Inflammatory breast cancer: 14 things to know

Inflammatory breast cancer (IBC) is a rare subtype of breast cancer whose symptoms typically first appear as breast skin changes. It accounts for only about 2% to 4% of new breast cancer diagnoses annually. But because it’s so aggressive, IBC makes up a disproportionate number of breast cancer-related deaths each year.

Still, there is much cause for hope. We continue to make inroads in the diagnosis and treatment of this disease. And many — though not all — cases of inflammatory breast cancer can be cured. 

Here are 14 of the most common questions I hear as executive director of MD Anderson’s Inflammatory Breast Cancer Clinic. 

1. What does inflammatory breast cancer look like?  

Typically, inflammatory breast cancer presents with both red or discolored breast skin and swelling. So, the skin on or around the breast may look inflamed, or be a different color than the rest.  

Depending on your underlying skin tone, the discolored areas could be red, pink, or even purple or brownish. It may also feel like the skin has thickened, and your nipple may be inverted. 

2. How is inflammatory breast cancer typically diagnosed?  

Unlike other types of breast cancer, inflammatory breast cancer doesn’t usually show up as a lump or appear on a screening mammogram. That is why it’s so often misdiagnosed.  

But patients usually notice skin changes and breast swelling that develop fairly quickly and prompt a visit to the doctor.  

3. Does inflammatory breast cancer hurt?  

It can, but it doesn’t always. Some of our patients do report experiencing pain. 

4. Does inflammatory breast cancer itch? 

Sometimes, it can. But again, not always. 

5. How fast does inflammatory breast cancer spread?  

For some people, it can be a matter of weeks between when they first notice a change in their skin and when they realize that their whole breast is now involved. Some report abrupt changes over a matter of days.   

To be classified as inflammatory breast cancer, though, the skin changes must:  

• have occurred within the last 6 months, and 
• involve at least a third of the breast. 

6. How is inflammatory breast cancer treated? 

Systemic therapies — such as chemotherapy, targeted therapy and immunotherapy — come first, to get the best results from surgery.  

After that, inflammatory breast cancer patients undergo a mastectomy, a surgery that removes all of the cancerous tissue involved. That includes any skin that’s affected, so leaving some behind in order to place expanders or do immediate reconstruction is not appropriate.  

Finally, we use radiation therapy to target larger areas.  

7. Is inflammatory breast cancer curable?  

Yes, definitely. Not all of it can be cured, of course. As with all stage IV cancers, we can treat stage IV IBC, and we aim to achieve a prolonged “no evidence of disease” status with ongoing therapy, but we can’t cure it.  

Inflammatory breast cancer is always considered at least stage III, though, no matter how early you catch it. So, the sooner you can diagnose it and start treatment before it progresses to stage IV, the better chance you have of a cure. 

8. What causes inflammatory breast cancer? 

Nobody really knows for sure, but some risk factors are thought to overlap with those of regular breast cancer. Risk factors that may influence IBC include:  

• race: Black women have a higher incidence of IBC 
• high body weight: can increase your risk 
• breastfeeding: reduces risk 
• age at first pregnancy: being younger may increase your risk 

9. Is inflammatory breast cancer hereditary?  

It can be hereditary in the same way that non-inflammatory breast cancer is. So, if breast cancer runs in your family, you may be at higher risk of developing it yourself one day. But just because your mom had IBC doesn’t make it more likely that you’ll have that same type, too. 

As far as we know, there’s no inheritable component of inflammatory breast cancer that’s useful for genetic testing right now.  

10. Does inflammatory breast cancer show up in bloodwork?  

No. Not in a way that would be helpful to anyone as a patient. Liquid biopsies are starting to look more at circulating tumor material. But could I do a test right now and find IBC? No. 

11. Are some people more likely to develop inflammatory breast cancer than others? 

Yes. Although IBC can happen at any age, IBC is more common among women who: 

• are under the age of 40 
• have high body weight 
• have Black ancestry.

Development seems to be influenced by the normal changes that take place in breast tissue after childbirth (from dormancy to active milk production and back again) and that is actively being studied.  

12. What should patients look for when deciding where to seek IBC treatment? 

Because this disease is so rare and aggressive, where you go first for your inflammatory breast cancer treatment makes a big difference. To ensure you get an accurate diagnosis and the correct treatment from the beginning, it’s critical to go to a large, comprehensive cancer center like MD Anderson. 

Here, we offer patients two important benefits: specialized clinical trials and high-volume experience. Our physicians see multiple patients with inflammatory breast cancer every week, so we are the experts. Our results demonstrate that. We have some of the best published results in the country for treating inflammatory breast cancer. 

Our multidisciplinary approach also enables patients to visit with all three types of specialists (breast oncology, radiation oncology and surgical oncology) quickly. They work closely with our pathologists, radiologists and other specialists to provide the best treatment possible for each patient. 

That means patients can find everything they need right here. And that doesn’t just include your clinical care. It also includes support services such as social work counselors, support groups and even one-on-one support from other survivors. 

13. Why are the chances of recurrence so much higher with inflammatory breast cancer? 

Inflammatory breast cancer has specific features that drive progression, resistance and the migration of cancer cells, so it has a high rate of spreading and recurrence. It’s very aggressive. 

14. Is there anything you can do to lower your risk of IBC recurrence? 

The best way to reduce your chances of recurrence is to have the key therapies in the right order from the very beginning. That means systemic therapies first, followed by a modified radical mastectomy, and then comprehensive post-mastectomy radiation tailored to the original site of the disease. That also means taking advantage of any adjuvant therapies that may be offered.  

Inflammatory breast cancer is not a disease for diluting therapies or using less rigorous methods to try to reduce side effects. So, you want to avoid things like skin-sparing mastectomies, sentinel lymph node biopsies, and immediate reconstructions. With inflammatory breast cancer, the only role for non-guideline-based care is through a clinical trial. 

Wendy Woodward, M.D., Ph.D., is a radiation oncologist and researcher who specializes in the treatment of inflammatory breast cancer. She also serves as ad interim chair of the Breast Radiation Oncology department and executive director of MD Anderson’s Inflammatory Breast Cancer Clinic.

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