What Is Inflammatory Breast Cancer?

This rare and aggressive type of breast cancer comes with unique symptoms and risk factors.

Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer that has spread to the breast skin. Only about 1–5% of all breast cancer cases are inflammatory, per the National Cancer Institute (NCI).

IBC is diagnosed at the more advanced stages 3 or 4 because cancer cells have grown into the skin. At stage 3, it's still possible to cure, but at stage 4, when cancer has metastasized (spread) to distant organs, IBC becomes incurable. Treatment is then focused on reducing symptoms and prolonging lives, per the ACS.

IBC typically doesn't come with a lump, the most common sign of other breast cancers. Instead, according to the American Cancer Society (ACS), you may experience:

  • Redness
  • Inflammation
  • Dimpling (when breast skin has an orange peel texture)

Providers often mistake IBC for other skin diseases like mastitis—breast inflammation that most commonly occurs if you're breastfeeding, per the ACS—or cellulitis.

IBC comes with unique risk factors. It's essential to know early signs and symptoms and become aware of prevention and treatment options.

Causes

Breast cancer in general occurs when changes in your genetic material, DNA, cause cells in the breast tissue to grow out of control, per the National Library of Medicine MedlinePlus resource. You may inherit these mutations, such as a BRCA mutation, but more often the cause is unknown.

Like all cancers, breast cancer is related to both genetic and epigenetic abnormalities. Epigenetic factors are behavioral and environmental influences on how your genes work, per the Centers for Disease Control and Prevention (CDC).

Breast cancer, like all cancers is related to both genetic and epigenetic abnormalities. Sometimes, the genetic abnormalities may be inherited like BRCA genes mutation, for example.

Some lifestyle and environmental factors can play a role, per the CDC, such as:

  • Drinking alcohol
  • Having an early period
  • Radiation exposure

Researchers have found some unique risk factors for IBC, but, ultimately, they don't know why some people develop this type of breast cancer. In fact, family history may play a smaller role in IBC than other types of breast cancer, according to a May 2016 paper published in the journal BMC Cancer.

Risk Factors

IBC comes with some different risk factors than other types of breast cancer. Risk factors include:

  • Age: All people may develop IBC at a younger age than other types of breast cancer, per the 2020 study.
  • Dense breast tissue: Most people with IBC have dense breast tissue—which can make diagnosis harder, according to the NCI.

An October 2020 study published in the journal Breast Cancer Research and Treatment also found that Black cisgender women may be more likely to develop IBC than white cisgender women.

There are also some possible lifestyle-related factors. People who've breastfed after giving birth may have less aggressive IBC, according to a July 2017 paper published in the Journal of Cancer.

Additional general breast cancer risk factors include, per MedlinePlus:

  • Being assigned female at birth
  • Drinking alcohol
  • Prior radiation therapy to the chest or breast
  • Certain reproductive differences, such as getting your period at an earlier age

Symptoms

People often "describe IBC as a 'bug bite' or 'heat rash' that rapidly evolves to cover at least one-third of the breast tissue," according to an October 2021 paper published in the American Journal of Obstetrics & Gynecology. It's why the disease is often misdiagnosed as an infection or allergic reaction to a medication.

Symptoms develop within three to six months, according to an August 2018 paper published in the journal Surgical Clinics of North America. This is less than the time the ACS recommends between preventive breast mammogram screenings, so IBC is harder to catch early.

Symptoms of IBC include, per the ACS:

  • Swelling and redness on more than one-third of the breast
  • Skin that thickens and starts dimpling to look like an orange peel
  • One-sided changes in breast size and weight
  • A nipple that retracts or goes inward (inverts)
  • Warm, painful, tender, or itchy breast

Swollen lymph nodes under the arm or near the collarbone may also signal breast cancer, per the ACS. Lymph nodes are structures in the body's immune system. Like all symptoms of IBC, swelling can come from diseases or conditions that are much less serious, but it's important to ask your healthcare provider first, per the NCI.

Diagnosis

Early diagnosis of this aggressive disease is crucial. But an IBC diagnosis is especially difficult. A mammogram is less likely to detect IBC because it presents without a lump and the breast tissue in most people with IBC is dense. Healthcare providers will still likely order a mammogram as the first diagnostic tool, but then follow it up with an ultrasound of the breast and nearby lymph nodes, per the NCI.

With IBC, symptoms such as redness, swelling, dimpling, and unusual warmth usually come on fast (rather than gradually). They need to be present for less than six months, and the redness needs to cover at least a third of the breast, per the NCI.

Finally, a biopsy is needed to confirm the diagnosis—it's a procedure where cells or tissue are removed from the suspected area and examined by a specialist, per the NCI. The healthcare provider will then determine your cancer's stage—how far it has spread—through more imaging tests such as a PET scan, CT scan, or bone scan, per the NCI.

Treatment

IBC is aggressive, so healthcare providers often combine different treatments, per the NCI. Depending on the properties of cancer cells, you may receive a combination of these therapies:

  • Chemotherapy: IBC treatment typically begins here. Chemotherapy is a name for drugs that can be injected into the vein or taken by mouth, per the ACS. These drugs can destroy cancer cells throughout the body.
  • Surgery: Because the cancer is in the skin, surgery for IBC typically removes the whole breast and nearby lymph nodes—a radical mastectomy. Another surgery may rebuild the breast, but it's recommended to delay this procedure if you need radiation therapy, per the NCI.
  • Radiation therapy: After a mastectomy, you are typically given radiation therapy (treatment with high-energy rays or particles). Radiation may also be used along with new chemotherapy drugs before surgery if the original round of chemo didn't completely reduce redness.
  • Hormone therapy
  • Other drug therapies such as targeted agents
  • Clinical trials: Ongoing clinical trials may provide additional options for people with IBC, per the NCI. Patients can search for their condition in the NCI clinical trials database.

Chemo comes with common side effects, such as:

  • Hair loss
  • Mouth sores
  • Fatigue
  • Diarrhea
  • Loss of appetite
  • Weight changes
  • Hot flashes

Because the treatment goes through the whole body, chemotherapy can also affect cells in the bone marrow, leading to additional side effects, such as easier bruising or bleeding and a higher chance of infections, per the ACS.

Prevention

While it's impossible to fully prevent IBC, early diagnosis is crucial. You can take steps to reduce your risk of breast cancer in general, per the ACS:

  • Maintain a healthy weight
  • Get regular exercise
  • Drink less alcohol
  • If you've given birth and are able to, breastfeed for several months (the longer, the better)

If you have a higher risk of breast cancer because of personal or family history, BRCA1 or BRCA2 genetic mutation, or other lifestyle factors, you can take additional preventive steps after a discussion with your healthcare provider, per the ACS:

  • Pay close attention to symptoms
  • Get medical checkups every six to 12 months
  • Start getting annual mammograms and breast MRIs early, typically at 30 years old
  • In some cases, if your breast cancer risk is high, medications—such as Nolvadex (tamoxifen), Evista (raloxifene), or aromatase inhibitors—may decrease your risk of developing breast cancer. All these agents come with side effects, per the ACS. Your healthcare provider can help you weigh the risks and benefits.
  • Surgically remove the breasts (a mastectomy) or ovaries—this procedure is reserved for people with a "very high risk" of breast cancer, which a healthcare provider can help determine.

Getting an IBC diagnosis can be scary, but treatments are improving. Researchers are looking into more risk factors. Pay attention to your body, and speak to a healthcare provider if you feel something is off.

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