Pregnancy-associated breast cancer is one of the most challenging scenarios that we encounter in breast cancer care because we are making decisions that affect the life of a young patient and the fetus growing inside of her. The risks and benefits of each treatment modality must be discussed so that the patient fully understands and feels confident about the treatment decisions she and her physician are making (culturally appropriate decision making) whether this includes surgery while pregnant, systemic therapy, early delivery of the child, or terminating the pregnancy.