Inflammatory Breast Cancer

Inflammatory breast cancer, or IBC, is rare, accounting for 1–3% of all breast cancers. This type of cancer is distinct from other types, with major differences in symptoms, prognosis, and treatment.

IBC is a unique type of breast cancer that occurs when cancer cells block the lymph vessels in the skin. As a result, the breast can become firm, tender, itchy, red, and warm due to increased blood flow and a build-up of white blood cells. The term “inflammatory” refers only to the appearance of the breasts. When breasts become inflamed due to an infection or injury, they often become tender, swollen, red, and itchy. However, the underlying cause of IBC is unrelated to inflammation.

Because of the similar symptoms, inflammatory breast cancer may at first be diagnosed as a breast infection, such as mastitis. However, although antibiotics will resolve a breast infection, they cannot treat IBC. If your doctor prescribes antibiotics and your symptoms do not resolve within 7–10 days, this may be a sign that you have IBC.

IBC tends to grow quickly and aggressively, and is usually diagnosed when it is already in an advanced stage, typically stage IIIB or stage 4.

Inflammatory Breast Cancer Risk Factors

Anyone can get IBC, although very few women are at serious risk. Factors that may increase risk include:

• Age: Inflammatory breast cancer tends to occur at a younger age than other, more common forms of breast cancer. The average age at diagnosis for IBC is 52, compared to 57 for non-IBC breast cancer.
• Gender: Women are more likely than men to get IBC.
• Race: African American women are at greater risk for IBC than white women.
• Weight: IBC is more common among women who are overweight or obese.

Symptoms of IBC

Unlike other breast cancers, IBC rarely causes breast lumps and may not appear on a mammogram. Symptoms of inflammatory breast cancer include:

• Red, swollen, itchy breast that is tender to the touch
• The surface of the breast may take on a ridged or pitted appearance, similar to an orange peel (often called peau d’orange)
• Heaviness, burning, or aching in one breast
• One breast is visibly larger than the other
• Inverted nipple (facing inward)
• No mass is felt with a breast self-exam
• Swollen lymph nodes under the arm and/or above the collarbone
• Symptoms unresolved after a course of antibiotics

Detecting IBC

Unlike other breast cancers, IBC usually does not cause a distinct lump in the breast. Therefore, a breast self-exam, clinical breast exam, or even a mammogram may not detect IBC. Ultrasounds may also miss inflammatory breast cancer. However, the changes to the surface of the breast caused by IBC can be seen with the naked eye.

Symptoms of IBC can develop rapidly, and the disease can progress quickly. Any sudden changes in the texture or appearance of the breast should be reported to your doctor immediately.

For women who are pregnant or breast-feeding, redness, swelling, itchiness and soreness are often signs of a breast infection such as mastitis, which is treatable with antibiotics. If you are not pregnant or nursing and you develop these symptoms, your doctor should test for IBC.

If your doctor prescribes antibiotics and your symptoms do not disappear, several diagnostic tests may help determine whether cancer cells are present in the breast:

• Mammogram: Often the first step in diagnosing IBC, a mammogram may show thickened skin, usually without a visible mass. The affected breast may also appear larger and denser than the other breast. However, inflammatory breast cancer may not be detected by mammogram because there are no visible lumps.
• MRI (magnetic resonance imaging): If a mammogram is normal, an MRI may be used to detect abnormalities in the breast tissue.
• PET (positron emission tomography) and CT (computed tomography): A combined PET and CT scan can find IBC that has moved to nearby and/or distant lymph nodes, one of the most common areas to which IBC spreads. 
• Skin Biopsy: A definitive diagnosis of IBC is made by breast biopsy. If a breast exam or imaging study shows signs of IBC, your doctor will remove a sample of breast tissue and examine it under a microscope. Only a biopsy can show for sure that inflammatory breast cancer is present. If an apparent infection is not going away, you can consider asking your doctor for a skin biopsy.

Treatment for IBC

Combining chemotherapy, radiation therapy and surgery has led to significant improvements in survival for women with IBC. The exact treatment for IBC depends on the stage at diagnosis.

• Stage III: IBC that has not spread outside of the breast and nearby lymph nodes is considered stage III, and is usually treated with chemotherapy to shrink the tumor followed by surgery to remove the cancer. Surgery for IBC is usually a modified radical mastectomy, in which the entire breast and lymph nodes under the arm are removed. A partial mastectomy is usually not an option for IBC because it involves most or all of the breast and breast skin.
  
  Following surgical removal of the cancer, radiation may be given to destroy any remaining cancer cells. Additional chemotherapy may be given afterwards. When the cancer is HER2-positive—that is, the cancer cells have excess amounts of a protein called HER2—then anti-HER2 therapy may also be given.
  
  
• Stage IV: Inflammatory breast cancer that has metastasized is usually treated with chemotherapy and hormonal therapy. These are systemic therapies, which means that they reach all cells throughout the body. If the cancer cells are HER2-positive, then an anti-HER2 drug may also be given.