Inflammatory breast cancer is a rare, aggressive form of breast cancer

Globally, breast cancer is now the most commonly diagnosed cancer among women. Early diagnosis is crucial because if not diagnosed and treated early, it can invade nearby tissues or distant organs (metastasis).  Metastastatic disease always has a poor outcome. Breast cancer can occur in males also, although it is relatively uncommon.

Inflammatory breast cancer (IBC) is characterized by the blockage of lymph vessels, involving about a third of the skin of the breast, leading to swelling and redness (inflammation). IBC can progress very rapidly, usually in a matter of weeks. IBC is staged as III or IV (advanced) by cancer specialists depending on whether the cancer cells have spread only to nearby lymph nodes or to other organs as well. IBC is relatively uncommon variant of breast cancer and the incidence is 1.3-3.0/100,000 women.

This aggressive form of breast cancer generally affects younger women. The skin of the breast can take a dark red to purplish hue and the blocked lymphatic channels present as ridges or dimples, much like the skin of an orange (peau d’orange). Sometimes a breast lump may be felt, but often it is neither felt nor seen on a mammogram (an x ray image of the breast).

Patients may complain of a rapid increase in breast size, heaviness, burning, pain in the breast, or an inverted nipple. Swollen lymph nodes may also be present under the arm of the affected breast, near the collarbone, or both. When diagnosing IBC, other common conditions such as an infection (mastitis), injury, or other invasive breast cancer that is locally advanced must be ruled out.

IBC is challenging to diagnose early, but experts have established minimum criteria for the prompt diagnosis: rapid onset of symptoms present for less than 6 months, redness covering at least a third of the breast, and a tissue (biopsy) sample indicating invasive cancer.

Staging is based on the findings of a diagnostic mammogram, ultrasound of the breast and nearby (regional) lymph nodes & PET-CT to identify metastasis. Biopsy examination includes testing for hormone receptors and gene testing.

Treatment for IBC includes an initial round of chemotherapy (neoadjuvant) followed by radiation to shrink the tumor and then surgery. This multimodal approach has been seen to provide better outcomes. Chemotherapeutic regimen usually includes at least 6 cycles of anti-cancer medicines over a period of 4-6 months.

IBCs respond to targeted drugs, if found to have greater than normal amounts of the HER2 protein. This anti-HER2 therapy can be given both as part of neoadjuvant therapy and after surgery (adjuvant therapy). If the biopsy tissue contains hormone receptors, hormone therapy may be used.

A modified radical mastectomy is the standard surgical procedure for IBC where the entire affected breast and most or all the lymph nodes under the adjacent arm is removed. This is followed by radiation therapy to the chest wall under the breast that was removed. Furthermore, other adjuvant systemic therapies including additional chemotherapy, hormone therapy, targeted therapy or some combination of these treatments given after surgery can reduce the chance of cancer recurrence.

Prognosis in IBC is dependent on type, location, staging, response to treatments, and overall general condition of the patient. Despite multimodal treatment approach the outcome is poor with a 5-year survival rate ranging from 25% to 50%. Hence an early diagnosis is the key to overcome this disease.