Inflammatory Breast Cancer, Though Rare, Is Being Diagnosed More Often
Reviewed study: "Inflammatory Breast Cancer, Though Rare, Is Being Diagnosed More Often" by K.W. Hance et al., Journal of the National Cancer Institute, July 6, 2005
Is this for me? You might want to read this article if you've been diagnosed with inflammatory breast cancer or if you are concerned because your breast has become swollen, warm, and red.
Background and importance of the study: Inflammatory breast cancer is a relatively rare but very serious, aggressive type of stage IIIB breast cancer. The most distinguishing feature of inflammatory breast cancer is redness involving part or all of the breast. The redness feels warm. Sometimes the redness comes and goes. You may see swelling of the breast's skin that looks like the peel of a navel orange ("peau d'orange"), or even ridges, welts, or hives. And part or all of the breast may be enlarged and hard. A lump or a mass is present in about 50% of women, but it may be difficult to feel since the breast is often bigger and harder than normal. Sometimes inflammatory breast cancer is misdiagnosed as an infection.
Inflammatory breast cancer IS hard to diagnose. Because the disease is rare, many doctors have never seen it. Also, it has not been studied as much as other types of breast cancer. An infection is a more common cause of swelling and redness of the breast—so that's why doctors think of that diagnosis first.
Estimates of how often inflammatory breast cancer occurs have ranged from 1% to 10% of breast cancer cases. The large study reviewed here was done to learn more about how often inflammatory breast cancer happens and more about the disease's characteristics.
Study design: Researchers at George Washington University and the National Cancer Institute looked at information from 180,224 cases of breast cancer diagnosed in 1988 and 1999. The information came from the Surveillance, Epidemiology, and End Results (SEER) registry, a huge collection of information on how many people in the United States get cancer each year (incidence) and how long they live (survival). The National Cancer Institute manages this registry.
The researchers found all cases of women with inflammatory breast cancer in the registry for the chosen years. For each case they gathered information about survival, age at diagnosis, and race.
Results: The researchers found that inflammatory breast cancer accounted for 3,648 (2%) of the 180,224 breast cancer cases diagnosed. Between 1988 and 1999 the average number of inflammatory breast cancer cases increased from 2 per 100,000 women to 2.5 per 100,000 women. In contrast, other types of breast cancer combined decreased in the same time period, from an average of 108 cases per 100,000 women to 101 cases per 100,000 women.
Women were diagnosed with inflammatory breast cancer at an average age of 59—about 3 to 7 years younger than the average age of women diagnosed with other types of breast cancer. African American women had more cases of inflammatory breast cancer (3.1 cases per 100,000 women) than white women did (2.2 cases per 100,000 women).
Women with inflammatory breast cancer lived on average for about three years after diagnosis, compared to 6 to 10 years for women who had other types of breast cancer. African American women with inflammatory breast cancer lived a shorter time than white women—two years after diagnosis, compared to three. Overall, though, survival rates for inflammatory breast cancer improved slightly from 1988 to 1999.
Conclusions: The researchers concluded that inflammatory breast cancer continues to be relatively uncommon. But the number of cases diagnosed increased from 1988 to 1999. They also concluded:
- Survival rates are lower for inflammatory breast cancer than for other types of breast cancer, but they improved slightly over the years that were studied.
- Women diagnosed with inflammatory breast cancer are more likely to be younger than women diagnosed with other types of breast cancer.
- African American women are more likely than white women to be diagnosed with the disease and to live a shorter time after diagnosis.
What breastcancer.org says about this article…
Inflammatory Breast Cancer, Though Rare, Is Being Diagnosed More Often
Inflammatory breast cancer is very serious and very aggressive. But it is also very uncommon, diagnosed in only about 2.5 women out of every 100,000. This study is important because it gives us more details about inflammatory breast cancer and how age and race may affect risk for the disease.
If your breast is red, warm, and enlarged, and the skin looks thick, like an orange peel, call your doctor for an immediate evaluation. You probably have an infection in the breast, and that's particularly likely if you also have a fever and tenderness. A fever along with an infection requires urgent attention. If you have an infection, taking an antibiotic should make most of these changes improve or go away within a week. Sometimes there is a pocket of infection in the breast, maybe in a spot where an earlier biopsy was done. This is called an abscess, and the infection that involves an abscess takes longer to clear up. You may need surgery to drain the abscess.
Other things can make your breast red and swollen. One is receiving radiation therapy to the breast. Pinkness and redness of the skin and swelling and tenderness of the breast (without fever) usually start in the middle of radiation treatment and can last for a few months after radiation is over. Redness can also come from an outbreak of non-cancerous skin conditions such as psoriasis, eczema, and shingles.
If your breast remains red and swollen after you take antibiotics, and if you don't have one of the other non-cancerous skin conditions, then you should have a biopsy of the breast to check for inflammatory breast cancer. The biopsy may show signs of cancer. But sometimes a biopsy comes back "clear," even when the redness and swelling are getting worse. Another biopsy is then needed.
Inflammatory breast cancer is mainly diagnosed by physical examination, but it has to be confirmed by a biopsy. Making the diagnosis can be tricky. The lack of a mass or lump can be confusing, and having a biopsy come back "clear" is also confusing. If you're concerned that you may have inflammatory breast cancer, it's important to see a doctor who specializes in breast cancer and who has experience diagnosing and treating inflammatory breast cancer.
Aggressive treatment is necessary to fight inflammatory breast cancer. The best medicines, surgery, and radiation are used in combinations or in sequence within a treatment plan that's customized just for you. The first treatment for inflammatory breast cancer is chemotherapy. Herceptin (chemical name: trastuzumab) usually has an important role at the same time or after chemotherapy if the cancer is HER2-positive. Once the cancer has gotten smaller in response to these medicines, then local forms of treatment are used: surgery and radiation. You will also receive hormonal therapy if the cancer is hormone-receptor-positive. Breast reconstruction is not recommended until after all treatment is finished and there is no evidence of any persistent or recurrent breast cancer.
The kind and sequence of treatment depend on your individual situation. Don't be surprised if the plan is changed a few times during treatment. Your doctor will see how the cancer responds to therapy and make adjustments accordingly.
Stay tuned to Breastcancer.org for the latest research information on inflammatory breast cancer diagnosis and treatments.
