Inflammatory Breast Cancer
by Beth G. Hodges, MD

Inflammatory breast cancer is a rare type of breast cancer, affecting only 1-3% of those afflicted with breast cancer. It is an aggressive cancer, usually not seen on mammogram or ultrasound. The cancer cells spread in a linear fashion between planes of tissue, as opposed to forming a lump, which would be easier to find. Consequently, the woman involved usually does not realize there is a problem until the cancer is advanced.

Symptoms of Inflammatory Breast Cancer

At that point, she may experience one or more of several symptoms. She may develop pain in the breast, swelling of the breast or under the armpit, itching of the breast, or even unexplained bruising of the breast that is slow to resolve. The breast may become warm to touch and/or reddened, which explains why this type of cancer is often initially misdiagnosed as a breast or skin infection and is not correctly diagnosed until failure to respond to treatment raises the suspicions of the physician.

Changes in the skin texture or thickness of the skin of an area of the breast resembling an orange peel (called peau d'orange,) is another sign to arouse concern. The nipple may suddenly become retracted or develop discharge. Please note that a nipple that has always been retracted is not a problem; it should raise the alarm only if a previously protruding or flat nipple suddenly becomes inverted.

How it is Diagnosed and Treated

Since mammogram and ultrasound are poor at identifying inflammatory breast cancer, diagnosis is usually dependent on biopsy. Breast MRI can be somewhat more helpful at identifying a problem, but is not routinely done as a screening. It is the currently preferred method for post-inflammatory cancer surveillance for recurrence.

Treatment for inflammatory breast cancer involves a mastectomy of the involved breast (lumpectomy is not recommended for this type of cancer due to the way the cancer spreads out as it grows) with chemotherapy before and/or after surgery, followed by radiation treatments to the area. If the cancer is estrogen receptor positive, long term treatment with hormonal modulators, such as tamoxifen or Arimidex is offered.

The recurrence rate of this type of cancer is high, so close follow-up is advisable. Inflammatory breast cancer, because of the way it grows by spreading like a sheet between tissue planes in the breast, is classified as no less than a stage IIIb or stage IV cancer.

Of note, the average age of diagnosis of inflammatory breast cancer is age 59, younger than the average age of diagnosis of other types of breast cancer, and it is slightly more common in African Americans than in other ethnic groups.

Published - October, 2009