DAWN Ontario: DisAbled Women's Network Ontario

Inflammatory Breast Cancer (IBC)
The Silent Killer

July 25, 2006

 

What is Inflammatory Breast Cancer? 

Inflammatory Breast Cancer (IBC) is an advanced and accelerated form of breast cancer usually not detected by mammograms or ultrasounds.

Inflammatory breast cancer requires immediate aggressive treatment with chemotherapy prior to surgery and is treated differently than more common types of breast cancer. 

"African Americans have a higher incidence of IBC than do Caucasians and other ethnic groups (10.1%, 6.2%, and 5.1%, respectively)." Source PDF file

Watch the KOMO TV 4 video: The Silent Killer: Inflammatory Breast Cancer Video icon (6:00)

Read the KOMO 4 News Special Report dd May 7, 2006: Inflammatory Breast Cancer

 

Key Points

  • Inflammatory breast cancer is an uncommon type of breast cancer.

  • This disease occurs when cancer cells block the lymph vessels in the skin of the breast, causing the breast to become red, swollen, and warm.

  • Inflammatory breast cancer usually grows rapidly and often spreads to other parts of the body.

  • Treatment usually starts with chemotherapy, generally followed by surgery and/or radiation.

 

There is more than one kind of breast cancer

We have been taught and are reminded frequently by public service announcements and by the medical community that when a woman discovers a lump on her breast she should go to the doctor immediately.

Inflammatory breast cancer usually grows in nests or sheets, rather than as a confined, solid tumour and therefore can be diffuse throughout the breast with no palpable mass. The cancer cells clog the lymphatic system just below the skin. Lymph node involvement is assumed.  Increased breast density compared to prior mammograms should be considered suspicious.


You Don't Have to Have a Lump to Have Breast Cancer

Some women who have inflammatory breast cancer may remain undiagnosed for long periods, even while seeing their doctor to learn the cause of her symptoms.  The symptoms are similar to mastitis, a breast infection and some doctors, not recognizing IBC, will prescribe antibiotics. If a response to antibiotics is not apparent after a week, a biopsy should be performed or a referral to a breast specialist is warranted.

Age 52:  Median age at time of diagnosis of IBC ... versus
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 these young women are at lower risk for breast cancer and the fact that IBC is the most aggressive form of breast cancer may result in metastases when the diagnosis is made.


One or more of the following are Typical Symptoms of IBC:
  • 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, 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

    View pictures showing common presentation of some of these symptoms.

    Read what patients write about their own symptoms prior to diagnosis.

    View a 4:23 minute video about IBC shown on NBC5 in Chicago.

    These Symptoms May Be Present in Benign Breast Disorders. See your doctor if you have any of these symptoms.

    Inflammatory Breast Cancer is typically abbreviated as IBC.  Non-inflammatory breast cancer may include in its diagnosis the terms "in situ breast cancer," "infiltrating breast cancer," or "invasive breast cancer" all of which may be abbreviated with "ibc," but those terms alone do not specify inflammatory breast cancer

    To add to the possible confusion, the diagnosis may include more that one kind of breast cancer; for example "inflammatory breast cancer, invasive ductal carcinoma, and mucinous carcinoma" all in the same breast. 

    So if a person you know has been described as having IBC or ibc, it may be well to ask what that is abbreviating, since it may not be "inflammatory breast cancer" and therefore the symptoms and other information presented here may not apply.


Is inflammatory breast cancer the same disease in each person diagnosed?

Researchers and clinicians don't know the answer to that question but hypothesize that there are "types," "sub-types," or "categories" of IBC.  Typically, the sub-types hypothesized are divided by presentation at time of diagnosis:

    1. clinical symptoms only, with no pathological confirmation finding tumor emboli (tightly packed clumps of tumor cells, like a bunch of grapes but very tightly packed together) in the dermal lymphatics of the affected breast;
    2. pathological only, finding tumor emboli in the dermal lymphatics, without presentation of clinical symptoms; and
    3. clinical and pathological.

Another way to categorize IBC is by age and gender at time of diagnosis:

    1. There is documented evidence of two cases in girls as young as 12-years-old, one of whom had not begun menstruation.
    2. There are several documented cases of male IBC.
    3. There are cases diagnosed during pregnancy or lactation.
    4. And there are cases that don't fall into any of the first three categories, but are diagnosed in each of three menopausal periods of life: premenopausal, perimenopausal, and postmenopausal.

Beyond those categories, there are IBC cases that have special circumstances:

    1. 3 cases diagnosed in 10 months amongst 24 co-workers
    2. more than one case in the same family:  mother-daughter, sisters, and 1st degree cousins
    3. IBC diagnosed in a breast with an implant
    4. IBC diagnosed post-hysterectomy, in some cases including oophorectomy

Strange things doctors have told IBC patients about their symptoms prior to their diagnosis with IBC:
    1. The doctor said that if it was breast cancer he would be able to find a lump and not just  inflammation and swollen nodes, with a discharge and calcifications in the breast tissue due to caffeine (which she doesn't drink.)

    2. The doctor said she had spider bites when she developed skin metastasis following treatment for regular breast cancer.

    3. After her mammogram the radiologist told her to stop wearing under wire bras.

    4. She was told to change bras and detergent to get rid of the rash.

    5. My sister was told that her blue colored bruise was a fatty necrosis and no way was it cancer.

    6. At age 20 she was told the lump she felt was "rib cartilage" and not to worry as she was too young to have breast cancer. She wasn't properly diagnosed until 2 years and 3 exams later. She died of IBC at age 25.

    7. She was told she had regular breast cancer instead of IBC.  The doctor said he had seen plenty of IBC cases and she didn't have it.  (She did have IBC.  The clinical presentation of inflammatory breast cancer may vary from patient to patient.)

    8. She had inflammation with intense itching on one breast which appeared and disappeared 4 times. The first time it was diagnosed as spider bites.; the second time as an allergic reaction to food or detergent, and irritation from cyst fluid from fibrocystic breast the 3rd time.  The 4th time, she was diagnosed with inflammatory breast cancer.

    9. Her IBC was first diagnosed as shingles.

    10. Finally, although this woman had not been diagnosed with IBC when she wrote this, it does not change the fact that her doctor's explanation of how IBC starts is erroneous.  She was told she didn't need a biopsy because IBC "starts with a lump which then disperses and she couldn't have IBC because the lump would have shown up on one of her previous mammograms."

 

 


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