Breast cancer is the most common malignancy in women and the second leading cause of cancer death (exceeded by lung cancer in 1985). Breast cancer is three times more common than all gynecologic malignancies put together. The incidence of breast cancer has been increasing steadily from an incidence of 1:20 in 1960 to 1:7 women today.
The American Cancer Society estimates that 211,000 new cases of invasive breast cancer will be diagnosed this year and 43,300 patients will die from the disease. Breast cancer is truly an epidemic among women and we don't know why.
Breast cancer is not exclusively a disease of women. For every 100 women with breast cancer, 1 male will develop the disease. The American Cancer society estimates that 1,600 men will develop the disease this year. The evaluation of men with breast masses is similar to that in women, including mammography.
The incidence of breast cancer is very low in the twenties (age) gradually increases and plateaus at the age of forty-five and increases dramatically after fifty. Fifty percent of breast cancer is diagnosed in women over sixty-five indicating the ongoing necessity of yearly screening throughout a woman's life.
Breast cancer is considered a heterogenous disease, meaning that it is a different disease in different women, a different disease in different age groups and has different cell populations within the tumor itself. Generally, breast cancer is a much more aggressive disease in younger women. Autopsy studies show that 2% of the population has undiagnosed breast cancer at the time of death. Older women typically have much less aggressive disease than younger women.
Inflammatory breast cancer is a unique and uncommon type of breast cancer. It is unique in that inflammatory breast cancer does not produce a distinct mass or lump that can be felt within the breast. The lack of a lump or mass also makes inflammatory breast cancer difficult to detect by mammograms. Inflammatory breast cancer cells infiltrate the skin and lymph vessels of the breast. When the lymph vessels become blocked by the breast cancer cells the breast typically becomes red, swollen, and warm. The skin changes associated with inflammatory can cause the breast skin to look like the skin of an orange a finding called peau d'orange. The appearance of the breast is similar to other inflammatory conditions such as cellulitis or mastitis. Other possible associate symptoms include enlarged lymph nodes under the arm or above the collar bone on the affected side.
Inflammatory breast cancer is diagnosed based upon the results of a biopsy and the clinical judgment of the treating physician. Typically, inflammatory breast cancer grows rapidly and requires aggressive treatment. There are two aspects to treating all breast cancer, local treatment and systemic or total body treatment. Because inflammatory breast cancer is aggressive, most oncologists recommend both systemic and local treatment. The typical sequence of treatment is to start with chemotherapy, systemic treatment, followed by surgery and radiation therapy, which are the local treatments, often followed by additional chemotherapy and possibly hormone treatments. With aggressive treatment using this multimodality approach, the 5 year survival for inflammatory breast cancer has improved significantly from an average survival of 18 months to an approximately 50% survival rate at 5 years.
How many cases of IBC are diagnosed each year?
The numbers vary, but approximately 1% to 2% of newly diagnosed invasive breast cancers (that have spread beyond the breast) in the United States are described as inflammatory breast cancers.
What are the symptoms of IBC?
Symptoms may include:
What should people do if they have IBC symptoms? If one or more symptoms continue for more than a week, look for information and talk to a physician with experience with this particular type of breast cancer. The resources below may help guide you to physicians and centers with this expertise. How old are typical IBC patients at diagnosis? The median age range is between 45 and 55 years old, but there may be patients either younger or older. The symptoms must guide the diagnosis, and age should not be used to exclude it. How well do diagnostic tests work in identifying IBC? IBC typically cannot be identified through: Mammogram – Because IBC usually does not occur in the form of a lump (the cancer is spread throughout breast tissue), it is difficult to detect with a mammogram. The most characteristic mammography findings consist of swelling of the skin. Ultrasound – This test confirms the swelling (edema) of the skin and can better identify breast nodules (if present). It also is the most appropriate test for the evaluation of lymph nodes. Magnetic Resonance Imaging (MRI) – This is probably the most sensitive test because it includes a functional description of the abnormal findings. It should be included among the diagnostic tests once the pathological diagnosis is confirmed. It is extremely useful in evaluating the clinical response to chemotherapy. Core biopsy – Typically, fine-needle aspiration or a core biopsy (removal of tissue with a needle) is performed to obtain a pathological diagnosis of invasive disease, but these diagnostic procedures are not appropriate for IBC because of the peculiar growth pattern in the breast lymphatic system. What diagnostic tests identify IBC? Surgical biopsy – Most of the time a skin biopsy or a surgical biopsy is necessary. These procedures are able to collect larger samples that include the skin and underlying tissue with higher chances to identify the cancer cells. PET Scan – In the near future, this could be one of the most important diagnostic/staging tests for IBC, though it still is under study. We have found that with the PET scan we can see more disease. We can see lymph nodes far from the breast, which tells us we have a metastatic cancer already at the time of diagnosis. If we limit staging to mammogram, CT (computed tomography – computerized X-rays) and bone scans we may miss different components of this inflammatory spreading, which may have significant consequences in the way we treat the cancer and the way we process patients. What is the survival rate for IBC? The five-year median survival rate for inflammatory breast cancer is approximately 40%. The main reasons for such a disappointing outcome are multiple and include: a delay in diagnosis, the lack of expertise in treating IBC because it is so rare and the relative resistance the disease has to standard chemotherapeutic agents. With regard to the first critical issue, it is important to keep in mind that IBC is a fast-growing cancer (it can spread within weeks), and it is often mistaken for something other than breast cancer, such as a rash or infection. What are common mistakes in treating IBC? A surgeon might want to remove the breast too early, which would increase the chance of local recurrence (return of the disease). A radiation oncologist with experience in treating IBC also is important. IBC might require a different schedule than most breast cancers. You might need two treatments a day, instead of one, because this is a highly aggressive tumor. Patients also need a specific chemotherapy dose. A particular challenge with treating IBC is that it is difficult to measure response since a nodule or mass is usually not present. If patients have had incorrect treatment, it may be hard to go back and improve the prognosis (outcome). How is IBC currently treated? We typically treat IBC with chemotherapy before surgery, and we also are using drugs like Herceptin® (trastuzumab) or TykerbTM (lapatinib) in a subset of IBC patients who have the HER-2 gene. One of our challenges is to improve our current treatments. We are focused on finding ways to eliminate microscopic disease to prolong survival. |
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