Inflammatory breast cancer is a rare but aggressive form of breast cancer that affects young women more than older women. Because it’s relatively uncommon — it represents less than five percent of all breast cancer cases — people are often confused about what inflammatory breast cancer is and how you can detect it.
As a breast oncologist at Dana-Farber who specializes in inflammatory breast cancer (IBC), I want to share some of the common myths to help you separate fact from fiction about the disease.
FICTION: If there’s no lump, there’s no cancer.
Unlike other types of breast cancer, which are detected with a mass or lump in the breast, inflammatory breast cancer may be present without a lump. Symptoms of inflammatory breast cancer can include:
- Pain or itchiness of the breast
- Redness of the breast
- Swelling or enlargement of the breast
- Swelling of the lymph nodes in the armpit or above/below the collarbone
- Thickening of the skin of the breast or ridged or dimpled skin texture (sometimes called “peau d’orange,” because it looks like the skin of an orange)
FACT: Inflammatory breast cancer is often misdiagnosed as an infection.
Many of the symptoms of inflammatory breast cancer are like the symptoms of an infection called mastitis. This similarity can complicate the diagnosis. Mastitis is treated with antibiotics, but if symptoms don’t improve after a course of antibiotics, ask to have breast imaging. If a diagnosis of breast cancer is confirmed, you should also talk to an oncologist about inflammatory breast cancer.
FICTION: Mammograms are the best detection for inflammatory breast cancer.
Since IBC often does not cause a lump in the breast, an MRI may provide additional information in its diagnosis. Mammograms detect breast lumps, but MRIs can detect other signs of IBC, including skin thickening and structural changes within the breast.
FACT: There are effective treatments for inflammatory breast cancer.
As with many cancers, early detection is important to allow effective treatment. If you are concerned that you may have symptoms, don’t wait. See your doctor.
For IBC, the primary treatment course is chemotherapy, surgery, and radiation. There are also some targeted therapies — trastuzumab (Herceptin), for example, targets the HER2-positive subtype of breast cancer — or immunotherapies, that have been very effective in treating inflammatory breast cancer.
Once we get the maximum effect from chemotherapy, the next step is surgery. Unfortunately, inflammatory breast cancer involves the entire breast. It doesn’t just show up as a lump in one part of the breast but involves the lymphatics, which are channels that run around and through the breast. So, the surgery that we need to do is a mastectomy. We then follow up with radiation to take care of any residual cancer that may be in the chest wall or in the lymph node groups.
This combination of treatment — chemotherapy, mastectomy, and radiation therapy — has significantly improved survival, but more work is needed to understand this disease. As we understand more about IBC and its various subtypes (for example HER2-positive, triple negative, and hormone receptor-positive), continuing treatment focused on the breast cancer subtype after radiation can also improve survival.
FICTION: If I have a mastectomy as part of my treatment for inflammatory breast cancer, I can’t have breast reconstruction.
While we recommend that patients wait for six to twelve months before they have breast reconstruction, it is an option for women who have had inflammatory breast cancer.
FICTION: Because inflammatory breast cancer is rare, there is not a lot of focus on research.
There is a great deal of research underway at Dana-Farber’s Inflammatory Breast Cancer Program, one of the biggest in the nation, and we are continuing to deepen our understanding of this rare cancer. For example, a study that I recently co-led found that patients with HER2-positive IBC respond well to therapies targeting the protein — much like patients with HER2-positive non-IBC. This raises the possibility that such patients may be successfully treated with lower doses of highly targeted therapies than now.
It’s one of many important findings as we continue to learn more about what drives IBC and how to treat it. At Dana-Farber, we have researchers who focus on IBC, as well as medical oncologists, radiation oncologists, pathologists, and nursing care staff who specialize in caring for patients with IBC. It is a special environment to provide, and further, IBC treatment.