IBC: Inflammatory Breast Cancer

mammogram illustrating one test used to diagnose inflammatory breast cancer
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Inflammatory breast cancer is a rare and aggressive breast cancer that can cause the breast to appear red and swollen, giving the appearance of inflammation. In the United States, diagnoses of IBC account for one to five percent of all cases of breast cancer. Compared to other forms of breast cancer , inflammatory breast cancer 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.

Symptoms

Many of the symptoms of inflammatory breast cancer can mimic other conditions. In addition, these cancers may not show up on a mammogram so that having a high index of suspicion is critical. As IBC grows, it blocks lymph vessels and blood vessels in the breast, that in turn accounts for many of the symptoms. Signs and symptoms may include.

  • Redness and/or a rash on the skin (that may at first mimic eczema or a skin infection). There may be areas that are skin color, pink, red, or very dark with a blue or purple tinge. This redness is usually fairly extensive, covering a third of the breast or more.
  • Sudden increase in breast size (as much as a cup size in a few days).
  • Skin looks like an orange peel (called peau d'orange).
  • Constantly itching breast skin.
  • Breast heaviness, where one breast feels "heavier" than the other.
  • Firmness of hardening of one breast.
  • Warmth of one breast.
  • Breast is warmer, harder or firmer than usual.
  • Breast pain that is not related menstrual cycles.
  • Nipple retraction or other nipple changes.
  • Swollen lymph nodes under arm or above collarbone.

Causes and Risk Factors

We aren't certain what causes IBC, but some risk factors have been identified. Compared with other breast cancers, it is more common in younger women than older women. It is also more common in women who are overweight or obese (but can occur in people of normal weight as well.

Diagnosis

Your doctor will do a clinical breast exam, including a visual check of your breast 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. Your doctor will also check the lymph nodes in your armpits. If your breast skin is ridged, pitted, bumpy, or resembles an orange peel, that will also be noted. These symptoms can develop quickly, sometimes seemingly overnight and other times taking a few weeks or months.

Imaging Studies

After taking a careful history and doing a physical exam, your doctor will likely order imaging studies or a do a biopsy to further understand your symptoms. These studies can not only help diagnose an inflammatory breast cancer, but can help rule out conditions that appear similar, such as mastitis (a breast infection). Tests that may be done include:

  • Mammogram: As noted, a mammogram may be negative with IBC, but may also show evidence of skin thickening, a tumor, or increased breast density.
  • Ultrasound: Ultrasound may not be as helpful with IBC if a discrete mass is not present, but may also be helpful in evaluating axillary lymph nodes (armpit nodes).
  • CT scan: CT may be helpful on determining if the cancer has spread to distant sites.
  • MRI: An MRI can provide good information on soft tissues, and may detect an IBC that is not seen on a mammogram.
  • Bone scan: A bone scan is often done to look for the spread of the cancer to bones.
  • PET scan: A PET scan is a sensitive test for detecting areas of active cancer growth in the body. It is usually done more for staging than for diagnosis, and can be helpful in identifying possible metastases 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 of the abnormal area of skin may reveal the cancer.Most inflammatory breast cancers are invasive ductal carcinomas

Criteria for Diagnosis

IBC can be challenging to diagnose, so physicians have come up with minimal criteria to make the diagnosis. These include:

  • Symptoms such as redness, warmth, and/or swelling of the breast, with an orange-peel appearance that appear rapidly. A mass may or may not be present.
  • Duration of symptoms less than 6 months.
  • Symptoms that include a third or more of the breast.
  • A biopsy that shows invasive cancer.

Growth

Inflammatory breast cancer commonly grows in nests or sheets, not in lumps. IBC spreads through the body primarily via the lymph system. Early on, these tumors may appear to be slow-growing, low-grade tumors, but once the skin on the breast is inflamed, it can metastasize rapidly.

Stages

Unlike the breast cancer stages most people are familiar with (stages 1 through 4), IBC is classified either as stage 3 or stage 4.

  • Stage 3: Stage 3 cancers are larger than 5 cm in diameter and have spread to at least one lymph node, but have not spread to other regions of the body.
  • Stage 4: Stage 4 cancers are similar to stage 3B, but the cancer has also spread to distant regions of the body.

Treatments

Inflammatory breast cancer is aggressive, and is usually treated aggressively with a combination of therapies to reduce the risk of recurrence (for stage 3).

Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy refers to chemotherapy that is given prior to surgery. A combination of drugs is usually given in cycles for 4 to 6 months.

Surgery

The most common surgery is a modified radical mastectomy, similar to a mastectomy for other types of breast cancer. With IBC, however, one of the chest muscles (the pectoral minor) may be removed, and most lymph nodes are also removed (not just a sentinel node biopsy). If women desire reconstructive surgery, this is usually delayed until at least 6 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

Many inflammatory breast cancers are HER2 positive, so treatment with HER2 targeted therapies can be very effective in controlling the tumor. These drugs are usually given along with the other treatments after a diagnosis of IBC.

Hormonal Therapy

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, looking at combinations of the treatments above, as well as newer treatments such as immunotherapy.

Risk of Recurrence and Treatment

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

A Word From Verywell

If you or a loved one have been diagnosed with inflammatory breast cancer you're probably frightened, as well as discouraged by looking at statistics and comparing these tumors with other types of breast cancer. It's important to note that each person and every cancer is different. Treatment can be challenging, but there are long-term survivors of the disease. The side effects of treatment are also improving, as drugs such as HER2 targeted therapies often have fewer side effects than traditional chemotherapy drugs.

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