Pregnancy-Associated Breast Cancer: From Clinical and Treatment Challenges to the Emerging Role of Artificial Intelligence

Pregnancy-associated breast cancer (PABC) is a rare but increasingly encountered clinical entity, largely driven by delayed childbearing, and poses significant diagnostic and therapeutic challenges due to physiological breast changes and concerns regarding fetal safety. This narrative review aims to synthesize current evidence on the epidemiology, clinical presentation, diagnostic strategies, surgical management, systemic therapy, obstetrical considerations, and emerging applications of artificial intelligence in PABC. A comprehensive literature search was conducted across major databases, prioritizing recent studies, international guidelines, and large cohort analyses. Available evidence indicates that PABC is frequently diagnosed at a more advanced stage, partly due to delayed recognition. Ultrasound represents the first-line imaging modality, while mammography with shielding and selected MRI protocols may be safely used for staging. Surgical treatment is feasible during pregnancy, and anthracycline-based chemotherapy, with selected taxanes, can be administered during the second and third trimesters with acceptable maternal and fetal outcomes. In contrast, radiotherapy and most targeted therapies are deferred until postpartum. Obstetrical management should aim to avoid iatrogenic prematurity while ensuring adequate fetal monitoring. A multidisciplinary, trimester-adapted approach remains essential, although further prospective studies are required to address existing evidence gaps and optimize long-term outcomes.