INFLAMMATORY BREAST CANCER

Editor's note: This document provides a brief description of inflammatory breast cancer. For comprehensive information on this and other types of breast cancer, please refer to the American Cancer Society document Breast Cancer.

What is inflammatory breast cancer?

Inflammatory breast cancer (IBC) is rare. It is not a new type of breast cancer, but it is very important to distinguish IBC from other types of breast cancer because there are major
differences in its symptoms, prognosis, and treatment.
"Inflammatory" or "inflammation" refers to changes in the body's tissues that can be caused by injury, irritation, or infection. This reaction typically involves redness, warmth, and swelling in the involved parts of the body. These symptoms are caused by increased blood flow and the buildup of white blood cells.
Doctors call some breast cancers "inflammatory breast cancer" because the affected breast displays the same symptoms that occur with inflammation. However, the symptoms of IBC
are not caused by infection or injury. They are caused by cancer cells blocking lymph vessels in the skin.
Although there is some disagreement in the numbers, IBC probably accounts for about 1% to 3% of all breast cancers diagnosed in the United States.

How is IBC different from the more common types of breast
cancer?

IBC causes symptoms that are often different from those of more common breast cancers It often does not have a breast lump, and it may not show up on a mammogram. Because it
doesn't look like a typical breast cancer, it can be harder to diagnose.

IBC tends to occur in younger women, and African-American women appear to be at higher risk of IBC than white women.
IBC also tends to grow more quickly and aggressively than the more common types of breast cancer. It is already considered to be at least stage IIIB (locally advanced) when it is first
diagnosed,, and may be stage IV if it has spread to distant parts of the body. Because of this, IBC is often harder to treat successfully than other types of breast cancer.

What are the signs and symptoms of IBC?

Common signs and symptoms of IBC can include:

• breast swelling, which is usually sudden with one breast much larger than the other

• itching

• a pink, red, or dark colored area, sometimes with a texture
like the skin of an orange

• ridges and thickened areas of the skin

• breast feeling warm to the touch

• nipple retraction

• breast pain

The tenderness, redness, warmth, and itching that are often there, are also common symptoms of a breast infection or inflammation (such as mastitis). Because these conditions are much more common than IBC, a doctor may at first suspect them as the cause. This may delay the true diagnosis. By the time cancer is diagnosed, lymph nodes may be enlarged under the arm or above the clavicle (collar bone).

If you have any of these symptoms, it does not mean that you have IBC, but you should see your doctor without delay.

Can IBC be detected by mammogram or breast examination?

Because of the way IBC grows and spreads, a distinct lump may not be noticeable during a clinical breast exam, breast self-exam, or even on a mammogram. However, signs of IBC can
be seen on the surface of the skin, and skin thickening often shows up on a mammogram and can be seen during a clinical breast exam or breast self-exam. Symptoms of IBC can develop very quickly, so women should pay attention to how the skin on their breasts looks and tell their doctors about any changes in skin texture or breast
appearance.

Because breast redness and swelling is more often caused by an infection than by IBC, doctors may first try treatments such as antibiotics. However, you will need to keep your doctor informed if treatment is not clearing up the problem, and especially if the symptoms continue to worsen or spread. Ask for a referral to a specialist or seek a second opinion if you are concerned.

Following American Cancer Society guidelines for early detection of breast cancer can improve a woman's odds of finding breast cancer (especially the usual forms of breast cancer, but also IBC) as early as possible, when it can be treated most successfully.

• Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.

• Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional, preferably every 3 years. After age 40, women should have a breast exam by a health professional every year.

• Breast self-exam (BSE) is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.

• Women at high risk (greater than 20% lifetime risk) should get an MRI with their mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI
screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.
(For more information on the American Cancer Society guidelines, see the separate document, Breast Cancer: Early Detection.)

How is IBC diagnosed?

Like all types of breast cancer, the diagnosis is made by a biopsy -- removing a sample of the breast tissue and looking at it under the microscope. Breast biopsies can be done in many ways. Samples of breast tissue can be removed using fine needle aspiration, large core biopsy, vacuum assisted biopsy, or open (excisional or incisional) biopsies -- depending on where the affected area is, what it looks like, and who finds it. Skin biopsies are helpful in
some cases.

How aggressive is IBC?

IBC is more likely to grow quickly and to have spread to nearby lymph nodes at the time it is found than other types of breast cancer, and the prognosis (outlook) is generally not as good.
Doctors often use 5-year survival rates as a way to discuss prognosis in people with cancer.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after being diagnosed with cancer. (Many of these patients live much longer than 5 years.) Fiveyear relative survival rates, such as the numbers below, take into account the fact that some patients with cancer will die from other causes. Theyare considered to be a more accurate way to describe the outlook for patients with a particular type of cancer.

According to data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, for women who were diagnosed with inflammatory breast cancer
between 1988 and 2001, the 5-year relative survival rate was about 40%. This compares with about 87% for all breast cancers combined.

Although these numbers are among the most current available, they were derived from patients treated at least several years ago. Improvements in treatment since then mean that the survival rates for women now being diagnosed with thesecancers may be higher. Survival statistics can sometimes be useful as a general guide, but they may not accurately represent any one person's prognosis. A number of other factors, including other tumor
characteristics and a person's age and general health, can also affect outlook. Your doctor is likely to be a good source as to whether these numbers may apply to you, as he or she is familiar with the aspects of your particular situation.

How is IBC treated?

The usual treatment for IBC starts with chemotherapy. Using chemotherapy before surgery is called neoadjuvant chemotherapy. Anthracyclines (doxorubicin or epirubicin) and taxanes
(paclitaxel or docetaxel) are the most effective chemotherapy drugs for IBC, and most women with IBC receive a combination of at least two different drugs. If the cancer is HER2-positive (the cancer cells have too much of a protein called HER2), another drug
called trastuzumab (Herceptin) may be given as well.
Aggressive chemotherapy is often followed by local regional treatment. This means surgery if the cancer has not spread too far to be removed or if the chemotherapy causes the cancer to
shrink enough to be removed. The usual operation is a modified radical mastectomy, where the entire breast and the lymph nodes under the arm are removed.

Radiation is used in most cases, whether or not surgery is done, to further slow the disease. This is usually followed by additional systemic treatment such as chemotherapy, hormonal
therapy (tamoxifen or an aromatase inhibitor, if the cancer cells contain estrogen receptors), and/or trastuzumab (if the cancer is HER2-positive).

For more information on breast cancer treatment, see the
"How Is Breast Cancer Treated?"
section of the separate American Cancer Society Breast Cancer document.

What's new in IBC research?

Because IBC is so rare, it makes it harder for researchers to find people to study and find the best treatments for it. However, there have been some recent advances in understanding and
treating IBC. Studies have shown that over the past couple of decades, IBC has become more common, while other forms of locally advanced breast cancer have become less common. Researchers
are still not sure why this has happened.

Studies comparing DNA and other molecules from IBC with that of usual types of breast cancer have shown some important differences. Scientists believe that some of these differences are responsible for the unique and aggressive way that IBC spreads and grows. They are hopeful that understanding these differences will lead to more effective treatments that target molecules specific to IBC. Clinical studies during the past decade have shown doctors how to modify the usual breast cancer treatments (chemotherapy, radiation, hormonal therapy, and surgery) so that they are
best suited for women with IBC. For example, studies have shown the value of using chemotherapy that is more intense than the usual regimens for breast cancer, and the importance of using chemotherapy as the first treatment, before surgery or radiation.

Where can I find more information about IBC?

Inflammatory Breast Cancer Research Foundation
Telephone: 251-866-0907
Web site: www.ibcresearch.org

For more information about breast cancer, please see the separate American Cancer Society documents Breast Cancer and Breast Cancer: Early Detection.

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Last Medical Review: 9/18/2008
Last Revised: 9/18/2008
2008 Copyright American Cancer Society