When you think of the symptoms of breast cancer, the first thing you likely picture is a lump in the breast. However, not all types of breast cancer can be detected by looking for lumps. By knowing the symptoms of inflammatory breast cancer (IBC), you can help protect yourself against one of the most aggressive forms of breast cancer out there. 

“While inflammatory breast cancer is rare, it is important to be aware of the signs since it is aggressive, meaning it spreads quickly,” says Melanie Crutchfield Whitten, MD, breast surgical oncologist at Methodist Cancer Institute. “This is especially true because it can be harder to diagnose than other types of breast cancer.”

How Is Inflammatory Breast Cancer Different Than Other Breast Cancers?

While most types of breast cancer begin in the ducts or lobules of the breast, IBC is caused by cancer cells blocking lymph vessels in the skin of the breast. For this reason, it often doesn’t cause a lump to form and might not show up on a mammogram.

IBC is also unique in several other ways:

• Black women seem to develop IBC more often than white women.
• IBC occurs more frequently in women 40 years old or younger.
• IBC tends to grow and spread much more quickly than many other types of breast cancer.
• Women who are overweight or obese are more likely to develop IBC.

Additionally, IBC is always at least at stage III when it is diagnosed. This is because the breast cancer cells have already grown into the skin, making it locally advanced. 

Know the Symptoms of Inflammatory Breast Cancer

The symptoms of IBC develop quickly — within three to six months — and are quite different from those of other breast cancer types. The first sign of IBC is often swelling of the skin of the breast, along with redness that can cover more than one-third of the breast. Other symptoms include:

• An inverted nipple
• One breast that feels warmer and heavier and looks larger than the other
• Pain, tenderness or itchiness of the breast
• Skin that is thickened, ridged or pitted, making it look and feel like an orange peel
• Swelling of nearby lymph nodes (e.g., above the collarbone and under the arms)

“Some of these symptoms, such as tenderness, redness and itching, can be signs of other more common conditions, including a breast infection or an inflammation called mastitis,” Dr. Crutchfield Whitten says. “But if you experience any possible signs of IBC, see your doctor as soon as possible for an accurate diagnosis.” 

How Is Inflammatory Breast Cancer Diagnosed?

If your doctor suspects you have IBC, they will likely order imaging tests, including a diagnostic mammogram. This may show a large mass, thickening of the skin or a large area of calcification. Other tests may include an ultrasound of the breast and nearby lymph nodes or a breast MRI. 

“Because IBC and mastitis — an inflammation in the breast typically due to an infection — can look very similar, your doctor might prescribe a short course of antibiotics before doing further testing,” Dr. Crutchfield Whitten says. “If symptoms improve with antibiotics, it could be a breast infection. If not, a biopsy will be done.”

A biopsy to diagnose IBC involves a doctor removing a small piece of the abnormal breast tissue to have it examined in a lab. If the biopsy shows cancer, your physician may also do tests to see if it has spread to other parts of the body. These might include:  

• Bone scan: A small amount of radioactive material is injected into a vein and collects in the bones. This can show cancer that has spread to the bone.
• Computed tomography (CT) scan: A special X-ray machine takes a series of detailed images of tissues and organs inside the body.
• Positron emission tomography (PET) scan:A small dose of radioactive glucose (used as a tracer) is injected into one of your veins. Then, a scanner takes detailed pictures inside the body to see where the glucose is absorbed. Cancer cells can take up more glucose than healthy cells.
  
  

Treating Inflammatory Breast Cancer

People diagnosed with inflammatory breast cancer may have several treatment options, depending on the stage of the disease. In most cases, doctors use a multimodal approach combining chemotherapy, surgery and radiation therapy. 

Treatments may include:

• Neoadjuvant chemotherapy: This refers to chemotherapy given prior to surgery, usually at least six cycles over a period of four to six months.
• Targeted therapy: Inflammatory breast cancer often causes abnormal amounts of a protein called HER2. Targeted drugs can be used before and after surgery to treat this.
• Modified radical mastectomy: This is a type of surgery in which the entire affected breast — along with most or all lymph nodes under the arm — are removed. 
• Post-mastectomy radiation therapy: This therapy targets the chest wall under the removed breast. 
• Hormone therapy: This is an option if the cancer cells contain hormone receptors, which attach to the hormones estrogen and progesterone in the blood. Because cells with hormone receptors need these hormones to grow, hormone therapy drugs can be used to lower the amounts found in the blood or prevent them from attaching to the cancer cells.

What Is the Prognosis of Women With Inflammatory Breast Cancer?

Because IBC is an aggressive form of cancer, patients with this type of cancer generally do not survive as long as those with other forms of breast cancer. However, several factors can affect the prognosis (or likely outcome) for patients diagnosed with IBC. These include:

• How well the disease responds to treatment
• The patient’s age and general health
• The stage of the disease, which means whether it has spread to lymph nodes or other parts of the body

Ongoing research is leading to new types of treatments, which is why many doctors recommend that patients with IBC take part in clinical trials.

Ready to Schedule Your Mammogram?

If you’re in your late 30s or 40s, talk to your doctor about when you should start screening mammograms at Methodist Le Bonheur Healthcare and make an appointment by calling 901-516-9000.

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