Inflammatory Breast Cancer (IBC): When a Red Breast Means Cancer
A 44-year old professional horse trainer, Jesse had been extremely active all of her life. She had no medical problems other than a broken leg as a young girl. One day, after several hours of riding, she noticed in the shower that her right breast was quite red. Jesse didn’t remember falling or hitting her breast. She examined herself and couldn’t feel any lump. However, the breast skin looked different, thicker, and a bit warm. She saw her gynecologist who sent her immediately for a mammogram which confirmed thickening of the breast skin only.
Jesse was sent to a breast cancer surgeon who biopsied her breast, confirming inflammatory cancer. She was seen by a medical oncologist who ordered a PET/CT scan which revealed no evidence of cancer spread. Jesse underwent 6 cycles of chemotherapy which promptly decreased the redness and discomfort in her breast after the first 2 cycles. She underwent a mastectomy followed by 6 weeks of radiation therapy. Jesse tolerated her treatment well. On follow-up with her 3 cancer specialists over the past 3 years, she has done well, with no evidence of recurrence of her cancer. She is back to training her horses regularly & enjoying life.
Possible Reasons for a Red Breast
There are several reasons why a woman or man can develop acute (fairly sudden onset of) breast redness. Infection and inflammation are the two most common causes. Both of these conditions need to be treated in a timely fashion in order to improve health & minimize pain. They usually resolve over a week or two. However, there is one cause of breast redness that is always life-threatening: inflammatory breast cancer (IBC).
IBC is a particularly aggressive form of breast cancer. Among every 100 patients diagnosed with breast cancer, about 2 – 5 will have IBC. It’s more commonly diagnosed in younger women and the redness can come on literally over a few days. While most people who develop a red breast will NOT have IBC, both patients and their primary doctors need to be aware of the possibility. This diagnosis should be particularly suspected in patients who still have a red breast after treatment with antibiotics or anti-inflammatories for a presumed infection or inflammation. The classic description of the appearance of IBC is peau d’orange (orange peel) skin.
Diagnosis & Staging
The diagnosis is confirmed by biopsy of the breast skin, usually by a breast surgeon or radiologist. Pathologists, the specially trained doctors who look at the biopsy tissue under the microscope, will usually describe tumor cells in the lymphatic channels of the breast tissue and breast skin. The blockage of these channels is usually the cause of the breast redness in IBC. Often there is no specific mass or lump in the breast, only diffuse red, thickened breast skin. Evaluation of the breast itself should include mammogram, often ultrasound (if a mass is felt), and sometimes MRI. All patients with IBC are considered to have aggressive disease. In that regard, unless the patient is in very poor condition and would not tolerate treatment, staging studies should be performed to assess whether the cancer has visibly spread elsewhere. These scans would include PET/CT or CT of chest and abdomen and bone scan. Patients with symptoms such as severe headache, nausea, and vomiting should also have MRI of the brain.
Treatment & Outcome
As with all breast cancers, the treatment for IBC can be broken down into two categories: locoregional (breast and lymph nodes) and systemic (throughout the body). A common mistake that a surgeon can make is to recommend a mastectomy (removal of the breast) first. Patients who are in reasonable medical condition should almost always have chemotherapy first, then mastectomy, then radiation therapy (RT) to the chest wall and regional lymph nodes. All three treatments, chemotherapy, surgery, and RT, are required in order to provide the best chance for cure. Hormonal and targeted therapies (such as Herceptin) may be recommended also, depending on the specific tumor biology. Among patients who have no evidence of metastasis (disease spread to distant areas in the body) at the time of diagnosis and are potentially curable, 40-50% are alive 5 years later. Awareness about this particularly aggressive form of breast cancer and its treatment is critical to ensure the best chance for cure.