Top

June 2020 : Inflammatory breast cancer symptoms: What to know

Inflammatory breast cancer symptoms: What to know

Inflammatory breast cancer is a rare but serious form of breast cancer and its symptoms can be confusing. Here’s what you need to know about inflammatory breast cancer from our expert.

BY Heather Alexander

Inflammatory breast cancer makes up 1-5% of invasive breast cancers, so it is rare.

But inflammatory breast cancer is very aggressive, and its symptoms can easily be confused with other, more minor illnesses. So it’s important to recognize the signs of inflammatory breast cancer and take action right away.

“Even though it’s uncommon, inflammatory breast cancer is very serious, so you have to rule out that risk before you assume the problem is something less concerning,” says Wendy Woodward, M.D., Ph.D., professor in MD Anderson’s Radiation Oncology Department.

Symptoms of inflammatory breast cancer

Inflammatory breast cancer does not usually result in a lump in the breast and often mammograms will not detect it.

That’s because the cancer cells grow as smaller clusters instead of as one big mass. These clusters get into the lymph vessels of the breast and clog them, so inflammatory breast cancer often looks like an infection.

“Many times patients will be diagnosed with mastitis or some other infection,” says Woodward. “They’ll be given antibiotics before a diagnosis of cancer.

If you have any of these inflammatory breast cancer symptoms, talk to your doctor right away:

Breast swelling that appears suddenly with one breast much larger than the other
Persistent, unexplained itching of the breast
Pink, red, or dark area on the breast, sometimes with dimpling of the breast skin that looks like an orange peel (called peau d’orange)
Ridges and thickened areas of the skin on the breast
Breast that feels warm to the touch
Flattened or retracted nipple
Breast pain or tenderness

“If you are given a short course of antibiotics for one of these symptoms, and it’s not clearly better in five or 10 days, your doctor needs to do more investigation right away,” says Woodward.

That should include a mammogram and ultrasound. If the mammogram is negative but the problem persists, an MRI or biopsies of the red or swollen skin also should be done.

“It’s helpful if patients can advocate for themselves,” says Woodward. “Don’t allow the work-up to stop at antibiotics or a mammogram. If your symptoms come back or are not improving, insist on reimaging like an MRI.”

Who is at risk for inflammatory breast cancer?

There are certain groups of women who seem to be more likely to get inflammatory breast cancer:

Inflammatory breast cancer often affects women under 40.
Race may also play a part in risk for inflammatory breast cancer. Some studies suggest African American women are more at risk for inflammatory breast cancer.
Women who are obese are at higher risk for inflammatory breast cancer.

You can lower your risk for inflammatory breast cancer and breast cancer in general by following a healthy lifestyle. Eat a plant-based diet and get at least 150 minutes of moderate or 75 minutes of vigorous exercise.

You can also choose to breastfeed, try to stay lean after menopause and limit the amount of alcohol you drink.

Talk to your doctor to see if you are at high risk for breast cancer. Some women may be referred for genetic counseling or other medical exams.

Inflammatory breast cancer: 14 things to know

BY Wendy Woodward, M.D., Ph.D. 

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.

Request an appointment at MD Anderson online or call 1-877-632-6789.