Cáncer de mama y embarazo
El mes de octubre de cada año constituye una marca para todos los sistemas sanitarios a nivel mundial, pues a raíz de “la carrera de la cura” celebrada en Texas, Estados Unidos, en el año 1983 queda establecido este mes como el “Mes de la Lucha Contra el Cáncer de Mama”. La intensión de contar con todo un mes de sensibilización sobre el cáncer de mama, es el interés de que hombres y mujeres aumente en torno al tema, especialmente para contribuir a cómo detectarlo oportunamente, conocer sobre el tratamiento y así como tener presente cuáles son los cuidados posteriores al tratamiento de dicha enfermedad.
A nivel mundial, las estadísticas del cáncer de mama son notorias y alarmante, pues cada año en las Américas, más de 462,000 mujeres son diagnosticadas con cáncer de mama, y casi 100,000 mueren a causa de esta enfermedad. Si las tendencias actuales continúan, para el año 2030, se prevé que el número de mujeres diagnosticadas con cáncer de mama aumente en un 34% en las Américas. Y nuestro país no está exento de la primacía de esta malignidad, según las estadísticas del Instituto de Oncología Dr. Heriberto Pieter, recogidas en su 12vo. Registro Hospitalario de Tumores, en nuestro país el cáncer de mama constituye la primera causa de cáncer en la mujer con un 22.49%.
Pero, conociendo la radicalidad del tratamiento una vez se diagnostica un cáncer de mama, existen condiciones donde el medico se ve limitado al batallar contra esta enfermedad, el cáncer de mama es casi exclusivo de la mujer, aunque un bajo porcentaje de su incidencia se presenta en hombres.
El cáncer de mama en el embarazo se define como aquel que se presenta durante la gestación o hasta 1 año después de un parto o un aborto. Su incidencia es baja, de un 0.2% a un 3.8% de todos los cánceres mamarios lo que corresponde a 1 de cada 3,000 embarazos.
El diagnóstico del mismo durante el embarazo se ve dificultado debido a los cambios fisiológicos que experimentan las mamas en su preparación para la lactancia influidos por los cambios hormonales propios de la gestación. La interpretación de los hallazgos del examen físico es más difícil a medida que progresa el embarazo y se han reportado retrasos de hasta 2-15 meses en el diagnóstico, lo que conduce a que el tratamiento se realice en etapas más avanzadas de la enfermedad.
La mamografía, método diagnostico que juega un importante papel en la detección de esta patología, no tiene algún efecto fetal conocido, sin embargo, su efectividad es controversial reportándose de un 20% a 70% de falsos negativos debido al aumento de densidad mamaria en pacientes gestantes.
Según el literal “a”, sección 11, titulo 11 del artículo 8 de la constitución de la Republica Dominicana, el estado debe otorgar la más implícita protección posible a la maternidad, sea cual fuere la condición o el estado de la mujer.
A pesar de que contamos con las Normas Nacionales para la Prevención y Manejo de Patologías de Mama y Embarazo, estas estadísticas escasean, pero las guías internacionales también nos ayudan como referencias para el manejo de forma oportuna.
Como medida diagnostica es indispensable la exploración mamaria en su primera visita prenatal, la existencia de una masa palpable persistente generalmente mayor de 2-4 centímetros o de una masa sospechosa, obliga a un diagnóstico.
Dentro de las imágenes recomendadas a realizar la sonomamografia es la prueba de primer nivel durante el embarazo. En caso de realizar mamografía esta se puede y debe utilizarse con protección abdominal ante la sospecha de una patología maligna.
Los canceres de mama en embarazadas suelen compartir características biológicas con esta misma patología en pacientes jóvenes; Alto grado, presencia de invasión linfovascular, ausencia de receptores hormonales, HER-2 positivo o aproximadamente de un 30%.
Los protocolos internacionales, así como las guías de diferentes países recomiendan un tratamiento multidisciplinario, siempre tomando en cuenta el trimestre en que se encuentre la gestación y tener en cuenta los siguientes puntos: el pronóstico de la enfermedad no difiere de la paciente no gestante con el mismo estadio, la terminación del embarazo no influye en el pronóstico de la enfermedad, las pruebas de imágenes para el diagnóstico no difieren de las recomendadas para pacientes no gestantes, en estudio de extensión siempre valorar riesgo beneficios siempre y cuando exista alta sospecha de metástasis, la cirugía es el estándar de tratamiento, fundamentalmente la mastectomía radical modificada, no debe aplicar ni radioterapia ni hormonoterapia durante el embarazo.
Es controversial el ejercicio de la obstetricia debido a que como profesionales de esta área se manejan situaciones que incluyen un binomio, madre-hijo, es por ello que al momento de implementar medidas ante catástrofes como lo representa las malignidades mamarias. Pero es un hecho innegable que no existe un consenso mundial que nos permita un abordaje amparado en las regularizaciones de patologías de esta índole, recordando que la interrupción medica del embarazo es penado y prohibido mediante el código procesal penal de nuestro país.
El cáncer de mama es la principal causa de muerte en mujeres, su incidencia sigue en aumento y las mujeres embarazadas no están exentas de esto, pero, los propios cambios fisiológicos de las mamas frutos de la gestación podrían interferir al momento de realizar un diagnóstico oportuno y por lo tanto un desenlace favorable para toda mujer.
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- Que se Promueva la Investigación en estos casos para documental nuestras estadísticas.
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