What Is Inflammatory Breast Cancer?

Inflammatory breast cancer (IBC) is an uncommon and aggressive type of breast cancer. It can cause the breast to appear red and swollen, giving the appearance of inflammation. In the United States, diagnoses of IBC account for 1 to 5% percent of all cases of breast cancer.

Both women and men can develop IBC. Compared to other forms of breast cancer, IBC tends to strike younger women and is more common in Black women than White women. Men who are diagnosed with IBC are older on average than female patients.

IBC is often mistaken for other conditions. It's important to talk with a healthcare provider if you are experiencing symptoms.

inflammatory breast cancer symptoms
 Verywell / Emily Roberts

Symptoms

IBC is fast-growing cancer that can block lymph vessels and blood vessels in the breast. This causes signs and symptoms to develop quickly, sometimes seemingly overnight, or over a few weeks or months. IBC may not contain a solid tumor that you can feel, and symptoms can be similar to those of other conditions.

It is important to watch for physical changes and to describe them to your healthcare provider.

Common symptoms of IBC include:

  • Redness and/or a rash on the skin: There may be areas of the breast that are pink, red, or very dark with a blue or purple tinge (like a bruise). This redness is usually fairly extensive and can cover a third of the breast or more. It also may itch.
  • Sudden increase in breast size (as much as a cup size in a few days)
  • Skin dimpling akin to an orange peel (called "peau d'orange")
  • Breast heaviness (one side more than the other)
  • Hardness or burning sensations in the breast
  • Feeling that one breast is warmer than the other
  • Breast pain that is not related to your menstrual cycle
  • Nipple retraction or other nipple changes
  • Swollen lymph nodes under the arms or above the collarbone

With IBC, many people may at first think they have a benign skin rash such as eczema or an infection such as mastitis. IBC may not show up on a mammogram, so being aware of the symptoms and reporting them to your healthcare provider is critical.

Causes and Risk Factors

Researchers aren't certain what causes IBC specifically, but some risk factors have been identified:

  • Gender: Though IBC affects both women and men, women are more likely to be diagnosed with this type of breast cancer than men. 
  • Age: IBC is more common in younger people (in their 40s or 50s).
  • Ethnicity: Black women are at a greater risk for developing IBC than White women.
  • Weight: People who are overweight or obese have a slightly increased risk of IBC, but it can impact people of normal weight as well.

Diagnosis

IBC can be challenging to identify, but there is a set of criteria to help healthcare providers reach a diagnosis:

  • Symptoms appear rapidly. A mass may or may not be present.
  • Symptoms affect a third or more of the breast.
  • Duration of symptoms is less than three months.
  • A biopsy shows invasive cancer.

Breast Cancer Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Old Woman

Breast Exam

Your healthcare provider will perform a clinical breast exam, including a visual check of your breast. This involves looking for changes in skin color that may be caused by cancer cells blocking the lymph nodes and vessels in your breast skin. If your breast is swollen, it may be caused by fluid buildup, a condition called edema

If your breast skin is ridged, pitted, bumpy, or resembles an orange peel, that will also be noted.

Your healthcare provider will also check the lymph nodes in your armpits. 

Imaging Studies

After taking a careful medical history and doing a physical exam, your healthcare provider will likely order imaging studies or perform a breast biopsy to further understand your symptoms. These studies not only help diagnose IBC, but also but help rule out conditions, such as mastitis, that can cause similar symptoms.

Tests that may be done include:

  • Mammogram: Because IBC does not always have a solid tumor, a mammogram may be negative. However, this test can show evidence of skin thickening or increased breast density, both signs of potential IBC.
  • Ultrasound: Ultrasound may not be as helpful with IBC if a mass is not present, but may be helpful in evaluating axillary lymph nodes (armpit nodes).
  • Computed tomography (CT) scan: CT may be helpful in determining if cancer has spread to other parts of the body.
  • Magnetic resonance imaging (MRI): An MRI can provide information about soft tissues and may detect IBC that is not seen on a mammogram.
  • Bone scan: A bone scan is often done to look for the spread of cancer to bones.
  • Positron emission tomography (PET) scan: A PET scan is a sensitive test that detects areas of active cancer growth in the body. It is usually done more for cancer staging than for diagnosis, and can be helpful in identifying possible metastases (spread) to lymph nodes and other parts of the body.

Biopsy

If a mass is noted, a breast biopsy may be done. If a mass is not present, a skin biopsy done on the abnormal area of skin may reveal the cancer.

Most inflammatory breast cancers are diagnosed via biopsy as invasive ductal carcinomas.

Staging

IBC does not always present with a lump like other cancers. It grows in sheets (sometimes called "nests") and can spread through the body primarily via the lymphatic system.

IBC is classified either as stage 3 or stage 4 depending on how far it has spread in the body.

Stage 3 cancers have spread to at least one lymph node, but not to other regions of the body. Stage 4 cancers are similar to stage 3B, but the cancer has also spread to distant regions of the body.

Treatment

Inflammatory breast cancer is aggressive. Therefore, it is usually treated with a combination of therapies (sometimes called a "multimodal approach") to reduce the risk of recurrence.

Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy refers to chemotherapy that is administered prior to surgery. A combination of drugs is usually given in cycles for four to six months, depending on how quickly the cancer is growing. In some cases, patients may receive additional chemotherapy after surgery (called adjuvant chemotherapy).

Surgery

The most common surgery is modified radical mastectomy, which is similar to a mastectomy for other types of breast cancer. With IBC, however, the lining of the chest muscles is also removed. Sometimes, one of the chest muscles (pectoral minor) may be removed.

Most lymph nodes are also removed.

If women desire reconstructive surgery, it is usually delayed until at least six months after radiation therapy has been completed.

Radiation Therapy

Radiation therapy is usually used after a mastectomy to treat the chest wall and any remaining lymph nodes.

Targeted Therapies and Hormone Therapy

Many inflammatory breast cancers are HER2 positive, so treatment with HER2-targeted therapies can be effective in controlling the tumor. These drugs are usually given along with the other treatments after a diagnosis of IBC. If the cancer is sensitive to estrogen, hormone therapy may also be an option.

Most inflammatory breast cancers are estrogen receptor and progesterone receptor negative, so hormonal therapy with tamoxifen or aromatase inhibitors isn't commonly used.

Clinical Trials

There are a number of clinical trials in progress for inflammatory breast cancer that are looking at combinations of the treatments above as well as newer treatments, such as immunotherapy.

Recurrence

IBC has a higher risk of recurrence than some other forms of breast cancer. If recurrence does occur, treatment is available and may include HER2-targeted therapies, chemotherapy, hormonal therapy, or other treatments available in clinical trials.

Recurrence is possible at any time, whether it is months after treatment or years down the road. 

  • If IBC recurs in the area of a reconstructed breast or near the mastectomy scar, it is considered a local recurrence.
  • Regional recurrence is found in the lymph nodes or near the collarbone on the same side as the previously affected breast, and a distant recurrence is found elsewhere in the body. 
  • The most common sites for recurrence are the lymph nodes, bones, liver, and lungs.

Healthcare providers cannot predict with certainty which tumors will result in a recurrence.

The highest risk of recurrence occurs in the first few years following treatment, and a person’s risk is reduced after they have been cancer-free for five years. One 2018 review looked at data from people with triple-negative breast cancer. The results indicated that if a person survived for five years following treatment, there was a low probability of it recurring in the next year. IBC recurrences tend to occur earlier because IBC is more aggressive and progresses much more quickly than other types of breast cancer.

After IBC treatment, healthcare providers monitor patients periodically to check for recurrences. The timetable is determined based upon the patient's unique situation, but for most types of breast cancer, general physical exam follow-ups are every three to six months after diagnosis for the first three years, and then one to two times a year from year four onward. These checkups include annual mammograms.

Because the potential for recurrence with IBC is high, healthcare providers recommend performing monthly breast self-exams and paying close attention to symptoms of recurrence. 

Frequently Asked Questions

What is the survival rate for people with inflammatory breast cancer?

The five-year survival rate for people with inflammatory breast cancer depends on whether the stage is localized, regional, or distant. These define how far the cancer has spread. For regional inflammatory breast cancer stages, in which the cancer has spread to nearby lymph nodes or structures, the five-year survival rate is 56%. For distant stages, where the cancer has spread to distant areas such as the lungs, liver, or bones, the five-year survival rate is 19%. The average for all stages is 41%.

Can inflammatory breast cancer symptoms appear, disappear, and then reappear?

Most symptoms of IBC do not come and go, such as the orange peel dimpling appearance of the skin, swelling, and tenderness. However, the redness that appears on the breast with IBC can come and go in some cases.

A Word From Verywell

It's important to remember that each person and every cancer is different. While treatment for IBC can be challenging, know that there are long-term survivors of this disease. In addition, newer treatments often have fewer side effects than traditional chemotherapy drugs.

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Article Sources
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