Inflammatory Breast Cancer
Inflammatory breast cancer (IBC) is an aggressive type of breast cancer with symptoms that differ from other types of breast cancer. The redness, warmth, and swelling that often accompanies IBC is caused by the blockage of lymph vessels by cancer cells1 At the time of diagnosis, most women with IBC will have lymph node metastases and roughly one third will have distant metastases.2
A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.
The following is a general overview of the treatment of inflammatory breast cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.
Frequency of Inflammatory Breast Cancer
IBC is less common than non-inflammatory breast cancer, but its poor prognosis highlights the importance of raising awareness about this cancer. IBC accounts for an estimated two percent breast cancer diagnoses in the U.S., but seven percent of breast cancer deaths.3 Furthermore, from the late 1980s to the late 1990s, the incidence of IBC increased by roughly 25 percent.3
Risk factors for IBC are poorly understood, and currently it is not possible to estimate a woman’s risk for this type of cancer. IBC tends to occur at a younger age than other types of breast cancer, however, prompting interest in the role of genetic predisposition and early-life exposures.3 Rates of IBC increase rapidly up to age 50 and then stabilize. IBC is also more common in African-American women than in White women.
Diagnosis of Inflammatory Breast Cancer
The diagnosis of IBC is based on the rapid development of symptoms characteristic of IBC, coupled with the presence of cancer cells on a breast biopsy.1
- Redness, warmth, and swelling in the breast (often without a distinct lump)
- Breast skin that appears pink, reddish purple, or bruised
- Breast skin that has ridges or appears pitted, like the skin of an orange
- An increase in breast size
- Heaviness, burning, aching, or tenderness in the breast
- A nipple that becomes inverted
- Swollen lymph nodes under the arm or above the collarbone
These symptoms can also be caused by conditions other than cancer, and it is important for you to discuss them with your healthcare provider.
Women who have had mastitis (a breast infection that most commonly occurs in breastfeeding women) will notice that the symptoms just mentioned are similar to the symptoms of mastitis. However, unlike mastitis, inflammatory breast cancer is generally not accompanied by a fever and will not respond to treatment with antibiotics. If you’re being treated for mastitis but notice that your symptoms are not improving, you may wish to talk with your doctor about a breast biopsy or a referral to a breast specialist.
Treatment of Inflammatory Breast Cancer
Treatment of IBC generally begins with chemotherapy.4 Chemotherapy is a systemic (whole-body) treatment. The objective of chemotherapy is to both eliminate areas of cancer that have already spread beyond the breast, and also to reduce the amount of cancer in the breast prior to locoregional therapy (therapy delivered to the breast and surrounding tissues).
Depending on the nature of the cancer and response to initial chemotherapy, locoregional therapy consists of surgery to remove the breast and nearby lymph nodes coupled with radiation therapy or radiation therapy alone. Patients often then receive additional systemic therapy, which may consist of additional chemotherapy, hormonal therapy, targeted therapy, or a combination of these approaches.1
Survival with IBC is worse than with other types of breast cancer, with an estimated 25 to 50 percent of women surviving for at least five years.1 While these numbers are sobering, they represent an important improvement over the past. The addition of chemotherapy to locoregional therapy with surgery and/or radiation has allowed some women with IBC to become long-term survivors.5 Nevertheless, further improvements in treatment are clearly needed.
Strategies to Improve Treatment of Inflammatory Breast Cancer
Because the prognosis of IBC remains worse than for other types of breast cancer, identifying improved approaches to the treatment of IBC is an important priority. Treatments currently being evaluated in clinical trials include new targeted agents such as Tykerb® (lapatinib). 6 Tykerb targets two proteins—EGFR and HER2—that are abnormally expressed in many (but not all) cases of inflammatory breast cancer. Inhibiting these proteins can slow or stop cancer growth.
In addition to aberrant expression of EGFR and HER2, several other factors are likely to contribute to the development and growth of IBC cells as well. Research is underway to better understand these factors, with the goal of identifying weakness of IBC cells that could be targeted by new therapeutic approaches.
1 National Cancer Institute Fact Sheet. Inflammatory Breast Cancer: Questions and Answers. Available at: http://www.cancer.gov/cancertopics/factsheet/Sites-Types/IBC (Accessed April 30, 2007).
2 Merajver SD, Sabel MS. Inflammatory Breast Cancer. In: Harris JR, Lippman ME, Morrow M, Osborne CK, eds. Diseases of the Breast. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:971-982.
3 Hance KW, Anderson WF, Devesa SS, Young HA, Levine PH. Trends in Inflammatory Breast Carcinoma Incidence and Survival: The Surveillance, Epidemiology, and End Results Program at the National Cancer Institute. Journal of the National Cancer Institute. 2005;97:966-75.
4 Cristofanilli M, Buzdar AU, Hortobágyi GN. Update on the Management of Inflammatory Breast Cancer. The Oncologist. 2003;8:141-148.
5 Giordano SH, Hortobagyi GN. Inflammatory Breast Cancer: Clinical Progress and the Main Problems that Must be Addressed. Breast Cancer Research. 2003;5:284-288.
6 Cristofanilli M, Boussen H, Baselga J, et al. A Phase II combination study of lapatinib and paclitaxel as a neoadjuvant therapy in patients with newly diagnosed inflammatory breast cancer. Proceedings from the 2006 annual San Antonio Breast Cancer Symposium. Oral presentation December 14, 2006. Abstract #1.