Recognizing inflammatory breast cancer symptoms

Inflammatory breast cancer is a unique disease that doesn’t look or act like most other breast cancers. It begins when cancer cells build up in the breast and block lymph vessels, which regulate fluid balance and filtering in the breast. This causes the breast to swell, turn red and look “inflamed.” Inflammatory breast cancer (IBC) is an aggressive form of breast cancer that can develop over weeks or months. But it’s also rare, affecting between 1% and 5% of people in the United States.

Since IBC doesn’t produce a tell-tale lump in the breast and it doesn’t always show up on mammogram images, it can be confused with other, less serious conditions. It can also go unnoticed entirely.

“Inflammatory breast cancer is less common than other types of breast cancer, so it’s not something that patients and primary care physicians see very often,” said Dr. Carla Fisher, surgical oncologist and Director of Breast Surgical Oncology at IU Health. “Patients may notice redness in their breast and become worried about inflammatory breast cancer, but it often turns out to be an infection. On the other hand, patients who’ve received treatment for ongoing breast infection over a long period of time may experience a delay in the diagnosis of inflammatory breast cancer because it looked like the infection. Early diagnosis is very important.”

Signs and symptoms of inflammatory breast cancer

As the inflammatory breast cancer cells spread beyond the milk ducts, they inflame the skin (dermal) lymphatics, or blood vessels in the middle layer of skin. This can cause swelling, redness, and other symptoms that may indicate IBC, including:

• Rapid change in size or shape of the breast
• Redness (erythema) of the breast
• Swelling (edema) of the breast
• Thickening or dimpling of the breast, giving the appearance of an orange peel
• One breast that feels warmer or heavier than the other
• Swelling near the collarbone or armpit nearest to the affected breast

These symptoms can also indicate other, less serious conditions, so diagnosis of IBC requires a physician’s evaluation. The physician may order a biopsy and breast imaging, such as a mammogram, ultrasound or MRI. A doctor may take a “skin punch” biopsy by removing a small bit of the skin overlying the breast to examine under the microscope. However, due to the nature of IBC, a single sample can miss the cancerous tissue. The physician will consider a combination of symptoms and test results to determine a cancer diagnosis. Researchers are currently investigating more effective ways to diagnose this type of cancer.

IBC is a fast-growing and aggressive cancer. By the time it’s diagnosed, IBC is already considered advanced stage because it’s present in the skin and lymph vessels.

The cause of IBC is unknown but tends to occur in women younger than 40. It’s also more common among Black women and women who have a higher weight.

Inflammatory breast cancer vs. mastitis

Unfortunately, there’s no easy way to tell the difference between IBC and less serious conditions like a breast infection or mastitis, which is an inflammation of breast tissue typically associated with breastfeeding. If there’s a logical reason for a breast infection, such as a clogged milk duct from recent breastfeeding that leads to an infection, cancer is less likely. However, IBC can also be mistaken for an infection or even another type of breast cancer that has spread through the lymph nodes.

A clear way to know the difference between cancer and something less serious is if antibiotic treatment clears up the problem. A round of antibiotics should help alleviate mastitis or other breast infections, but if problems persist, more investigation into the cause of the problem may be necessary.

Treating inflammatory breast cancer

IBC treatment involves a combination of therapies often used in the treatment of other breast cancers. These include:

• Chemotherapy. Neoadjuvant, or pre-surgical, chemotherapy is often a first step in IBC treatment
• Immunotherapy may be an offered alongside chemotherapy, depending on the patient’s particular cancer
• Surgery in the form of a modified radical mastectomy to remove the affected breast and any nearby lymph nodes
• Radiation therapy to destroy any remaining cancer cells

After a patient finishes medical treatment and surgery, surgeons are looking for what’s called the “pathological complete response”: Does any cancer remain? How well did the treatment work? A patient’s response to treatment helps physicians understand the prognosis of the disease and any additional treatments that should follow.

While breast reconstruction after a mastectomy is an option for some patients, it is often not available when treating IBC. For a safe and successful breast reconstruction, the surgeon performing a mastectomy must preserve breast skin and, sometimes, the nipple. However, IBC makes this process more challenging because of how it infiltrates the skin overlying the breast tissue. If breast reconstruction is important to you, discuss with your surgeon whether it is possible later.

Though it is less common than other breast cancers, inflammatory breast cancer is an aggressive and challenging disease to identify and treat. By performing regular, at-home breast self-exams and discussing concerns with your doctor, you can head off concerning symptoms as soon as possible.