Inflammatory Breast Cancer in Women

Inflammatory breast cancer is a type of breast cancer that involves the skin of the breast. This type of cancer comprises less than 4% of all breast cancers diagnosed each year in the US. The physical symptoms of inflammatory breast cancer include redness of the skin of the breast and a general swelling of the breast. In some cases, a lump may be present.

Warning Signs of IBC

  • Change in breast texture — skin which is red or appears dimpled like an orange
  • Breast size increases over a short period of time
  • Change in nipple — becomes flattened or inverted, possibly with a discharge
  • Breast area becomes itchy over long periods of time. Ointments and creams for rashes give no relief
  • Sudden appearance of a large lump in the breast
  • Pain in the breast
  • Swollen lymph nodes under the arm or above the collar bone

All of the symptoms may also be present with benign breast disorders. If you experience any of these symptoms, see your healthcare provider.

A healthcare provider’s first response may be to suspect an infection and prescribe antibiotics. While this may be the appropriate treatment for an infection, we suggest that patients ask that a skin biopsy be done to rule out or confirm inflammatory breast cancer.

NEVER DO A SECOND OR THIRD ROUND OF ANTIBIOTICS WITHOUT HAVING A SKIN BIOPSY DONE.

A skin biopsy consists of removing a small sample of breast skin. This sample is then sent to a pathologist who examines it for breast cancer cells in the lymph vessels. Your healthcare provider will discuss the results and their consequences with you.

Studies of inflammatory breast cancer have shown that this type of cancer tends to be more aggressive than other types of breast cancer. Because inflammatory breast cancer (IBC) is also present in the skin of the breast at diagnosis, treatment must begin with chemotherapy before surgery is performed to remove the lump or the breast.

Chemotherapy is given before surgery to kill the cancer cells in the skin and breast, and to reduce the likelihood that the cancer will extend into the chest wall after surgery.

Treatments

Clinical Trials

There are many clinical trials available for women who are diagnosed with IBC, and it is highly encouraged that women consider participating in a trial to receive the most up to date treatments available. While some women decide not to participate in a clinical trial, they learn what types of drugs and therapy combinations have been used in clinical trials when mapping out a treatment plan. Clinical trials are not the only way to have access to the latest treatments–those approved by the FDA are available to any oncologist. However, being in a trial can provide access to drugs that are not widely available and are being studied for their effectiveness for IBC.

It may also be important for women with IBC to seek several opinions about treatment, and to consider seeking treatment (or an opinion) at an academic medical center. Physicians at academic medical center may have more experience treating IBC, or immediate access to information about the latest treatments that have been shown to be effective. (As it is a rare cancer, chances are that many community physicians will not have encountered this diagnosis in their practices.) It is a very reasonable course of action to seek an opinion at an academic medical center, make a decision about treatment, and have the oncologist work with your local physicians (also oncologists) to deliver your treatment locally.

Chemotherapy and Mastectomy

After chemotherapy treatments (typically 6-8 months) a mastectomy is performed, along with an auxiliary node dissection. A mastectomy is necessary in order to reduce the risk of recurrence and to maintain “local control” of the disease. That’s a fancy surgical term that means it is better to remove the breast to maximize the odds that the cancer has been eradicated. After a mastectomy, a woman with IBC will usually receive further chemotherapy and chest wall radiation.

While inflammatory breast cancer is one of the toughest breast cancers to treat, there are survivors out there for you to talk to. Call the Reach To Recovery volunteer service from American Cancer Society, at 1-800-227-2345 at 1-800-221-2141 (English) and 1-800-986-9505 (Spanish) and ask to be matched with a survivor of IBC.

We know what a frightening time this can be, and we’re here to help with information and support. The treatments are challenging, and the diagnosis can be devastating, but it is possible to get through this. There are other women who have been there too.

Myths and Facts About IBC

Myth: If I don’t have a lump, I don’t have breast cancer.

Fact: Rarely is a lump evident with IBC. IBC grows along the chest wall and is usually diagnosed only after it has invaded the breast and possibly other organs.

Myth: My breast(s) is looking like the skin of an orange. I just had a mammogram and there was no evidence of a problem. It can’t be anything important.

Fact: Mammograms, ultrasound, and even biopsies don’t always find IBC until it has already invaded tissue and organs. If there is a change in your breast(s) appearance or texture, if it is hot, or if your nipple(s) has changed, an immediate appointment with your healthcare provider could be life saving.

Myth: My breast(s) has become swollen and hot. My Doctor says it’s only an infection and we should try different antibiotics.

Fact: Precious time will be wasted while you are trying different antibiotics. Insist on a mammogram, ultrasound, and/or biopsy. The first round of tests may discover nothing. However, if the antibiotics still aren’t working after the second week, insist on repeating the tests.

Myth: I am a man, and breast cancer is not a concern for me.

Fact: Men and women are breast cancer candidates. Men as well as women need to be aware of their breasts and seek medical advice when a change appears.

Myth: I am pregnant and my breast(s) has become swollen and hot within the last few days. Before that, it was very itchy for weeks. It’s probably just because I’m pregnant.

Fact: Breast cancer can strike at any time. IBC strikes fast and hard. Any change in your breast(s) at any time should be investigated promptly. Waiting until after a pregnancy could mean the difference in controlling the cancer and losing the battle before you’ve begun to fight.

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