Inflammatory Breast Cancer
Inflammatory breast cancer (IBC) is rare. It differs from other types of breast cancer in its symptoms, outlook, and treatment. Symptoms include breast swelling, redness of the skin, and pitting or ridging of the skin of the breast so that it may look and have a texture like orange peel. If you have any of these symptoms, it does not mean that you have IBC, but you should see a doctor right away.
What is inflammatory breast cancer?
Inflammatory breast cancer (IBC) has some symptoms of inflammation like swelling and redness. But infection or injury do not cause IBC or the symptoms. IBC symptoms are caused by cancer cells blocking lymph vessels in the skin.
How is inflammatory breast cancer different from other types of breast cancer?
Inflammatory breast cancer differs from other types of breast cancer in several key ways:
- Inflammatory breast cancer (IBC) doesn't look like a typical breast cancer, It often does not cause a breast lump, and it might not show up on a mammogram. This makes it harder to diagnose.
- IBC tends to occur in younger women (at an average age of 52 versus 57 for more common forms of breast cancer).
- African-American women appear to be at higher risk of IBC than white women.
- IBC is more common among women who are overweight or obese.
- IBC also tends to be more aggressive—it grows and spreads much more quickly—than more common types of breast cancer.
- IBC is always at a locally advanced stage when it’s first diagnosed because the breast cancer cells have grown into the skin. (This means it at least stage IIIB.)
- In most cases, IBC has already spread (metastasized) to distant parts of the body when it is diagnosed. This makes it harder to treat successfully.
What are the signs and symptoms of inflammatory breast cancer?
Inflammatory breast cancer (IBC) causes a number of signs and symptoms, most of which develop quickly and start at the same time, including:
- Thickening (edema/swelling) of the skin of the breast
- Redness involving more than one-third of the breast
- The breast may become harder
- Pitting or ridging of the skin of the breast so that it may look and have a texture like orange peel
- Sometimes the nipple is inverted.
- Swelling can make one breast look larger than the other.
- The breast feels warm and can feel heavy compared to the other breast.
- The breast may also be tender and painful or itchy.
Tenderness, redness, warmth, and itching are common symptoms of a breast infection or inflammation, such as mastitis if you’re pregnant or breastfeeding. Because these problems are much more common than IBC, your doctor might at first suspect infection as a cause and treat you with antibiotics.
This may be a good first step, but if your symptoms don’t get better in 7 to 10 days, more tests need to be done to look for cancer. The possibility of IBC should be considered more strongly in a woman who has these symptoms and is not pregnant or breastfeeding, or has been through menopause.
IBC grows and spreads quickly, so the cancer may have already spread to nearby lymph nodes by the time symptoms are noticed. This spread can cause swollen lymph nodes under your arm or above your collar bone. If the diagnosis is delayed, the cancer can spread to lymph nodes in your chest or to distant sites in the body.
If you have any of these symptoms, it does not mean that you have IBC, but you should see a doctor right away. If treatment with antibiotics is started, you’ll need to let your doctor know if it doesn't help, especially if the symptoms get worse or the area affected gets larger. Ask to see a specialist (like a breast surgeon) or you might want to get a second opinion if you’re concerned.
How is inflammatory breast cancer diagnosed?
If inflammatory breast cancer (IBC) is suspected, one or more of the following imaging tests may be done:
- Breast ultrasound
- MRI (magnetic resonance imaging) scan
- CT (computed tomography) scan
- PET (positron emission tomography) scan
Sometimes a photo of the breast is taken to help record the amount of redness and swelling before starting treatment.
Breast cancer is diagnosed by a biopsy, taking out a small piece of the breast tissue and looking at it under a microscope. Your physical exam and other tests may show findings that are "suspicious for" IBC, but only a biopsy can tell for sure that cancer is present.
Tests on biopsy samples
The cancer cells in the biopsy sample will be graded based on how abnormal they look. They will also be tested for certain proteins that help decide which treatments will be helpful.
The cells are tested for hormone receptors. Women whose breast cancer cells contain hormone receptors are likely to benefit from treatment with hormone therapy drugs.
Cancer cells are also tested to see if they contain too much of a protein called HER2/neu (often just called HER2) or too many copies of the gene for that protein. If they do, the woman may be helped by certain drugs that target HER2.
Stages of inflammatory breast cancer
Inflammatory breast cancer that has spread outside the breast and nearby lymph nodes is stage IV.
All other inflammatory breast cancers are stage III. If the cancer has spread to lymph nodes around the collarbone or inside the chest, it’s stage IIIC. Otherwise, it’s stage IIIB.
If you need more details, read about breast cancer staging.
Survival rates for inflammatory breast cancer
Inflammatory breast cancer (IBC) is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time it’s found, and is more likely to come back after treatment than most other types of breast cancer. The outlook is generally not as good as it is for most other types of breast cancer.
Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any particular person's case. Many other factors can affect a person's outlook, such as age, general health, treatment received, and how well the cancer responds to treatment. Your doctor can tell you how the numbers below may apply to you, as he or she is familiar with your situation.
These survival rates are based on people diagnosed years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with inflammatory breast cancer.
These numbers are based on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, for patients who were diagnosed with inflammatory breast cancer between 1990 and 2008.
Median survival is the length of time for half of the patients in a group to have died. By definition, half of the patients in that group are still alive. It is important to remember that the median is just a kind of average used by researchers. No one is "average" and many people have much better outcomes than the median. Also, people with inflammatory breast cancer can die of other things, and these numbers don’t take that into account.
- The median survival rate for people with stage III inflammatory breast cancer is about 57 months.
- The median survival rate for people with stage IV inflammatory breast cancer is about 21 months.
How is inflammatory breast cancer treated?
Inflammatory breast cancer (IBC) that has not spread outside the breast or nearby lymph nodes is stage IIIB or IIIC. In most cases, treatment is chemotherapy to try to shrink the tumor, followed by surgery to remove the cancer. Radiation is given after surgery, and, in some cases, more chemo may be given after radiation.
IBC that has spread to other parts of the body (stage IV) is treated with chemotherapy, hormone therapy, and/or with a drug that targets HER2.
For details, see treatment of inflammatory breast cancer.
What's new in inflammatory breast cancer research?
Studies comparing DNA and other molecules from IBC with that of the usual types of breast cancer have shown some important differences. Scientists believe that some of these differences account for the unique and aggressive way that IBC spreads and grows. There’s hope that understanding these differences will lead to better treatments that target cell changes specific to IBC.
Dawood S, Cristofanilli M. Inflammatory breast cancer: what progress have we made? Oncology (Williston Park). 2011 Mar;25(3):264−270, 273.
Dawood S, Cristofanilli M. What progress have we made in managing inflammatory breast cancer? Oncology. 2007;21:673−679
Dawood S, Merajver SD, Viens P, et al. International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol. 2011 Mar;22(3):515−523.
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. J Natl Cancer Inst. 2005;97:966−975.
Hennessy BT, Gonzalez-Angulo AM, Hortobagyi GN, et al. Disease-free and overall survival after pathologic complete disease remission of cytologically proven inflammatory breast carcinoma axillary lymph node metastases after primary systemic chemotherapy. Cancer. 2006;106:1000−1006.
Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site, April 2012.
Kaufman B, Trudeau M, Awada A, et al. Lapatinib monotherapy in patients with HER2-overexpressing relapsed or refractory inflammatory breast cancer: final results and survival of the expanded HER2+ cohort in EGF103009, a phase II study. Lancet Oncol. 2009;10:581−588.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Version 3.2014. Accessed at www.nccn.org on June 10, 2014.
Panades M, Olivotto IA, Speers CH, et al. Evolving treatment strategies for inflammatory breast cancer: a population based survival analysis. J Clin Oncol. 2005;23:1941−23:19
Schlichting JA, Soliman AS, Schairer C, Schottenfeld D, Merajver SD. Inflammatory and non-inflammatory breast cancer survival by socioeconomic position in the Surveillance, Epidemiology, and End Results database, 1990-2008. Breast Cancer Res Treat. 2012 Aug;134(3):1257-68. Epub 2012 Jun 26.
Sinclair S, Swain SM. Primary systemic chemotherapy for inflammatory breast cancer. Cancer. 2010 Jun 1;116(11 Suppl):2821−2828.
Yang WT, Le-Petross HT, Macapinlac H, Carkaci S, Gonzalez-Angulo AM, Dawood S, Resetkova E, Hortobagyi GN, Cristofanilli M: Inflammatory breast cancer: PET/CT, MRI, mammography and sonography findings. Breast Cancer Res Treat. 2008 Jun;109(3):417-26. Epub 2007 Jul 26. Review
Last Medical Review: June 1, 2016 Last Revised: August 18, 2016