Inflammatory Breast Cancer: The Silent Killer

Most women think they know all about breast cancer, and they look for lumps, have mammograms, see their doctors. But none of that will diagnose one silent breast cancer killer that most women know virtually nothing about.

Inflammatory Breast Cancer (IBC) is an aggressive, rapid-growing form of breast cancer usually not detected by mammograms or ultrasounds. It requires immediate treatment with chemotherapy prior to surgery and is treated differently than more common types of breast cancer. This type of cancer generally advances rapidly, and the cancer cells often spread to other parts of the body, causing more tumors (metastases).



Higher Incidence Among

African American Women


Dr. Helen Wiest,
Medical Director of Asheville Breast Center, says that more African
American women die from breast cancer than white women. She cited a
study by K.W. Hance, et. al., in the July 2005 Journal of the National
Cancer Institute that showed that “IBC incidence rates were
statistically significantly higher in black women (3.1 per 100,000)
than in white women (2.2 per 100,000) in 1998-2000.”


The study also
found that women diagnosed with IBC had significantly poorer survival
(2.9 years) than women with locally advanced breast cancer (6.4 years).
Black women with either type of breast cancer had poorer survival rates
than white women with the same diagnosis.


Another study,
by Massimo Cristofanilli et al., University of Texas Cancer Center,
found that “African Americans have a higher incidence of IBC than do
Caucasians and other ethnic groups: 10.1%, 6.2%, and 5.1% of breast
cancer cases, respectively.”


Dr. Wiest added,
“We’ve known for a long time that more black women than white were
dying from breast cancer. These studies showed that this was not just
because the white women were having more mammograms and thus earlier
detection, but that there was a higher incidence of this very
aggressive form of cancer, which has lower chances of survival. It is
crucial to get medical attention quickly if any of the symptoms are
present.”


You Don’t Have to Have a Lump

to Have Breast Cancer


IBC usually
grows in nests or sheets, rather than as a confined, solid tumor, and
therefore can be diffuse throughout the breast with no palpable mass.
Thus, it may easily be missed on a mammogram and can be diagnosed only
via biopsy. The cancer cells clog the lymphatic system just below the
skin, causing swelling and inflammation.


Women with IBC
are sometimes misdiagnosed, since the symptoms can be similar to
mastitis, a breast infection. Therefore some doctors, not recognizing
IBC, will prescribe antibiotics. If a response to antibiotics is not
apparent after a week, a referral to a breast specialist is warranted
and a biopsy should be performed.


Younger Women Are at Risk

Age 52:  Median age at time of diagnosis of IBC.

Age 62: Median age at time of diagnosis of Breast Cancer.


A surprising
portion of young women with IBC had their first symptoms during
pregnancy or lactation. The misconception that young women are at lower
risk for breast cancer, coupled with the fact that IBC is so
aggressive, may result in metastases by the time the diagnosis is made.



One young woman
was just 16 when she died from IBC. She was too embarrassed to tell her
mother her breast “looked funny” – slightly enlarged and the nipple
inverted – classic IBC symptoms. There is documented evidence of two
cases in girls as young as 12 years old, one of whom had not begun
menstruation, and there have been cases in women who are premenopausal,
perimenopausal, and postmenopausal.


Typical Symptoms of IBC include one or more of the following:

•    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

•    What appears to be a bruise that does not go away

•    Nipple retraction

•    Nipple discharge, which 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 aureole


Trust Your Intuition,

Demand a Diagnosis


In 17 years as a
Breast Program Nurse at Mission Hospital doing pre- and post-operative
teaching and prosthesis fitting and running a support group, Denise
Steuber has seen fewer than ten cases of IBC, out of 300 women a year
with breast cancer. These women were usually in their forties and early
fifties; all were successfully treated.


“When a woman
has Inflammatory Breast Cancer, the symptoms are fairly obvious. The
first thing our physicians think of is, ‘Is this inflammatory?’”
Steuber says. She tells women, ‘If you think something is wrong with
your breast, and the doctor says it’s fine, come back in six months –
don’t listen! You say, ‘No, I need to know what this is.’”


Nancy Key didn’t
know. “I was furious and at the same time, terrified that I was going
to die, ‘cause I didn’t know,” she said. “How can I have something when
I go to the doctor every year, I do self breast exams every month and
what is this? Why am I surprised?” asks Nancy.


Kristine Turck
was just 37 when she was diagnosed with IBC, three years away from the
recommended age to start mammograms. “It’s gonna be a tough fight,” she
says.


What Marilyn Willingham didn’t know killed her. “She smiled and took a breath and went to sleep,” says her husband Phil.


The only
definitive diagnosis of IBC is made with a biopsy; it doesn’t show up
on a mammogram.

Every woman needs to be aware of her breasts and how
they feel. If something doesn’t feel right, she needs to get a
diagnosis. If a doctor treats a rash on the breast with antibiotics and
it doesn’t go away, it could be IBC. If a doctor dismisses it, get a
second opinion.


Steuber noted
that she had not noticed a higher incidence of African American women
with the disease, but added that there is not a large African American
population in Asheville. “I am here to be a resource for women,” she
says, inviting the public to call her at 213-1839 with their questions.


Standard Treatments for IBC


One of the
unique features of IBC is that before they receive surgery or radiation
patients normally receive chemotherapy to shrink the tumor so that
surgery is more successful.


Treatment of
inflammatory breast cancer usually involves local treatment to remove
or destroy the cancer in the breast and systemic treatment to control
or kill cancer cells that may have spread to other parts of the body.
Local treatment affects only cells in the tumor and the area close to
it; systemic treatment affects cells throughout the body.


The local
treatment may be surgery and/or radiation therapy to the breast and
underarm. The systemic treatment may be chemotherapy, hormonal therapy
to counteract the effects of estrogen, or both.


In some cases,
local treatment may be followed by additional systemic treatment with
hormonal therapy, chemotherapy, or both. Some women also may have
biological therapy, which stimulates the immune system to fight the
cancer. Recent studies have shown a 50% survival rate after five years
following treatment, and a 35% survival rate after 10 years.


For more
information, visit the IBC Research Foundation at www.IBCresearch.org
or phone 1-877-STOPIBC. Another good resource, the Susan G. Komen
Breast Cancer Foundation, was founded by the sister of a young woman who died of breast cancer (www.komen.org).