What is Inflammatory Breast Cancer (IBC)?

Inflammatory breast cancer (IBC) is a rare and extremely aggressive and rapidly growing type of breast cancer. It often progresses in a matter of weeks or months. Usually, at diagnosis, IBC is already in stage III or IV because the breast cancer cells have grown into the skin and possibly spread to other tissue. It affects black women at a higher rate than others and it occurs more in women younger than 40 years of age. Women who are obese are also at an increased risk of developing IBC.

Often, IBC can be difficult to diagnose because the symptoms are like a breast infection and there is not the characteristic lump or mass like in other types of breast cancer, which makes it harder to detect during a breast exam or with a mammogram.

The most common symptoms of IBC are when the breast is red, swollen, and tender. This occurs when cancer cells block the lymphatic vessels in the skin that cover the breast. Contact your healthcare provider immediately if you have any of these symptoms.

Treatment includes chemotherapy, surgery, and radiation. It is important to contact your doctor immediately when you first notice symptoms as this type of cancer is extremely aggressive and grows and spreads rapidly. The prognosis for this type of cancer is more challenging as a person is typically already in stage III or IV at diagnosis.

Signs and Symptoms

IBC can be difficult to diagnose because of the similar symptoms it shares with a breast infection, which is less serious. The most common symptoms and first signs of IBC are related to the inflammation of the breast. The breast will appear red and swollen (sometimes purple in color like a bruise) and is painful and tender. The symptoms of inflammatory breast cancer progress rapidly, over the course of 3-6 weeks. Symptoms may include:

• Areas of discoloration (red, pink, or purple), that may resemble a bruise and spreads over a third of your breast
• A rash that spreads over a third of your breast
• Dimpling, pitting, or thickening of your breast skin (resembles an orange peel)
• Swelling, pain, itchiness, firmness, or tenderness of one breast
• Burning or warming sensation of one breast
• Heaviness or enlargement of one breast
• Inverted or retracted nipple
• Swollen lymph nodes under your arm or near the collar bone

If you notice any of these symptoms, contact your healthcare provider immediately. As IBC is an aggressive and rapidly growing cancer, early detection will aid in better treatment outcomes.

Causes

There is no known cause as to why certain cells become cancerous or develop into IBC. Most IBC cases are classified as invasive ductal carcinoma, which is cancer that develops from the cells lining the milk ducts in the breast. When it is invasive, it means that the cancer has spread beyond the milk ducts and into other healthy tissue.

Specifically, IBC develops when the cancer cells block the lymph vessels in the skin that covers the breast. These vessels allow lymph fluid to drain out of your breast, which is why the blockage from the cancer cells causes the breast to become red, swollen, and painful. Most cases of IBC metastasize from your lymph vessels and begin to affect other organs and tissue, making it more difficult to treat.

Risk Factor

There are several risk factors for developing IBC. Risk factors include:

• Women are more likely to develop IBC (men can develop IBC, but it is extremely rare)
• Women who are 40 years of age or younger
• Being obese
• Black women have a higher likelihood of developing IBC

Diagnosis

There are many methods a doctor can use to diagnose IBC. During a routine breast exam, a doctor will notice any abnormalities or symptoms of IBC. If IBC is suspected, your doctor will likely have you do imaging tests (mammogram, ultrasound, or an MRI) to detect cancer. Additionally, it may be recommended to perform a biopsy, which removes a sample of tissue to be analyzed in a lab to check for signs of cancer. If cancer is diagnosed, your doctor may order additional testing such as a CT scan, PET scan, or bone scan to see if the cancer has spread. At this point, your doctor will determine the staging of your cancer. Typically, with IBC, at the time of diagnosis, you may already be in stage III or IV.

Treatment

Treating IBC usually begins with chemotherapy. If the cancer hasn’t metastasized to other organs or tissue in the body, the next step of treatment is surgery and radiation therapy. If the cancer has spread to other areas in the body, your doctor may recommend other types of treatments to slow the growth and spread of the cancer. The most common forms of treatment for IBC include:

• Chemotherapy. This uses powerful medications to destroy the rapidly growing cancer cells. Chemotherapy is used prior to surgery for IBC to help shrink the cancer and increase the chances for a successful surgery.
• Surgery. Following chemotherapy, you may have surgery to remove the affected breast and some of the nearby lymph nodes (mastectomy and axillary dissection). Reconstructive breast surgery is typically delayed until completion of all treatments.
• Radiation therapy. This treatment uses high powered rays of energy (X-rays or protons) to destroy cancer cells. It is usually used after surgery to help destroy any remaining cancer cells
• Targeted therapy. This type of therapy seeks to target specific abnormalities about the cancer cells. Targeted therapies help to damage the cancer cells but will spare the healthy cells. It can be a more specified and protective way to stop cancer cells from growing and surviving.
• Immunotherapy. This treatment uses your body’s own immune system to battle cancer. It helps to identify and fight cancer cells. Additionally, immunotherapy helps to interfere with the cancer cell’s ability to hide from the immune system cells.
• Hormone therapy. This therapy seeks to block the hormones that cancer cells use to grow and spread. Hormone therapies are typically used after surgery to reduce the chance of cancer recurrence. It may also be used to shrink and control cancer that has already spread.

Prevention

Unfortunately, IBC cannot be prevented. However, early detection can result in better treatment outcomes. As in all other cases of breast cancer, the best prevention measures include:

• Routine breast exams or mammograms
• Maintaining a healthy weight
• Regular exercise
• Limiting alcohol intake
• Knowing your family medical history
• Genetic testing

Complications

Treatment for IBC may have complications or side effects. The most common side effects include lymphedema (pooling of lymphatic fluid), fatigue, and pain. Additionally, because IBC develops so rapidly, it has often already spread to other tissues in your body at the time of diagnosis. More treatment will be needed if the cancer has spread.