positive). Her breast cancer, categorized as estrogen receptor (ER)-weakly positive and human epidermal growth factor receptor 2 (HER2)-negative (pT2N0M0/stage IIA), was treated with chemotherapy and radiation therapy, aiming for pregnancy and childbirth. After delivery, she planned to undergo risk-reducing salpingo-oophorectomy and endocrine therapy. However, at 18 months postoperatively (15 weeks of pregnancy), the patient developed recurrences in the chest wall, liver, and bones (ER-negative, HER2-negative). Respecting the patient’s wish to continue the pregnancy, treatment for breast cancer was commenced and she successfully delivered a child at 33 weeks of pregnancy. Treatment continued after childbirth, but the patient died 12 months following the recurrence. The presence of the child provided emotional support for the patient and her family during treatment. This case report with literature review discusses perioperative and recurrent breast cancer management in reproductive-aged patients with HBOC.