Inflammatory Breast Cancer What Is It? What is Inflammatory Breast Cancer? Truthfully, until I saw a piece on Inflammatory Breast Cancer (IBC) on the news last week, I had never heard of it. Apparently I’m not alone because the report stated that many doctors have never seen a case of IBC because it is rare. According to the Susan G. Komen Foundation it is identified as “rare and the most aggressive form of breast cancer.” Its name comes from the fact that the main symptom of the disease is swelling and redness (inflammation) of the affected breast. Also, unlike other forms of breast cancer, IBC does not have the characteristic lump or tumor. Instead cancerous cells grow in sheets which can spread throughout the breast. In addition because there is no defined lump IBC often goes undetected by standard tests such as a mammogram or ultrasound. Who is at risk? Statistics show that about one percent (1%) to five percent (5%) of breast cancer cases diagnosed in the United States are Inflammatory Breast Cancer. The average age at the time of diagnosis (for cases inside the United States) is younger for both Caucasian and African American women1. Statistics also show:
IBC is slightly more common in African American women. As many as ten percent (10%) of new breast cancer cases in African American women are IBC, compared with six percent (6%) of breast cancer cases involving Caucasian women and five percent (5%) for other races.
IBC is more common in younger women that other forms of breast cancer. In addition, it has been seen in women who are pregnant as well as women who are breast-feeding.
Like other forms of breast cancer, it has also been seen in men. What are the symptoms of IBC? As was noted earlier, the primary symptom of IBC is inflammation (redness), edema (swelling), and warmth in the affected breast. The inflammation and warmth are caused by cancer cells which are blocking the lymph vessels in the skin. In addition, patients with IBC might also notice that the affected breast appears to be pink, reddish purple or bruised. The skin of the breast may also have ridges or a pitted appearance similar to the skin of an orange (known as Peau d’orange) which is the result of a build-up of fluid and edema (swelling) in the breast. Additional symptoms include: heaviness of the affected breast, burning, aching, increase in breast size, tenderness or the nipple might become inverted (facing inward). It should be noted that these symptoms usually develop quickly over a period of weeks or months. In addition to the symptoms already mentioned, the patient may experience swollen lymph nodes either under the arm, above the collarbone or in both places. It should be noted, however, that these symptoms are also indicative of other conditions such as infection, injury or other types of cancer and should promptly be checked by a doctor. How is IBC diagnosed? According to the National Cancer Institute2, diagnosis of IBC is based primarily on the results of a doctor’s clinical exam. Diagnosis is confirmed by use of either a biopsy, mammogram or breast ultrasound. It (IBC) is classified as either Stage III-B or Stage IV breast cancer. Cancer classified as Stage III-B means that it is locally advanced (within the affected breast) while Stage IV means the cancer has spread from its original point of origin to other organs. IBC tends to grow rapidly and the physical appearance of the affected breast (see photograph above) is different from that of patients with other Stage III breast cancers. Doctors categorize it as “an especially aggressive, locally advanced breast cancer.” Cancer staging (ie: Stage III-B) describes the extent of severity of an individual’s cancer. (Additional information on staging is available in the National Cancer Institute (NCI) fact sheet Staging: Questions and Answers. It’s available at: http://www.cancer.gov/cancertopics/factsheet/Detection/staging Knowing a cancer’s stage helps the doctor(s) to develop a treatment plan and estimate prognosis (the likely outcome or course of the disease; the chance of recovery or recurrence.) How is IBC treated? Treatment for IBC consists of chemotherapy, targeted therapy, surgery, radiation therapy and hormonal therapy. In addition, patients might also receive supportive care to assist them in managing the side effects of the cancer as well as its treatment. As might be expected, treatment for IBC is done in stages with chemotherapy (anti-cancer drugs) being the first stage. Known as a Neoadjuvant Therapy (meaning it precedes surgery, radiation therapy, etc.) it is a systemic treatment meaning that it affects cells throughout the patient’s body. This means it is able to control or kill cells including those that may have spread to other parts of they body or metastasized. The next stage in treatment is surgery followed by radiation therapy of the chest wall. Unlike the chemotherapy, both the surgery and radiation therapy are local treatments that affect only the cells in the tumor and the area immediately around it. During the surgery the doctor or doctors might remove the affected breast (or as much of the breast tissue as possible) as well doing a lymph node dissection. The latter allows for pathological examination of lymph nodes removed from the armpit under a microscope. Following the initial systemic and local treatments, patients with IBC might receive additional systemic treatments to reduce the risk of re-occurrence. This might include additional chemotherapy, hormonal therapy (treatment that interferes with the effects of the female hormone estrogen, which can promote the growth of breast cancer cells), targeted therapy or a combination of all three. As noted above, patients with IBC may also receive supportive care which is designed to improve the quality of life for patients who have a serious or life-threatening disease, Use of supportive care prevents and/or treats the possible symptoms of the disease as well as psychological, social and spiritual problems the patient might be experiencing as a result of either the disease or treatment. For example, for patients who have had lymph nodes removed, supportive care might provide pressure garments to treat lymph edema (swelling caused by excess fluid build-up. What is the prognosis for patients with IBC? The prognosis is a description of the likely course and outcome of a disease or, simply put, the chance that a patient will recover or have a recurrence. In patients with IBC, the cancer is more likely to have metastasized at the time of diagnosis than non-IBC cases. As a result, the five-year survival rate for IBC patients is between 20 and 50 percent, which is significantly lower than the survival rate for patients suffering from non-IBC breast cancer. Since statistics cannot be used to predict what will happen to a particular patient, they are encouraged to consult with their doctor regarding their situation and prognosis.
1: Merajver SD, Sabel MS, “Inflammatory breast cancer in Harris JR”
2: National Cancer Institute (http://www.cancer.gov/cancertopics/factsheet/sites-types/ibc )