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Inflammatory Breast Cancer

Inflammatory breast cancer is a rare and aggressive type of invasive breast cancer with different symptoms and treatments than other types of breast cancer.

Inflammatory breast cancer is a rare and aggressive type of invasive breast cancer with different symptoms and treatments than other types of breast cancer.

About 1-5% of all breast cancers are inflammatory breast cancers. Inflammatory breast cancer is more common in:

  • women younger than 40

  • Black women

  • women who are overweight


Symptoms of inflammatory breast cancer

Instead of a lump, inflammatory breast cancer usually starts with a feeling of thickness or heaviness in the breast. Other symptoms include:

  • swelling of part or all of the breast

  • redness of all or part of the breast

  • thickening and pitting of the breast skin so it looks and feels like an orange peel

  • flattening or inversion of the nipple

  • the affected breast feeling warmer and heavier than the other

  • other breast skin changes, including the skin looking pink or bruised, or ridges, welts, or hives on the breast skin

  • a breast that aches or burns, or is tender or itchy

  • swelling of the lymph nodes under the arm or above the collarbone

Most of the symptoms of inflammatory breast cancer develop quickly, within three to six months.

Some of these symptoms are similar to those caused by a breast infection, such as mastitis if you’re pregnant or breastfeeding.

If you’re diagnosed with a breast infection that isn’t responding to treatment, it’s a good idea to ask your doctor about testing for inflammatory breast cancer.


Diagnosis of inflammatory breast cancer

Because inflammatory breast cancer often doesn’t cause a lump, your doctor may not feel
it during a breast physical exam and it may not show up on a mammogram.

If your doctor suspects inflammatory breast cancer because of changes to your breast, your doctor will do a biopsy to confirm the diagnosis.

Your doctor also may do other imaging tests, such as ultrasound or breast MRI.


Staging inflammatory breast cancer

Inflammatory breast cancer is always at least locally-advanced when it’s first diagnosed because the breast cancer cells have grown into the skin. This means it is at least stage III.

In about 30% of cases, the inflammatory breast cancer has already spread to parts of the body away from the breast when it is diagnosed. This means the cancer is metastatic or stage IV.

After inflammatory breast cancer is diagnosed, your doctor will do more tests to collect information on the characteristics of the cancer. These tests, as well as the results of your biopsy and any imaging tests, make up the parts of your pathology report.

Other information commonly collected on inflammatory breast cancer includes:

  • lymph node status

  • hormone receptor status

  • HER2 status


Treatment of inflammatory breast cancer

Because inflammatory breast cancer is aggressive and has grown into the breast skin, the order of treatments is different than it is for other types of invasive breast cancer.

  • Chemotherapy is usually the first treatment, with the goal of shrinking the cancer and easing the swelling. This may make it easier for your surgeon to remove the cancer.

  • If the cancer is HER2-positive, targeted therapy is given at the same time as chemotherapy.

  • After chemotherapy and any targeted therapy are completed, your doctor will check to see how well the cancer has responded to the treatment, meaning the breast skin looks normal or close to normal. If the cancer has responded, you will have mastectomy and lymph node dissection, which means one or more lymph nodes will be removed.

  • If the cancer doesn’t respond to chemotherapy and possibly targeted therapy before surgery and the breast is still very swollen and red, surgery can’t be done. If this is the case, your doctor may recommend a different chemotherapy regimen or radiation therapy.

  • In some cases, you will have more chemotherapy after mastectomy, but before radiation therapy.

  • After mastectomy, you will likely have radiation therapy to destroy and cancer cells that may have been left behind. If you had radiation therapy before surgery because the cancer didn’t respond to pre-surgery chemotherapy, you will not have radiation again after surgery.

  • If the cancer is hormone receptor-positive, you will receive hormonal therapy after all chemotherapy has been completed.

  • If the cancer is HER2-positive, your doctor may recommend more targeted therapy treatment after radiation therapy is completed.

Survivorship care after inflammatory breast cancer treatment

Because of treatments they’ve received, many breast cancer survivors have a higher risk of developing other diseases as they age, including high blood pressure, heart disease, and osteoporosis. To make sure breast cancer survivors are regularly screened for these and other diseases, experts have developed the idea of survivorship care planning.

Survivorship care plans are written documents made up of two parts.

The first part is a treatment summary, a record of all the breast cancer treatments you’ve received.

The second part is basically a roadmap of what you can expect in the years after treatment, including any late or long-term side effects you might have, and a schedule of how you’ll be monitored for these side effects and other health conditions. This part of the survivorship care plan usually includes:

  • the tests you’ll have

  • which doctors will order the tests

  • a schedule of when the tests will be done

  • healthy living recommendations

  • resources, if you need more information

Learn more at Before Treatment: Planning Ahead for Survivorship.

Reviewed by 1 medical adviser
Jenni Sheng, MD
Johns Hopkins University School of Medicine, Baltimore, MD
Learn more about our advisory board

— Last updated on July 27, 2022, 1:48 PM

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