Inflammatory Breast Cancer

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Definition

Inflammatory breast cancer (IBC) is an aggressive form of breast cancer. It is different because it grows in more of a sheet-like shape and brings changes to the skin in response to inflammation. Inflammation occurs when the body is fighting infection, injury, or irritation. The changes in the skin appear similar to other conditions like mastitis. Early diagnosis and treatment are important with IBC. The sooner it is found, the more favorable the outcome.

IBC is rare in women and extremely rare in men.

Breast Changes Associated With IBC

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Skin changes that resemble the skin of an orange and/or inversion of the nipple may be signs of IBC.Copyright © Nucleus Medical Media, Inc.

Causes

Cancer occurs when cells in the body divide without control or order. Eventually these uncontrolled cells form a growth or tumor. The term cancer refers to malignant growths. These growths invade nearby tissues and spread to other parts of the body. It is not clear exactly what causes these problems in the cells, but is probably a combination of genetics and environment.

Risk Factors

The average age for women with IBC (59 years old) is lower than that of women with other breast cancers. Other factors that may increase your risk of IBC include:

  • African American race
  • Obesity
  • History of flattening, crusting, or retraction of the nipple
  • History of mastitis that doesn't respond to antibiotic treatment
  • Family members with breast cancer
  • Increased breast density

Note: Studies show that most women with known risk factors do not get breast cancer. Many women who get breast cancer have none of the risk factors listed above.

Symptoms

Normally, breast cancer cells create a tumor. IBC cells develop in a sheet-like pattern so you may not feel any lumps or masses. Symptoms of IBC can occur together and develop quickly. IBC may cause:

  • Rapid change in the size, shape, or feel of one breast (can occur over days or weeks)
  • Discoloration of the breast; breast may appear red, purple, pink, or bruised
  • Peau d'orange—an area of the breast that looks like the skin of an orange
  • Thickened areas of skin
  • Breast feels warm to the touch
  • Changes in the nipple, such as flattening, turning in, retracting, or areola color change
  • Enlarged lymph nodes under the arm or above or below the collarbone
  • Itching
  • Breast pain

Some of these symptoms are similar to a condition known as mastitis. However, mastitis should respond to treatment. If it does not, talk to your doctor again right away.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will also be done. Since IBC develops in a sheet-like pattern, it is hard to find by a breast exam or mammogram.

Test may include:

If cancer is detected, the cancerous tissue will also be tested to look for:

  • Hormone receptors
  • HER2 gene—suggests an aggressive form of cancer

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. IBC is generally detected in later stages, which gives cancer cells more time to invade other tissues.

Treatment

Talk with your doctor about the best plan for you. Finding cancer in later stages reduces the chances of a favorable outcome. Better outcomes are achieved with a combination of therapies.

Treatment may include one or more of the following:

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including pill, injection, and via an IV. The drugs travel through the body in the blood, killing mostly cancer cells. Some healthy cells are killed as well. Chemotherapy drugs for IBC may include:

  • Anthracyclines
  • Taxane
  • Antimetabolites

Surgery

The only surgery recommended for IBC is a modified radical mastectomy. This involves removal of the whole breast, lymph nodes under the arm, and the lining over the chest muscles under the breast.

Radiation

Radiation therapy is the use of radiation to kill cancer cells. It may be necessary in cases when chemotherapy prior to surgery isn't effective. Radiation may be used to shrink cancer cells in advance of surgery. Types of radiation therapy include:

  • External radiation therapy—radiation directed at the breast from a source outside the body
  • Internal radiation therapy—radioactive materials placed into the breast in or near the cancer cells

Other

There are other factors about your specific type of cancer that can affect treatment such as:

  • Hormone receptors—some cancers have hormone receptors attached to them. Certain drugs can target these receptors to help control or eliminate the cancer. This hormone therapy may include drugs such as:
    • Tamoxifen
    • Aromatase inhibitor
  • HER2—Cancers with the HER2 gene tend to be more aggressive. Drugs that may be effective against HER2-positive cancer include:
    • Trastuzumab
    • Lapatinib

Prevention

It is important to catch IBC as early as possible. If you have any of the symptoms listed above, see your doctor right away. If you are being treated for mastitis that is not responding to treatment, see your doctor again.

Breast exams may help identify changes in your breast, such as the orange-peel skin. For breast exams, the American Cancer Society recommends:

  • Women aged 20 or older may perform a breast self-exam (BSE) every month. Report any changes to your doctor right away.
  • Women aged 20-39 should have a clinical breast exam by a health professional every three years. Starting at age 40, women should have a clinical breast exam every year.
    • A breast exam should be done more regularly if there is a family history or there have been previous breast biopsies.

Revision Information

  • National Breast Cancer Foundation

    http://www.nationalbreastcancer.org

  • National Cancer Institute

    http://www.cancer.gov

  • Canadian Cancer Society

    http://www.cancer.ca

  • Women’s Health Matters

    http://www.womenshealthmatters.ca

  • Breast cancer in men. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.. Updated August 1, 2012. Accessed January 2, 2014.

  • Breast cancer in women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.. Updated December 16, 2013. Accessed January 2, 2014.

  • Dawood S, Merajver SD, et al. International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol. 2011;22(3):515-523.

  • Inflammatory breast cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/002298-pdf.pdf. Accessed January 2, 2014.

  • Inflammatory breast cancer. National Breast Cancer Foundation website. http://www.nationalbreastcancer.org/inflammatory-breast-cancer. Accessed January 2, 2014.

  • Inflammatory breast cancer fact sheet. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Sites-Types/IBC. Updated April 18, 2012. Accessed January 2, 2014.