October 2006: Inflammatory Breast Cancer

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Ask-the-Expert Online Conference

On Wednesday, October 18, 2006, our Ask-the-Expert Online Conference was called Inflammatory Breast Cancer. Gabriel Hortobagyi, M.D., Thomas Buchholz, M.D., and moderator Jennifer Sabol, M.D. answered your questions about inflammatory breast cancer, a rare but aggressive form of breast cancer.

Inverted nipple a sign of cancer?

Question from BethL: Is an inverted nipple only associated with inflammatory breast cancer (IBC) or can it be present in other types of breast cancer?
Answers - Jennifer Sabol, M.D., F.A.C.S. An inverted nipple can be seen in a lot of conditions, some of which are benign and some of which are malignant. It is not always associated with breast cancer, and even when it is, it is not necessarily associated with inflammatory breast cancer. This is the type of condition that you should report to your doctor to be evaluated further.

Symptoms of inflammatory breast cancer?

Question from Dale: I am unsure if I have IBC. I am a 42-year-old female whose right breast inflames, turns red, and has a burning sensation. It has felt "tight," and increasingly so for the past two and a half years. Now the sensations have wrapped around my right upper body, and military doctors refuse to give me an incisional biopsy since nothing shows on mammogram and ultrasound. I was given Zithromax, but it did not help. Could this be IBC?
Answers - Thomas Buchholz With those symptoms, you should be seen and examined by an experienced breast physician. If you've had the symptoms for over two years, this is unlikely to be IBC. It's difficult to make a judgment in this type of setting. So I'd recommend you be carefully examined, because as you may be aware, sometimes breast cancer is not picked up with mammography.
Gabriel N. Hortobagyi, M.D., F.A.C.P. It is definitely not inflammatory breast cancer because by definition, inflammatory breast cancer is a rapidly progressing disease. Whether you have breast cancer or not is a different question, and so you do need to be screened and examined. Untreated inflammatory breast cancer has a survival of about a year to a year and a half, so the fact that you have had symptoms for two and a half years to me excludes this diagnosis.

Do IBC symptoms come and go?

Question from LionP: Do the symptoms (rash, etc.) of inflammatory breast cancer come and go? I've had breast cancer in my right breast and got a rash in my left breast two years later. It went away but sometimes it still looks like a mild rash is back. My doctor thought it was just a spider bite.
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. It's hard to comment without seeing it, but in general terms a rash that is related to the progression of cancer does not come and go, especially over many months and several years. It is unlikely to be related to cancer. There are many other things that can cause a rash on the chest wall, so one would have to place this in context of all other symptoms and circumstances of that rash.
Jennifer Sabol, M.D., F.A.C.S. It sounds like you have had a previous diagnosis of breast cancer, so you may be connected with a breast surgeon who would probably be in the best situation to evaluate that rash.

How does IBC get missed when tested?

Question from Cathy: My skin pathology came back negative for IBC. Two months later, I had three tumors and the surgeon said I do have IBC. How was this missed the first time?
Answers - Thomas Buchholz When patients present with IBC, they often have congestion of fluid within their skin that's associated with small pieces of the tumor being present in some of the lymphatic channels of the skin. It is possible to take a biopsy of the skin and not find tumor cells associated with the cells that are examined. I'm not sure if this is what happened in your particular case. It sounds as if over the two month period the tumor became more present and therefore easier to detect. Inflammatory breast cancer is a breast cancer that is associated with clinical findings of thickened skin and redness of the breast that have a rapid onset and are associated with the underlying breast cancer. Oftentimes this is confirmed with the finding of a tumor within the lymphatic channels of the skin, but the diagnosis of inflammatory breast cancer is not dependent on proving that the cancer is within the skin. Therefore, inflammatory breast cancer is sometimes referred to as a clinical diagnosis meaning that a lot of the diagnosis is dependent on the history and physical examination findings.

Does nursing affect risk of IBC?

Question from Memama: Do your chances for IBC go up if you have had lots of breast infections while nursing your children?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. I've never seen any data to suggest that is or is not true.
Thomas Buchholz I don't think a history of breast infection predisposes to inflammatory breast cancer.
Jennifer Sabol, M.D., F.A.C.S. The only data we have does show that lactation reduces your risk of developing breast cancer in general, but it's hard to take that data and apply it towards inflammatory breast cancer.

IBC: Causes? Treatment? Cure rate?

Question from GSanders: What causes this type of cancer? How is it normally treated? What is the cure rate? Will I have to take medication for the rest of my life?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. The short answer is we don't know what causes inflammatory breast cancer. We do know that there seem to be differences in the frequency with which it is diagnosed in different parts of the world. In northern Africa and sub-Saharan Africa, they report much higher rates than in North America or Western Europe. I'm unsure if that is a real difference or not, but the true cause of inflammatory breast cancer to the best of my knowledge is not known. We have emerging information that suggests the molecular abnormalities that can be found in inflammatory breast cancer might be different in frequency when compared with non-inflammatory breast cancer. So for instance, reports suggest that the frequency of HER2 is more common in inflammatory breast cancer than in non-inflammatory breast cancer. There are reports to suggest that genes that predispose to blood vessel formation are more frequently activated in inflammatory breast cancer. Then there are several additional molecular differences, but that still doesn't give us a cause. But it might in the future give us a lead to develop treatments that are perhaps more specific for inflammatory breast cancer than what we use today.
Jennifer Sabol, M.D., F.A.C.S. Can you elaborate on the present treatment for inflammatory breast cancer?
Thomas Buchholz The treatment for inflammatory breast cancer really requires a closely coordinated effort from all disciplines involved in breast cancer care. Prior to treatment, it is important to investigate the extent of the disease and stage the disease to determine whether it appears to be confined to the breast and lymph nodes, or whether it has spread to other sites in the body. After the staging studies have been completed, the initial treatment approach is combination chemotherapy. Ultimately, inflammatory breast cancer is best treated with combinations of chemotherapy, surgery (including mastectomy), and radiation treatment. Some inflammatory breast cancer may also respond to trastuzumab (brand name: Herceptin) or hormonal therapy, depending on the molecular features of the disease.
Gabriel N. Hortobagyi, M.D., F.A.C.P. Prior to 1975, inflammatory breast cancer was treated with either surgery or radiation therapy or the two together, but without chemotherapy or hormone therapy. The results of that were very poor because of the very aggressive nature of the disease. So in general terms, less than 5% of patients would survive five years. When the combination chemotherapy was introduced into this combined treatment approach, with surgery and radiation therapy, the five year survival increased to somewhere between 30 and 40% in most reports. That continues to be the case today. So about one in three patients with inflammatory breast cancer will survive five years, and the great majority of those who do are probably cured of their inflammatory breast cancer. Most of the recurrences of inflammatory breast cancer have been very early, within the first couple of years.

The majority of inflammatory breast cancers are not hormone dependent, and if in addition to that they do not have the HER2 gene, the treatment will probably be completed in nine months. If the HER2 gene is amplified, in addition to chemo and surgery and radiation, one would probably use Herceptin for about a year. If the inflammatory breast cancer in a particular patient also has estrogen or progesterone receptors, one would use in addition to chemotherapy, radiation and surgery, an aromatase inhibitor like Femara (chemical name: letrozole). That would require at least five years of treatment, possibly longer, and it is possible that as new knowledge evolves, that might mean for life. But I estimate that applies to a minority of patients with inflammatory breast cancer.

Is IBC hereditary?

Question from Karen: My mum was diagnosed with IBC in June 2005 and passed away in August 2006. My sister and I are concerned about whether or not this form of breast cancer is hereditary, and what should we know now? We are 29 and 32.
Answers - Thomas Buchholz All individuals with a family history of breast cancer do have a greater risk of developing breast cancer themselves. However, the data isn't clear that inflammatory breast cancer necessarily predisposes to the development of inflammatory breast cancer in relatives. It sounds as if you and your sister are still relatively young compared to the age that your mother developed breast cancer. I would follow standard guidelines for screening, mammography, and physical examination beginning at age 40, unless you also have many other relatives with breast cancer history or relatives who have ovarian cancer history.
Jennifer Sabol, M.D., F.A.C.S. If there is a more extensive family history of breast or ovarian cancer, you might want to be referred to a genetic counselor for at least screening and possibly genetic testing.

Lymph node removal with IBC?

Question from Tamera: Is it commonplace for surgeons not to remove lymph nodes with IBC because it is strictly for staging?
Answers - Thomas Buchholz The standard treatment for IBC first consists of chemotherapy. After a response to chemotherapy is achieved, the standard surgical treatment is to remove both the breast and the axillary (under the arm) lymph nodes. Dissection remains a standard part of the surgical treatment of inflammatory breast cancer. Subsequently patients should receive radiation and, as Dr. Hortobagyi just mentioned, Herceptin and hormonal treatment when appropriate.

Mastectomy when metastatic?

Question from Fiona: Is mastectomy done even when the cancer has spread to, say, the bones?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. In general terms, the standard of care today is that when metastases are present at the time of diagnosis of the primary, then no definitive surgery is performed on the primary unless there is a need to control a bleeding, ulcerated breast for quality-of-life purposes. In recent years, the question has been raised whether removing the breast in the presence of metastasis might favorably affect survival. There is interest in addressing that through additional research and there is at least one ongoing clinical trial outside the United States looking at that, but it is not considered a standard procedure nor is there definitive evidence that it helps. There are no trials currently in the U.S. But there has been some skepticism in the medical community, so there is no trial ongoing or planned for this issue.

Non-surgical treatments for IBC?

Question from Terry: I'm 70 and have been diagnosed with IBC. I do not wish at my age to have chemotherapy or radiation unless it is beam radiation. Are there any non-surgical treatments? I have been told I will die if I don't have either surgery, chemo, radiation or a combination of all. Quality of life is more important that quantity. Any suggestions appreciated.
Answers - Thomas Buchholz Terry, I'm sorry to hear about your condition, because I realize it is difficult no matter which way you go. For healthy women who are 70 we still recommend aggressive treatment because inflammatory breast cancer left untreated or just partially treated can have bad effects both on your quality and quantity of life. Radiation treatment alone was tried in the 1970s before chemotherapy was available and most patients had rapid disease progression. Seventy is now considered a young age, and if you're healthy I would still consider seeing a medical oncologist and carefully discussing the risks and benefits of chemotherapy. It may be that some of your fears of chemotherapy are due to misinformation and after getting a comprehensive discussion, you'll be well informed to make the best decision for you.
Gabriel N. Hortobagyi, M.D., F.A.C.P. The life expectancy of a healthy 70-year-old woman in the U.S. is 16 years. The average survival of a person with untreated inflammatory breast cancer is less than 2 years.

How is extent of IBC determined?

Question from Wayne: How does a surgeon determine the extent of the IBC after it has been visually eliminated by the chemotherapy? How do they determine the extent of the disease?
Answers - Jennifer Sabol, M.D., F.A.C.S. When a mastectomy is performed, the surgeon will generally go in and remove the nipple and areola and as much of the overlying skin that has the inflammatory characteristics as they can. There are certain margins when the breast is removed, such as the collarbone, breastbone, and a line out of the arm that determine the edges of every mastectomy. The additional tissues that are removed under the arm, the axillary lymph nodes, is standard for both regular breast cancer and inflammatory breast cancer. If there are additional tissues involved outside the axillary, they will be removed as well. The final extent is really determined by the pathologist.
Gabriel N. Hortobagyi, M.D., F.A.C.P. There is much interest, although no definitive proof, in using presurgical imaging such as MRI (magnetic resonance imaging) or PET (positron emission tomography) in an attempt to guide the surgeon in finding the extent. Additional research will be needed to validate that.

Has the inflammatory breast cancer spread?

Question from Cathy: My axillary lymph nodes were removed 11 years ago from first go-around with cancer. I was subsequently diagnosed with IBC in the same breast. There were no lymph nodes to take this time. How do I know for sure that the cancer did not spread?
Answers - Thomas Buchholz When inflammatory breast cancer develops in a breast that has already been treated for breast cancer, the first step would be to perform a series of staging tests to assure that the cancer has not spread. It is correct that once the axillary lymph nodes have been removed, there may not be more removed at the time of surgery. But otherwise, the treatments would be the same with initially finding the extent of the disease, beginning with chemotherapy, subsequently performing a mastectomy, and then considering radiation. Some of the chemotherapy and radiation decisions may also depend on the previous breast cancer treatment.

Symptoms of IBC post-mastectomy?

Question from CWH: Is there any way that DCIS or invasive ductal carcinoma could "turn" into IBC? I was diagnosed with DCIS in 2004, then IDC earlier this year. I'm currently in chemo to be followed by radiation. I have noticed a pink area adjacent to my original mastectomy scar and a hard spot underneath it. Ultrasound and mammogram were clear, but I'm still uneasy about it due to my history.
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. We don't know whether there is a natural sequence from one type of cancer or precancerous lesions to inflammatory breast cancer. We do know that after breast conserving surgery, there can be redness of the skin and skin edema (swelling) as a result of both the surgical operation and possibly radiation. Sometimes it is difficult to tell whether those changes represent a recurrence of the disease in the form of inflammatory breast cancer or simply post-surgical or post-treatment changes. Depending on the degree of suspicion of whether it is a recurrence or not, and depending on what imaging like ultrasound and mammography show, one might or might not want to do a biopsy to evaluate those changes. This is really a situation where being assessed by someone whose expertise within breast cancer management is really important.
Jennifer Sabol, M.D., F.A.C.S. I agree. It's important to emphasize that after surgery, especially a lymph dissection, there may often be swelling and redness of the skin. We frequently see it, and it usually gets better with time. If it continues to deteriorate or it gets worse, that's when we'd consider doing a biopsy.

IBC triple negative treatment?

Question from JB: What's the most current thinking on treating triple-negative IBC? Also, early trial results on Tykerb indicate positive results for IBCers. How does that translate to triple-negative IBCers?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. Probably about 40% of inflammatory breast cancers are likely to be triple negative. Those tumors that are triple negative are today treated with a combination of chemotherapy, surgery, and radiation. We have no evidence that any additional treatment is useful. Lapatinib, or Tykerb, is a drug that was developed specifically for tumors that have excess amounts of two specific proteins: HER1 and HER2. It does have anti-tumor activity, and its activity appears especially prominent in those patients that have HER2 abnormalities. In that sense, it is similar to Herceptin in its spectrum of activity. The initial trials with Tykerb that included just a small number of patients with inflammatory breast cancer suggest that Tykerb in the HER2 positive inflammatory breast cancer group was active in 1 in 3 patients. To the best of my knowledge, Tykerb has not been tested in the triple-negative group, nor is there a reason to do so at this time. Until Tykerb becomes commercially available, the treatment of choice for patients with inflammatory breast cancer that have HER2 abnormality would be Herceptin, or trastuzumab, in combination with chemotherapy as well as surgery and radiation therapy.

Possible extended Femara treatment?

Question from Cathy: I am the minority with IBC that was also HER2, ER and PR positive. I have completed combination chemo, mastectomy, radiation, Herceptin and am now on Femara. Do you think Femara treatment will be extended beyond the 5-year plan?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. That's a crystal ball question. I think we could say that there are ongoing clinical trials to determine whether prolonging the duration of Femara or similar drugs beyond 5 years is useful and well tolerated. The results of those trials will become available probably in the next 3-5 years.

Clinical trials for IBC with brain metastases?

Question from AllanJeffry: Are there any clinical trials available at M.D. Anderson Cancer Center that would benefit an IBC patient who has received treatment as you've outlined yet now has evidence of recurrence in the chest and brain metastases? Now evidently a stage IV patient.
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. In general terms, most clinical trials unfortunately do not include patients with brain metastases, mostly because of safety concerns. So at this point, and without looking at my priority list, I can't think of a specific clinical trial for patients with inflammatory breast cancer and brain metastases. We might have a clinical trial of new drugs for patients with metastatic brain cancer and brain metastases, and whether a particular patient could be a candidate would require a more in-depth assessment for all the relevant information. The right person to call for this would be Dr. Stacy Moulder at 713-792-2817, or Dr. Massimo Cristofanilli at the same number.
Thomas Buchholz If the patient has brain metastases and has yet to receive treatment for them, it might be best to have their oncologist assess their overall performance status and the safety of traveling to a different institution, or whether they should receive radiation treatment to the brain.

Gene therapy for IBC?

Question from Gina: What kinds of gene therapy are being looked at for IBC?
Answers - Thomas Buchholz I'm not aware of a gene therapy trial.
Gabriel N. Hortobagyi, M.D., F.A.C.P. I'm not aware of a gene therapy trial for inflammatory breast cancer. There are ongoing trials for breast cancer in general, but all of them are in the very early stages of development, mostly Phase 1 trial. But nothing specifically for inflammatory breast cancer. When new drugs are developed, the very first step is to establish what is the best way to give the drug, how much should be given, how frequently, and how well patients tolerate that way of administering the drug. The same is true for gene therapy, for gene therapy is, in a way, a drug. So at this stage in the gene therapy trial, they are trying to determine the best way to administer the gene therapy, how frequently, and how much needs to be administered to get the predicted effect. Only later in the second stage do those clinical trials get to be reliable enough so that one knows that the drug or gene therapy is given the best way so one can expect the best possible results. At this point, gene therapy is not considered part of standard treatment of inflammatory breast cancer.

Risk of IBC recurrence?

Question from Kat: Since IBC is an aggressive form of breast cancer, if it should spread to other areas of the body, does it act the same way there—for example, fast growing? I was diagnosed with it December 2003, completed treatment August 2004 and have had no evidence of disease since.
Answers - Thomas Buchholz Kat, I'm happy to hear you're doing well after completion of your treatment. It is true that if IBC were to recur, it tends to reoccur earlier compared to non-IBC breast cancer. For example, non-IBC breast cancer can even recur a decade after treatment. This would be very, very unusual for patients with IBC. I hope yours will never recur.

Double mastectomy for IBC?

Question from Christycat: Is the presence of IBC in one breast enough justification for the doctor to remove the other breast?
Answers - Thomas Buchholz Removal of the other breast does not in any way improve the cure rate for patients with inflammatory breast cancer. Therefore it's not a standard part of treatment.

Twice-a-day radiation more effective with IBC?

Question from Krysti: Have there been studies that show that twice-a-day radiation is more effective with IBC? Should it be standard protocol for IBC?
Answers - Thomas Buchholz At M.D. Anderson, for many years we've been investigating whether giving radiation twice a day instead of once a day leads to an improved outcome. The information we have from our own institutional experience leads us to be optimistic about this approach. The theory behind giving twice-a-day radiation is that you can complete the treatment in a shorter period of time and therefore have less of a chance of the IBC tumor cells growing during the course of treatment. The treatments, however, have some side effects and risks that also need to be considered. In addition, this approach hasn't been thoroughly studied in a big head-to-head comparative trial, in part because IBC is a rare disease. I would hate to say that giving once-a-day radiation is wrong. It remains the most common radiation delivery schedule given in the United States. I do think it is reasonable to consider twice-a-day radiation, given the good results that have been reported by investigators at M.D. Anderson.

How does IBC act when metastasized?

Question from Funny: You didn't answer Kat's question re: does the IBC behave the same way in other parts of the body as it did in the primary site? We are not asking about likelihood of recurrence as much as what happens [and] how quickly in a secondary site?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. First of all, I think we need to dispel the idea that inflammatory breast cancer looks like inflammation under the microscope. It does not. In terms of the question specifically, once inflammatory breast cancer spreads to other organs, it tends to behave much like other rapidly growing or aggressive breast cancer. Now because it is an aggressive form of breast cancer, it has a pattern of spread that is somewhat different from other forms of breast cancer. It tends to spread more often to the lungs, the brain, and the liver although certainly not exclusively so. Once it spreads, it is an aggressive tumor and tends to grow more rapidly and spread more rapidly than other forms of breast cancer like the hormone dependent non-inflammatory breast cancer.

Repeat chemo for IBC recurrence okay?

Question from AllanJeffry: Can chemotherapy for IBC be repeated when there is evidence of recurrence after one year? The first round of chemo was well tolerated, surgery and radiation also performed.
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. In general terms, when recurrence is detected within about 6 months or less from the last dose of a specific type of chemotherapy, then that same chemotherapy would not be the first choice for treating the recurrence because the time is so short that one would assume the tumor was resistant to that type of chemotherapy and one would select a chemotherapy drug that was not included in that first treatment. Fortunately for the breast cancer patients, there are multiple types of chemotherapy that are effective in managing breast cancer, including recurrent inflammatory breast cancer. Lapatinib, or Tykerb, was recently tested in a clinical trial specifically in patients with recurrent inflammatory breast cancer, and Tykerb was shown to have anti-tumor effects in about 1 in 3 patients if they had the HER2 abnormality.

High-dose chemo and IBC?

Question from Fiona: What's your opinion on high-dose chemotherapy for use with IBC?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. High dose-chemotherapy remains a treatment under investigation for any and all types of breast cancer. It is not part of standard treatment. Whether it will have or whether it would have had effects in patients with inflammatory breast cancer remains to be determined, and unfortunately because there is such a small number of inflammatory breast cancers, there will never be a definitive trial of that question.

Post-treatment testing for recurrence?

Question from Fiona2: What is the normal testing post-treatment to check for recurrence?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. For most breast cancers, the follow-up is based on history and physical examination about ever 4-5 months after diagnosis, then every 3-6 months for the next 3 years or so, and yearly thereafter. In addition, one should do a mammogram of the remaining breast tissue once a year. For inflammatory breast cancer, probably the only consideration is that recurrences tend to happen early, within the first 2 years or so, and because it is a more aggressive disease, one might want to consider more frequent visits for examinations. But there is no need for imaging of the brain, liver, or lungs at this point.

Taxol vs. Abraxane in recurrent IBC?

Question from Barb: Can you comment on the use of Taxol vs. Abraxane in the treatment of recurrence in IBC, especially for the triple-negative cases?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P.

Abraxane (chemical name: albumin-bound or nab-paclitaxel) is a new formulation of paclitaxel, which is the active component of Taxol. There is a single head-to-head comparison of Abraxane and Taxol which suggests that we can give higher doses of Abraxane and that Abraxane is slightly more effective at those higher doses than a standard dose of Taxol. Whether this applies to inflammatory breast cancer or not is unknown. But clearly Abraxane is an effective drug, although whether the cost differential is justified in the case of an individual patient should be discussed with the treating oncologist.

Other options for professional opinion?

Question from Fiona: Could you advise whether M.D. Anderson would give second opinions via telephone/email for overseas patients with their new IBC clinic?
Answers - Thomas Buchholz The management of M.D. Anderson is very complex and dependent on a closely coordinated team effort. The diagnosis and work-up and treatment decisions also depend on the ability to take a careful history and examine the patient. For these reasons, telephone and email consultations have the risk of providing individual patients less than optimal information. Accordingly, it is not M.D. Anderson's policy to offer such second opinions via email.

IBC Research Foundation's BioBank beneficial?

Question from Barb: Are you aware of the Inflammatory Breast Cancer Research Foundation's BioBank and do you feel this will be beneficial in the research we need?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. For further understanding of the biology of inflammatory breast cancer, it is critical to develop collections of tumors and a well-annotated description of the patients and the treatment used for the treatment of that tumor. The more these selections of well-annotated tumors can be developed, the more rapidly we will learn how to best treat, monitor, and prevent these tumors.

Treatment for ulcerating skin metastases?

Question from Hania: What treatment is suggested for ulcerating skin metastases?
Answers - Thomas Buchholz Radiation tends to be effective at helping ulcerations heal and helps frequently with pain associated with ulceration.
Gabriel N. Hortobagyi, M.D., F.A.C.P. Depending on the timing of these ulcerated lesions in the overall treatment history, as well as the number and location of these lesions, one might select different treatments or treatment combinations. In the presence of a single or limited number of closely clustered ulcerated lesions, radiation might be an excellent choice. If there are multiple, especially widely spread lesions, then systemic therapy alone or in combination with selected local treatments might be a good choice too. Systemic treatments might be chemotherapy or hormonal therapy or something like Herceptin, depending on the type of tumor.

Look for treatment near home, or travel?

Question from Etofhb: IBC diagnosed 2 days ago. Trying to decide if it's better to travel 2 hours alone to a major cancer center or stay with my support and go to a local cancer center in our area. How important is the psychological support versus a cutting-edge hospital?
Answers - Gabriel N. Hortobagyi, M.D., F.A.C.P. For high-risk and aggressive breast cancers, including inflammatory breast cancer, one usually has a single opportunity for cure. It is critical to find a well-trained and highly interactive team of breast cancer specialists in order to succeed. So especially for inflammatory breast cancer, it would be important to make the extra effort to find such a team. If such a team exists in your local community, then great. If it does not, the 2-hour trip is more than worth it.
Thomas Buchholz I agree with Dr. Hortobagyi.

Specialists in inflammatory breast cancer?

Question from Tamera: Is there a database of oncologists and surgeons that specialize in IBC?
Answers - Jennifer Sabol, M.D., F.A.C.S. I don't believe there is.
Gabriel N. Hortobagyi, M.D., F.A.C.P. Major cancer centers with strong inter-disciplinary teams would have the necessary expertise, but there is no list that I am aware of.
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