Management strategy for breast cancer in pregnancy

A 34-year-old primigravid woman presents for a routine prenatal visit at 18 weeks of gestation with a breast lump. On examination, she has a painless, firm breast mass measuring 3-4 cm in diameter with overlying skin dimpling. A diagnostic mammogram shows findings suspicious for malignancy (Breast Imaging Reporting and Data System [BI-RADS] 4), and core biopsy demonstrates an invasive ductal carcinoma with both estrogen and progesterone receptor-positive staining.