People With Inflammatory Breast Cancer Have High Risk of Cancer Spreading to Brain
People diagnosed with inflammatory breast cancer — an uncommon and aggressive type of breast cancer — have a high risk of the cancer spreading to the brain within five years of diagnosis, according to a Dana-Farber Cancer Institute study.
The research was published online on Oct. 10, 2022, by the journal Cancer. Read “Incidence, characteristics, and management of central nervous system metastases in patients with inflammatory breast cancer.”
Inflammatory breast cancer
Inflammatory breast cancer usually starts with a feeling of thickness or heaviness in the breast rather than with a lump. The symptoms of inflammatory breast cancer are different from the symptoms of other types of breast cancer and may include:
visible swelling of the affected breast
discoloration that makes the breast look red, pink, or even bruised
dimpling, pitting, or ridges on the skin of the affected breast, so it looks and feels like an orange peel
tenderness, pain, aching, burning, itchiness, or unusual warmth of the affected breast
About 1% to 5% of all breast cancers are inflammatory breast cancers.
By the time a doctor diagnoses inflammatory breast cancer, the breast cancer cells have usually grown into the skin. This means the cancer is at least stage III. In some cases, the cancer cells have already spread to parts of the body away from the breast — which means the cancer is stage IV or metastatic.
Earlier studies have suggested that inflammatory breast cancer has a high risk of spreading to the brain, called brain metastasis or central nervous system metastasis by doctors.
Still, because inflammatory breast cancer is rare, the studies have been small.
About the study
In this study, the researchers wanted to look at how many people diagnosed with inflammatory breast cancer developed brain metastases, and also identify any risk factors for this type of spread.
The study included 531 people diagnosed with inflammatory breast cancer between Jan. 1, 1997 and Dec. 31, 2019 who were treated at the Dana-Farber Cancer Institute:
372 people (70%) were diagnosed with stage III disease
159 people (30%) were diagnosed with stage IV disease; of these people, five had brain metastases at diagnosis in addition to other metastases
half the people were older than 51 and half were younger
30% of the cancers were hormone receptor-positive and HER2-negative
21% of the cancers were hormone receptor-negative and HER2-positive
21% of the cancers were hormone receptor-positive and HER2-positive
24% of the cancers were triple-negative
4% of the cancers had missing information so the doctors didn’t know the subtype
Overall, 124 people (23%) developed brain metastases during the study. This number includes the five people who had brain metastases at diagnosis. Of these 124 people, the brain was the first site of cancer spread for 49 of them — 9% of all 531 people in the study.
Of the 124 people with brain metastases:
102 people had parenchymal metastases, meaning the cancer had invaded the functional tissue of the brain, which is made up of two types of brain cells, neurons and glial cells
35 people had leptomeningeal disease, meaning the cancer had invaded the cerebrospinal fluid, the liquid that circulates nutrients and chemicals to the brain and spinal cord
20 people had both parenchymal and leptomeningeal metastases
During follow-up, 258 people (49%) in the study died, including 103 of the 124 people with brain metastases.
Half the people survived for more than 0.6 years after being diagnosed with brain metastases and half survived for shorter periods of time.
People diagnosed with triple-negative inflammatory breast cancer had the shortest survival time after being diagnosed with brain metastases — 0.2 years — versus people diagnosed with other subtypes of inflammatory breast cancer.
The researchers also looked specifically at brain metastases by stage.
After about 5.6 years of follow-up, among the 372 people diagnosed with stage III inflammatory breast cancer:
66 people developed brain metastases; of these 66 people, 17 had brain metastases as the first and only site of metastasis
76 people died before being diagnosed with brain metastases
Among all people with stage III inflammatory breast cancer, the rate of brain metastases was:
5% one year after diagnosis
9% two years after diagnosis
18% five years after diagnosis
Of the 372 people diagnosed with stage III inflammatory breast cancer, 304 people received trimodality therapy, which is:
chemotherapy before surgery
surgery
radiation after surgery
Of the 304 people who received trimodality therapy:
51 people developed brain metastases
58 people died before developing brain metastases
Among the 304 people who received trimodality therapy, the rate of brain metastases was:
5% one year after treatment
11% two years after treatment
19% five years after treatment
After about 1.8 years of follow-up, among the 154 people diagnosed with stage IV inflammatory breast cancer:
53 people developed brain metastases
36 people died before being diagnosed with brain metastases
Among all people with stage IV inflammatory breast cancer, the rate of brain metastases was:
17% one year after diagnosis
30% two years after diagnosis
42% five years after diagnosis
Of the 154 people diagnosed with stage IV inflammatory breast cancer, 50 people received trimodality therapy. Among these 50 people, the rate of brain metastases was:
21% one year after treatment
28% two years after treatment
35% five years after treatment
The researchers found that people diagnosed with stage IV triple-negative inflammatory breast cancer had a higher risk of brain metastases than people with other subtypes of inflammatory breast cancer.
Other risk factors for brain metastases were:
having the cancer spread to the soft organs, such as the liver or lungs — called visceral metastases — rather than to the bones
being younger
“The relatively high incidence of brain metastases seen in the study population highlights the need for future research on the potential role for surveillance brain imaging for high-risk patients,” Laura E.G. Warren, MD, of the Dana-Farber Cancer Institute, said in a statement. “It also emphasizes the need to obtain brain imaging in patients with inflammatory breast cancer presenting with neurologic symptoms given the high incidence of brain metastases in this population.”
What this means for you
If you’ve been diagnosed with inflammatory breast cancer, the results of this study are very troubling. But they do suggest that talking to your doctor about monitoring for brain metastases before you develop neurological symptoms may be a good idea.
Although routine brain imaging tests for people diagnosed with inflammatory breast cancer are not the norm, they may be a good option for you and your unique situation.
Learn more about inflammatory breast cancer.
— Last updated on March 29, 2025 at 4:07 PM