Pregnancy during adjuvant tamoxifen therapy: A case of temporary interruption and postpartum metastatic recurrence

Authors

  • Dr. Morris Maganjo University of Nairobi, Department of Obstetrics and Gynaecology, Nairobi, Kenya https://orcid.org/0000-0001-7075-0200
  • Professor Rose Kosgei University of Nairobi, Department of Obstetrics and Gynaecology, Nairobi, Kenya
  • Dr. Humphrey Obwaya University of Nairobi, Department of Obstetrics and Gynaecology, Nairobi, Kenya https://orcid.org/0000-0002-0827-4116
  • Dr. Allan Ikol Kenyatta National Hospital, Department of Obstetrics and Gynaecology, Nairobi, Kenya https://orcid.org/0009-0005-4879-9792
  • Dr. Maurine Mutua University Health Services, University of Nairobi

DOI:

https://doi.org/10.59692/jogeca.v37i3.420

Keywords:

breast cancer, endocrine therapy, metastasis, pregnancy, tamoxifen

Abstract

Background: Limited data exist regarding recurrence risk in pregnant women with hormone receptor-positive breast cancer who temporarily discontinue endocrine therapy.

Case presentation: A 37-year-old gravida 4, para 3, presented for antenatal care at 13 weeks’ gestation while on adjuvant tamoxifen, which she had taken for two months before conception. Examination revealed a fundal height of 18 weeks and a healed mastectomy scar. Ultrasonography confirmed a dichorionic diamniotic twin pregnancy. Tamoxifen was discontinued, and pregnancy proceeded uneventfully until spontaneous preterm delivery at 34 weeks. Both neonates were clinically normal. Tamoxifen was resumed postpartum; however, 5 months after delivery, the patient developed metastatic recurrence and subsequently succumbed.

Conclusion: Pregnancy during breast cancer is not uncommon and poses complex clinical challenges. A multidisciplinary team is key to optimize maternal and neonatal outcomes.

Keywords: breast cancer, endocrine therapy, metastasis, pregnancy, tamoxifen

Author Biographies

  • Dr. Morris Maganjo, University of Nairobi, Department of Obstetrics and Gynaecology, Nairobi, Kenya

    Resident,

    Department of Obstetrics and Gynaecology

    University of Nairobi

  • Professor Rose Kosgei, University of Nairobi, Department of Obstetrics and Gynaecology, Nairobi, Kenya

    Prof. Rose Jepchumba Kosgei

    MBChB, MMed (Obs/Gyn), Fell. Gyn Onc, MSc (Clinical Trials), PhD

    Associate Professor Department of Obstetrics and Gynecology 

    Coordinator Gyn. Onc Fellowship Program

    University of Nairobi 

  • Dr. Humphrey Obwaya, University of Nairobi, Department of Obstetrics and Gynaecology, Nairobi, Kenya

    Resident,

    Department of Obstetrics and Gynaecology

    University of Nairobi

  • Dr. Allan Ikol, Kenyatta National Hospital, Department of Obstetrics and Gynaecology, Nairobi, Kenya

    Consultant obstetrician and gynaecologist,

    Maternal fetal specialist

    Kenyatta National Hospital

References

Kenya Medical Research Institute. Nairobi cancer registry: Cancer incidence report 2000-2002. Nairobi: Kenya Medical Research Institute; 2006 Oct. Available from: https://www.healthresearchweb.org/les/CancerIncidenceReportKEMRI.pdf.

Kadakia KC, Henry NL. Adjuvant endocrine therapy in premenopausal women with breast cancer. Clin Adv Hematol Oncol. 2015;13(10):663-672.

Partridge AH, Gelber S, Peppercorn J, et al. Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol. 2004;22(20):4174-4183. doi:10.1200/JCO.2004.01.159

Anderson RA, Lambertini M, Hall PS, Wallace WH, Morrison DS, Kelsey TW. Survival after breast cancer in women with a subsequent live birth: Influence of age at diagnosis and interval to subsequent pregnancy. Eur J Cancer. 2022;173:113-122. doi:10.1016/j.ejca.2022.06.048

Partridge AH, Niman SM, Ruggeri M, et al. Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer. N Engl J Med. 2023;388(18):1645-1656. doi:10.1056/NEJMoa2212856

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Breast Cancer, Version 4.2025. NCCN.org. Updated April 30, 2025. Accessed October 7, 2025. https://www.nccn.org/guidelines/guidelines-detail?id=1419

Athman Omar AM, Abdel-Bary A, Elsaka RO. Tamoxifen exposure in pregnancy after synchronous breast and thyroid cancer. Ecancermedicalscience. 2020;14:1125. Published 2020 Oct 15. doi:10.3332/ecancer.2020.1125

Braems G, Denys H, De Wever O, Cocquyt V, Van den Broecke R. Use of tamoxifen before and during pregnancy. Oncologist. 2011;16(11):1547-1551. doi:10.1634/theoncologist.2011-0121

Loibl S, Azim HA Jr, Bachelot T, et al. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC). Ann Oncol. 2023;34(10):849-866. doi:10.1016/j.annonc.2023.08.001

Hartnett KP, Mertens AC, Kramer MR, et al. Pregnancy after cancer: Does timing of conception affect infant health?. Cancer. 2018;124(22):4401-4407. doi:10.1002/cncr.31732

Buonomo B, Brunello A, Noli S, et al. Tamoxifen Exposure during Pregnancy: A Systematic Review and Three More Cases. Breast Care (Basel). 2020;15(2):148-156. doi:10.1159/000501473

MacCallum J, Cummings J, Dixon JM, Miller WR. Concentrations of tamoxifen and its major metabolites in hormone responsive and resistant breast tumours. Br J Cancer. 2000;82(10):1629-1635. doi:10.1054/bjoc.2000.1120

Moorthie S, Blencowe H, Darlison MW, et al. Estimating the birth prevalence and pregnancy outcomes of congenital malformations worldwide. J Community Genet. 2018;9(4):387-396. doi:10.1007/s12687-018-0384-2

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Published

2025-09-30

How to Cite

Pregnancy during adjuvant tamoxifen therapy: A case of temporary interruption and postpartum metastatic recurrence. (2025). Journal of Obstetrics and Gynaecology of Eastern and Central Africa, 37(3), 108-112. https://doi.org/10.59692/jogeca.v37i3.420

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