Treating Inflammatory Breast Cancer With Surgery, Chemotherapy, and Radiation Improves Survival

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Inflammatory breast cancer (IBC) is a rare and very aggressive form of breast cancer. About 1% to 5% of all breast cancer cases in the United States are inflammatory breast cancer.

Although most breast cancers begin as lumps or tumors, IBC usually starts with a feeling of thickness or heaviness in the breast. You also may develop red, inflamed skin on the breast. IBC tends to grow in the form of layers or “sheets” of tissue, which doctors sometimes call “nests.” IBC tends to grow and spread quickly, with symptoms worsening within days or even hours.

IBC treatment guidelines recommend giving a chemotherapy regimen that includes an anthrycycline – and possibly targeted therapy – before surgery. Giving chemotherapy first helps shrink the cancer, reduce the swelling, and help the inflamed skin return to normal.

Anthracycline chemotherapy medicines include Adriamycin (chemical name: doxorubicin) and Ellence (chemical name: epirubicin).

After chemotherapy, most people diagnosed with IBC usually have a mastectomy followed by radiation therapy.

Still, not all women diagnosed with IBC receive chemotherapy, surgery, and radiation (doctors call receiving all three treatments trimodality therapy).

A study has found that women diagnosed with IBC who are treated with chemotherapy, surgery, and radiation have better survival rates than women who don’t receive all three treatments.

The research was published online on June 2, 2014 by the Journal of Clinical Oncology. Read the abstract of “Underuse of Trimodality Treatment Affects Survival for Patients With Inflammatory Breast Cancer: An Analysis of Treatment and Survival Trends from the National Cancer Database.”

In the study, the researchers looked at the records of 10,197 women diagnosed with non-metastatic IBC who had surgery to treat the disease.

The records were in the National Cancer Database, a collection of information on patients, cancer characteristics, treatments, and outcomes maintained by the American College of Surgeons, the American Cancer Society, and the Commission on Cancer. The database represents about 70% of all new cancer diagnoses in the United States each year.

Most of the women in the study were white and had insurance. They also had few or no other conditions (besides IBC) that would have affected their health.

When looking at treatments, the researchers found:

  • more than 93% of the women had a mastectomy
  • 13.2% of the women didn’t have any lymph nodes removed and 16.7% didn’t have any lymph node information in their pathology reports; this means that nearly 30% of the women (and their doctors) didn’t know if they had cancer cells in their lymph nodes
  • more than 93% of the women had chemotherapy; more than 90% of these women were treated with a regimen that included more than one chemotherapy medicine
  • about 5% of the women were treated with surgery alone
  • about 27% of the women were treated with surgery and chemotherapy
  • about 1.5% of the women were treated with surgery plus radiation therapy
  • about 67% of the women were treated with surgery, radiation therapy, and chemotherapy

So overall, trimodality therapy was the most common treatment for IBC.

The researchers found that:

  • being younger
  • living in a large urban area
  • having a higher income

made it more likely that a woman would receive all three treatments for IBC.

When looking at survival rates, the researchers found that women who received chemotherapy, surgery, and radiation therapy were likely to survive longer than women who received only surgery:

  • women who received all three treatments lived for about 6 years
  • women who received only surgery lived for about 2 years

This difference was significant, which means it’s likely because of the difference in treatment and not just due to chance.

At 5 years after diagnosis, survival rates were:

  • 55.4% for women receiving all three treatments
  • 42.9% for women treated with chemotherapy and surgery
  • 40.7% for women treated with surgery and radiation therapy

At 10 years after diagnosis, survival rates were:

  • 37.7% for women receiving all three treatments
  • 28.5% for women treated with chemotherapy and surgery
  • 23.5% for women treated with surgery and radiation therapy
  • 16.5% for women treated only with surgery

The results of this study strongly suggest that women diagnosed with inflammatory breast cancer who are treated with a combination of chemotherapy, surgery, and radiation therapy have better survival rates than women who are treated with less comprehensive regimens.

If you’ve been diagnosed with inflammatory breast cancer, you and your doctor will work together to develop a treatment plan that is tailored to your unique situation and preferences. If your doctor doesn’t recommend all three treatments -- chemotherapy, surgery, and radiation therapy -- to treat the IBC, you may want to ask why and talk to your doctor this study.

For more information on the symptoms of and treatments for IBC, visit the Inflammatory Breast Cancer pages in the Breastcancer.org Symptoms & Diagnosis section.


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