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Inflammatory Breast Cancer

Rare, Aggressive, Easy to Confuse With Benign Infections

By Maureen Salamon

Updated November 21, 2008

(LifeWire) - While many breast cancers announce themselves with the presence of a lump, the most aggressive, deadly form of the disease may initially be mistaken for other breast ailments because of the absence of lumpy tissue.

Inflammatory breast cancer (IBC) is diagnosed in 1 to 5% of the 213,000 American women found to have invasive breast cancer each year and is not usually detected until it becomes advanced. The reasons for this are twofold: IBC can quickly spread, even in a matter of days or weeks, and its most prominent symptoms mimic those of other common breast ailments, such as the infection mastitis.

The symptoms of IBC are varied depending on each case, but can include:

  • Swelling, the onset of which is abrupt and rapid
  • Nipple inversion, meaning the nipple turns inward
  • Discolored areas of skin (pink, red or bluish), which may be of a mottled texture, known as peau d'orange, and results from malignant cells blocking lymph channels in the skin
  • Nipple discharge, which may be bloody
  • A feeling of warmth, in part of the breast
  • Pain in the breast, throbbing or stabbing in nature
  • Thickened areas of skin, which can include ridges
  • Breast itchiness, the breast skin itches
  • Areola changes, in color or texture

Adding to the difficulty of detecting IBC, it doesn't always show up on a mammogram or other breast images, including ultrasound. Often doctors and patients will mistake emerging IBC for benign breast problems, giving it more time to spread as they wait for symptoms to either resolve spontaneously or use other treatments.

IBC also has a lower median age, 56 compared with age 62, of diagnosis than more typical breast cancers, although IBC has been documented in patients as young as age 12. For unknown reasons, African-American women are more likely to develop it than white women, and as with other breast cancers, men infrequently have been known to develop it as well.

Numerous patients, moreover, are younger women of childbearing age who may develop symptoms during pregnancy or breastfeeding. Since breastfeeding mothers often develop mastitis, a milk duct infection that also produces redness, swelling and pain, inflammatory breast cancer can be easy to miss.

Often, mammograms and ultrasounds will detect the skin thickening that accompanies more than 90% of all IBC cases. Once it is suspected, though, doctors will also look for other ways to make a definitive diagnosis. These would include a breast biopsy, in which tissue samples from affected breast areas are analyzed by pathologists under the microscope to determine whether they are malignant. These samples can be taken by several methods, with the preferred method being large core biopsy where larger cylindrical pieces of the affected area are removed with a large, hollow needle.

Once confirmed, IBC is treated in several steps. The first step is aggressive chemotherapy, which often is immediately followed by a modified radical mastectomy, surgery that results in the loss of the breast but removes any detectable remaining cancer.

Later, radiation therapy aimed at the location of the prior cancer bed will attempt to obliterate any invisible leftover cancer cells. All these treatments may be followed by systemic hormone therapy to hinder the production of the female hormone estrogen, which can fuel the growth of some breast cancers.

Even with multistep comprehensive treatment, the survival of a typical IBC patient is about 3 years from diagnosis, because this cancer is more likely to have spread to other parts of the body by the time it is detected. Accordingly, the 5-year survival rate for IBC patients is between 25 and 50%, which is lower than the 5-year survival rate of 84% for those with other types of invasive breast cancer that spreads within the breast, but not to other parts of the body.

As one might expect, patients with IBC need a variety of supportive care in addition to their medical procedures. The fear and frustration of dealing with a rare, hard-to-diagnose cancer often requires psychological and social assistance, which can be provided in the form of one-on-one counseling or larger support groups. When possible, IBC should be managed by specialized breast cancer physicians or a center experienced in IBC.

The American Cancer Society recommends these actions to improve the chances of detecting breast cancer, including IBC, as early as possible:

  • Women 40 years and older should have annual mammogram screenings.
  • Women in their 20s and 30s should have a clinical breast exam by their doctor every 3 years, and women over 40 years of age should have one every year.
  • Starting in their 20s, women should perform breast self-exams and report any changes to their doctor immediately.

Sources:

Azza, Ben Hamida. "Markers of Subtypes in Inflammatory Breast Cancer Studied by Immunohistochemistry: Prominent Expression of P-Cadherin." BioMed Central Cancer Journal 8:2829(2008): 1471-2407. 25 June 2008.

"Inflammatory Breast Cancer." Cancer.org. 6 Aug. 2007. American Cancer Society. 25 June 2008.

"Inflammatory Breast Cancer: Questions and Answers." Cancer.org. 2008. U.S. National Institutes of Health. 25 June 2008.

"Inflammatory Breast Cancer Research Foundation." Inflammatory Breast Cancer Research Foundation. 2008. IBC Research Foundation. 25 June 2008.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Maureen Salamon is a New Jersey-based freelance writer who has written for newspapers, websites and hospitals.
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