What does an early inflammatory breast cancer rash look like?

Redness or another change in the skin color of the breast, swelling on one side and/or a rash that appears quickly — sometimes literally overnight — are the hallmark symptoms of inflammatory breast cancer. 

But what does that rash actually look like? And how can you distinguish it from other, more benign conditions?

To learn more, we went to Wendy Woodward, M.D., Ph.D., a radiation oncologist and researcher who specializes in the treatment of inflammatory breast cancer. 

What does an inflammatory breast cancer rash look like?

That’s kind of hard to say, because not everyone’s rash looks the same. And, it doesn’t always look like a rash. Sometimes, you can just see the breast skin pores very clearly because they look exaggerated due to swelling. Or, there’s redness or some other type of discoloration of one breast.

The rash associated with inflammatory breast cancer can also vary in appearance based on someone’s skin tone. It may look dark or even purple on some women, rather than red. But there’s not a defining skin change that’s the same for everybody. And, no matter how early a rash is diagnosed as inflammatory breast cancer, it is always considered at least stage III. 

What characteristics distinguish an inflammatory breast cancer rash from other kinds?

Speed is one factor. Inflammatory breast cancer is quite aggressive, and it can develop very, very quickly. So, if you notice a marked change in the size of your breast or in its color or texture over a few weeks — or even a few days or hours — you should get it evaluated right away. 

In addition, though some women describe the rash as starting out small — or even resembling a bug bite — it often involves most of the breast within a very short time frame. So, a spreading rash deserves prompt attention, too.

Are there any other conditions that can cause rashes on the breast?

Yes. Mastitis is the top one. It’s fairly common during breastfeeding, so many people tend to assume that inflammatory breast cancer is just an infection. It gets mistaken for mastitis and abscesses a lot because most health care providers have never seen inflammatory breast cancer before. They tend to err on the side of the rash being caused by something more benign.

The number of people diagnosed with inflammatory breast cancer each year is incredibly small. It’s a drop in the bucket, compared to other types of breast cancer. And most people who notice changes in their breasts will not ultimately have breast cancer. 

By the time patients get to MD Anderson’s specialized Inflammatory Breast Cancer Clinic, though, they’ve often already gone through multiple rounds of antibiotics with no improvement.

Have there been any advances in the diagnosis of inflammatory breast cancer, based on rashes?

Yes. We’re working on two different projects right now. 

One is an update of the MD Anderson cancer algorithm to help patients obtain a faster diagnosis. If the changes they’ve noticed are enough to point to inflammatory breast cancer, they’ll be able to use this algorithm to back up their request for additional imaging or a breast biopsy. 

That way, if a doctor says, “OK, here are some more antibiotics,” patients can say, “Wait. Shouldn’t we try to rule this out first?” and show them the MD Anderson algorithm. A lot of doctors think of a breast biopsy as a really big step. But in this case, it’s not. It’s just the right thing to do.

We’re also in the very early stages of developing of an app that would let patients take a picture of their own breast, upload it and use artificial intelligence to compare it to photos of both healthy breasts and those from patients with confirmed inflammatory breast cancer diagnoses. The hope is to give patients a gauge to determine whether their rash is something to be concerned about and doctors a tool to make a diagnosis right away.

Is there anything else people should know about inflammatory breast cancer rashes?

Yes. Sometimes, it can be hard to distinguish non-inflammatory breast cancer from inflammatory breast cancer, since both can cause redness of the breast and skin changes that might be missed. 

But if you notice really rapid changes in one or both of your breasts, try to be seen by a doctor within two weeks. While a short course of antibiotics is not unreasonable when the suspicion of inflammatory breast cancer is low, don’t be afraid to ask for breast imaging or a biopsy if your symptoms don’t fully resolve in less than two weeks. If your condition gets better before the results come in, great. But if not, you’ll be that much closer to a diagnosis. 

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