By Cheryl Alexander
The symptoms are unusual; the diagnosis, difficult; the survival rate, dismal;
the treatment, menacing. The disease is inflammatory breast cancer (IBC).
In February of 2006, Anita turned 45, and weirdly began to feel as though one of
her breasts was larger than the other.
She even remarked to her husband and daughter that it felt like it did when she
was breast feeding. At their urging, Anita called her OB-GYN and made an
appointment three weeks out. At the appointment, the doctor administered a
physical and scheduled a mammogram for Anita. He told her that more than likely
what she was experiencing were symptoms of pre-menopause. She took him at his
word, and her mammogram came back normal.
Five and a half months later in mid-July, Anita noticed a patch of skin rash a
bit larger than a quarter on the same breast. Though it didn
’t grow or change much, it didn’t go away either. Since they already had a summer vacation planned, Anita made
another doctor
’s appointment after their return at the end of August.
At that appointment, Anita was prescribed an antibiotic for what was believed to
be an infection. When the antibiotic didn
’t clear it up, another mammogram was scheduled, along with both a skin and
needle biopsy. The biopsies finally revealed the ugly truth: Anita had breast
cancer; more specifically
—IBC.
Because her symptoms were camouflaged and mistaken for other conditions, and despite her willingness to undergo every treatment known
to fight this deadly disease, Anita died less than two years after her initial
diagnosis.
What are the symptoms?
Inflammatory breast cancer is a rare and very aggressive type of breast cancer
in which the cancer cells block the lymph vessels in the skin of the breast.
This type of breast cancer is called
“inflammatory” because the breast often looks swollen and red, or “inflamed.” The Inflammatory Breast Cancer Research Foundation lists the following symptoms
as typical:
Swelling, usually sudden, sometimes a cup size in a few days;
Itching;
Pink, red or dark colored area (called erythema) sometimes with texture similar
to the skin of an orange (called peau d
’orange);
Ridges and thickened areas of the skin;
Nipple retraction;
Nipple discharge, may or may not be bloody;
Breast is warm to the touch;
Breast pain (from a constant ache to stabbing pains);
Change in color and texture of the
areola.
If you have any of these symptoms, it doesn’t mean you have IBC, but you should see your doctor as soon as possible to have
your breasts examined.
How is IBC diagnosed?
Like all types of breast cancer, the diagnosis is made by a biopsy—removing a sample of the breast tissue and looking at it under the microscope.
Breast biopsies can be done
in several ways. Samples of breast tissue can be removed using fine needle
aspiration, large core biopsy, vacuum assisted biopsy, or open (excisional or
incisional) biopsies
—depending on where the affected area is, what it looks like and who finds it.
Skin biopsies are helpful in some cases.
IBC vs. Common Breast Cancer
IBC causes symptoms that are often different from those of more common breast
cancers. Often, no lump is present, and many times, like in Anita
’s case, it may not show up on a mammogram. Because it doesn’t look like a typical breast cancer, it can be harder to diagnose.
IBC tends to occur in younger women, and African-American women appear to be at
higher risk than white women.
IBC also tends to grow more quickly and aggressively than the more common types
of breast cancer. It is already considered to be at least stage IIIB (locally
advanced) when it is first diagnosed, and may be stage IV if it has spread to
distant parts of the body. Because of this, IBC is often harder to treat
successfully than other types of breast cancer.
How is IBC treated?
Treatment for inflammatory breast cancer typically begins with chemotherapy, followed by surgery and radiation therapy. This
combined-treatment approach has improved the outlook for women with IBC.
Chemotherapy (anti-cancer drugs) – Treatment of inflammatory breast cancer usually begins with several rounds of
chemotherapy to kill or control cancer cells. This pre-surgical treatment,
referred to as neoadjuvant therapy, is needed to shrink the cancer and resolve
skin problems before the operation, since swelling can prevent the surgical
incision from healing properly. The exact number of chemotherapy treatments
will depend on how well the cancer responds to the treatments.
Surgery – After chemotherapy, women with inflammatory breast cancer usually have an
operation to remove the affected breast (mastectomy). Surgery alone ( without
chemotherapy) offers a much smaller chance of a cure. Breast-conserving surgery
(lumpectomy) isn't recommended for women with inflammatory breast cancer. Most
women receive additional doses of chemotherapy after healing from the
operation.
Radiation therapy – After surgery and any further chemotherapy, a course of radiation therapy is
given to kill any remaining cancer cells in the breast and under the arm. This
can help decrease the chance of cancer coming back in the area. Radiation
typically involves about 30 treatments over six weeks.
What causes IBC?
As with other types of breast cancer, the exact cause of inflammatory breast
cancer is unknown. All cancers are characterized by unregulated cell division,
starting with one abnormal cell, in this case usually in one of the breast's
ducts. In inflammatory breast cancer, the abnormal cells rapidly infiltrate and
clog the lymphatic vessels in the skin over the
breast. The blockage in the lymphatic vessels causes red, swollen and dimpled
skin
—a classic sign of inflammatory breast cancer.
What is the prognosis?
According to Mayo Clinic research findings, IBC accounts for 1 percent to 6
percent of all breast cancer cases in the United States. Also notable is the
survival rate: IBC has a five-year survival rate of 40 percent-50 percent,
which is dismal when compared to five-year survival rates of 98 percent for
early-stage invasive breast cancer. These poor statistics point to the
aggressive nature of the disease. Take, for instance, it is automatically
considered Stage IIIB at diagnosis due to the fact that the cancer has already
spread from the interior of the breast to its skin and lymph nodes. And
consider that since many IBC symptoms are misdiagnosed as other problems,
delayed diagnosis is also a big issue in survival.
What’s new?
The American Cancer Society reports that because IBC is so rare, it is harder
for researchers to find people to study and to find the best treatments.
However, there have been recent advances in understanding and treating IBC.
Researchers at the University of Michigan recently discovered two genes that
play important roles in the development of IBC. Creating treatment from this
knowledge is still evolving, but the future holds more promise than ever
before.
Even just a decade or so ago, IBC had only a 2 percent five-year survival rate
and an average life expectancy of 18 months. Today it is not necessarily a
death sentence. Today, there are women 10 years out from diagnosis. As always
with cancer, and especially aggressive types like IBC, knowledge is power and
early treatment is key.
