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 accounts for 1%–5% of all breast cancer cases.

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.

This article will discuss the symptoms, diagnosis, and treatment of inflammatory breast cancer.

inflammatory breast cancer symptoms
 Verywell / Emily Roberts

Symptoms

IBC is a fast-growing cancer that can block lymph and blood vessels in the breast. As a result, signs and symptoms develop quickly, sometimes over 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 essential to watch for physical changes and 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 bluish (like a bruise). This redness is usually fairly extensive and can cover one-third of the breast or more. The skin also may itch
  • Sudden increase in breast size (as much as a cup size in a few days)
  • Skin dimpling similar 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 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 crucial.

Causes and Risk Factors

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

  • 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 average weight as well.

Diagnosis

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

  • Symptoms come on quickly. A mass may or may not be present.
  • Symptoms affect one-third or more of the breast.
  • Duration of symptoms is less than three months.
  • A biopsy (removing tissue to be examined in a lab) 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 understand your symptoms further. These studies help diagnose IBC and help rule out conditions, such as mastitis, that can cause similar symptoms.

These tests include:

  • Mammogram: A mammogram may be negative because IBC does not always come with a solid tumor. However, this test can show 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 help evaluate axillary lymph nodes (armpit nodes).
  • Computed tomography (CT) scan: CT may help determine 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 visualized on a mammogram.
  • Bone scan: A bone scan is often done to look for the spread of cancer to the 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 help identify metastases (spread) to lymph nodes and other body parts.

Biopsy

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

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

Staging

IBC does not always present with a lump like other cancers. Instead, 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 body regions. Stage 4 cancer is similar to stage 3B, but the cancer has spread to distant body areas.

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 (removing the entire breast), 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. In addition, most lymph nodes are also excised.

If women desire reconstructive surgery (plastic surgery to restore the appearance of the breast), it is usually delayed until at least six months after completion of radiation therapy.

Radiation Therapy

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

Targeted Therapies and Hormone Therapy

Many inflammatory breast cancers are HER2 positive (a protein that makes cancer grow), 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 evaluating the combination of the treatments above as well as newer treatments, such as immunotherapy (treatment that uses your body's immune system to help fight cancer).

Recurrence

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

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

  • 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 which tumors will result in a recurrence with certainty.

The highest risk of recurrence occurs in the first few years following treatment. A person's risk of recurrence is reduced after being cancer free for five years.  IBC tends to come back earlier because it's more aggressive, progressing more quickly than other types of breast cancer.

After IBC treatment, healthcare providers monitor patients periodically to check for recurrence. Physical exams are done at follow-up visits every three to six months after diagnosis for the first three years, then space out to one to two times yearly. 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. 

Summary

Inflammatory breast cancer is aggressive and affects both men and women. Symptoms include skin changes such as redness, rash, or dimpling. Once a biopsy and imaging are complete, IBC can be staged. Treatment for this type of breast cancer can include chemotherapy, hormonal therapy, or targeted therapy. You may also need surgery and radiation to treat IBC. Many clinical trials are looking into better treatment options for IBC.

A Word From Verywell

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

Frequently Asked Questions

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

    If the IBC hasn't spread to other parts of the body the five-year survival rate is 56%. If IBC has spread to other organs (lung, liver, and 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?

    Some of them can. While most symptoms of IBC do not go away, the skin redness can come and go.

  • What does inflammatory breast cancer pain feel like?

    Tenderness, redness, warmth, swelling, and itching are symptoms you may feel with IBC.

  • Does inflammatory breast cancer show up in blood work?

    No. Unfortunately, there is no blood test that shows IBC. A physical exam, biopsy, and imaging are ways to diagnose this disease.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. American Cancer Society. Inflammatory breast cancer.

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  4. U.S. National Library of Medicine. Study of immunotherapy in combination with chemotherapy in HER2-negative inflammatory breast cancer (PELICAN). Updated September 26, 2019.

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