Today there’s a wealth of information available about breast cancer symptoms—e.g., a lump in your breast being foremost, breast skin irritation, dimpling, new lump under your arm, redness, etc. Women are now being encouraged to know what their breasts look and feel like, using monthly self-exams and regular check-ups with their healthcare provider, so that they can identify any changes.
But inflammatory breast cancer (IBC) rarely appears as a painless, hard lump in the breast or underarm. Unlike other types of breast cancer, with inflammatory breast cancer—a rare, but the most aggressive form of breast cancer—there is no lump to detect during a self-examination or a mammogram.
The Look and Feel of Inflammatory Breast Cancer
Sudden swelling of a breast, which may look red, or feel itchy or warm
Ridges or raised or pitted marks (like the appearance of an orange peel) on breast skin
Nipple retraction or discharge
Swollen lymph nodes in the underarm or above the collarbone
What Makes IBC Different?
IBC accounts for only a tiny fraction of breast cancers but can spread more quickly than other types of breast cancer.
IBC also tends to show up in women younger than other breast cancers and is more common in women of African descent.
With IBC, cancer cells form in the breast, blocking the lymph vessels in the skin and causing infection-like symptoms instead of one solid lump, so it’s often diagnosed as an infection rather than breast cancer.
In addition, because IBC isn't found by mammography or ultrasound, it’s often in an advanced stage—with approximately one-third of inflammatory breast cancer patients diagnosed at stage 4.
Diagnosing IBC
Diagnosing inflammatory breast cancer can be challenging and is often misdiagnosed as a skin infection of the breast. Multiple tests are used to diagnose IBC, including:
Digital Mammogram Including 3D Digital Breast Tomosynthesis (DBT) uses X-rays to create a 3D rendering of the breast, allowing it to be viewed in layers or “slices.”
Breast MRI uses radio waves and strong magnets—rather than X-rays—to create detailed breast images. These images can locate and diagnose breast tumors.
Breast Ultrasound uses high-frequency sound waves to detect abnormalities in soft-tissue organs like the breast.
Diagnostic Surgery or Biopsy removes a small portion of the breast tumor to be analyzed for hormonal markers or genetic mutation.
PET or CT Scan, a positron emission tomography (PET), or computed tomography (CT) scan may be used if cancer is suspected of spreading to other parts of the body, like the lungs, brain, or bones.
There is still no diagnostic code for inflammatory breast cancer.
Treating IBC
Inflammatory breast cancer is considered locally-advanced breast cancer. It is typically treated with several types of treatment, including chemotherapy, surgery, radiation therapy, and targeted therapies in cases where the cancer is hormone receptor-positive and HER2-positive.
Chemotherapy is a drug treatment that uses powerful chemicals to kill fast-growing cancer cells in the body. For people with IBC, chemotherapy is usually used before surgery (when known as “neoadjuvant” chemotherapy) to reduce the size of tumors. But chemotherapy may also be necessary after surgery (when it is known as “adjuvant” chemotherapy) to eliminate any remaining cancer cells.
Surgery to remove cancerous breast tissue is usually the next stage of treatment for patients whose tumors respond well to neoadjuvant chemotherapy. Typically, this involves a mastectomy—the surgical removal of the entire breast and the lymph nodes under the adjacent armpit. Once treatment is complete, patients may wish to undergo breast reconstruction surgery.
Radiation therapy, also known as radiotherapy, uses high doses of radiation to kill cancer cells and shrink tumors. It is typically used following surgery to eradicate any remaining cancer cells. If a patient’s IBC does not respond well to neoadjuvant chemotherapy, radiation therapy may be used before surgery to reduce the size of the tumor.
Hormone therapy such as an aromatase inhibitor or Tamoxifen, is usually used after surgery in breast cancer cells that may be hormone receptor-positive (HR-positive). Hormone therapy medications can target HR-positive cancer cells either by reducing the body’s production of the relevant hormones or by blocking the hormone receptors on cancer cells.
Targeted therapies are used to slow or stop breast cancer cells’ growth with high levels of human epidermal growth factor 2 (HER2), a protein that helps HER2-positive cancer cells grow.
Immunotherapy, also called biologic therapy, uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.
Hope Is on the Horizon
IBC is rare—accounting for only one to five percent of all breast cancers—however, it remains one of the deadliest cancers, accounting for 10 percent of all breast cancer deaths or 4,200 people each year. However, women with IBC now live about twice as long after diagnosis as their counterparts did in the mid-to-late 1970s. As a result, researchers are working diligently on new drugs and treatment therapies.
For example, At NIH in Bethesda, MD, Dr. Sandra Swain is researching the experimental anti-VEGF antibody (Avastin) effect on advanced breast cancer. Additionally, research is being conducted to distinguish the molecular fingerprint of IBC to understand better why IBC is biologically different from other cancers. For example, figuring out the differences in gene expression patterns between normal and IBC cancer cells may reveal what sets IBC apart from other cancers.
Unlike other breast cancers, IBC is not inherited, so discovering IBC genes will not necessarily help predict who is more likely to get the disease. However, finding specific genetic markers in the tumors of a woman newly diagnosed with IBC could be a valuable tool for designing treatment plans.
Researchers at Duke University are experimenting with the use of heat therapy (hyperthermia) to draw chemotherapy drugs encapsulated in tiny fat bubbles (liposomes) to tumors in the fight against IBC. The heat also triggers the liposomes to release the drugs and settle inside the tumor. Since the drug is delivered only to the tumor, doctors can use higher doses of chemotherapy—30 times more—to kill cancer cells without poisoning other body tissues.
You’re Not Alone
A diagnosis of inflammatory breast cancer can be scary, overwhelming, and isolating. But, we’re here for you every step of the way, with educational resources, a caring online community, and anything else to give you strength and hope. You are never alone when you become part of our global community. Instead, you’re surrounded by others who have been touched by breast cancer.
RSVP for our next IBC MeetUp here.
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