IBC: Causes? Treatment? Cure rate?

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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.

The Ask-the-Expert Online Conference called Inflammatory Breast Cancer featured Gabriel Hortobagyi, M.D., Thomas Buchholz, M.D., and moderator Jennifer Sabol, M.D. answering your questions about inflammatory breast cancer, a rare but aggressive form of breast cancer.

Editor's Note: This conference took place in October 2006.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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