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Pregnancy-associated breast cancer is uncommon and presents unique challenges for the treating physician. Ultrasound should be performed for the evaluation of a breast mass discovered during pregnancy, although mammography can be obtained with proper fetal shielding. Biopsy of suspicious lesions should be performed. Surgery is safe during any stage of pregnancy and can consist of either mastectomy or breast-conservation therapy. Axillary staging is generally performed with axillary lymph node dissection, although sentinel lymph node biopsy can be performed without the use of blue dye, which is contraindicated in pregnancy. However, the accuracy of sentinel lymph node biopsy during pregnancy is not well established. Radiation therapy should be delayed until after delivery due to risk of fetal exposure. Chemotherapy is contraindicated during the first trimester of pregnancy. In addition, some chemotherapeutic agents are contraindicated during any stage of pregnancy. Neoadjuvant chemotherapy can be given to allow for breast-conservation therapy to be performed and also to allow for radiation to be delayed until after delivery.

Locally advanced breast (LABC) consists of inflammatory breast cancer (IBC) and non-IBC locally advanced breast cancer (non-IBC LABC).Although the diagnostic work-ups and management are similar, there are subtle differences in terms of biology and surgical management. Some of the topics in this chapter overlapped those in the early breast cancer chapter, Chap. 4. Therefore, readers are encouraged to review the early breast cancer chapter in order to have a more comprehensive understanding of managing patients with LABC.

The management of patients with early breast cancer (EBC) has dramatically evolved over the past decades. The rapid pace of progress and the frequent shift in treatment paradigms have underscored the importance of a multidisciplinary approach. Given the accelerated rate of emerging new information, it is conceivable that a number of management principles mentioned in this chapter will become obsolete by the time the book is published. Regardless, the purpose of this chapter is to provide a comprehensive framework so that the readers will have a greater appreciation and better understanding of the complexities of managing patients with early breast cancer.