Breast Cancer (Inflammatory Carcinoma of the Breast)

What is Breast Cancer?

Inflammatory breast cancer is a rare and aggressive form of invasive breast cancer, where the skin of the breast becomes red, inflamed and pitted in appearance.

Statistics on Breast Cancer?

Inflammatory breast cancer is one of the rarest types of breast cancer. Overall, inflammatory breast cancer makes up between 1-5% of all breast cancer cases.

Risk Factors for Breast Cancer

The causes of inflammatory breast cancer are still not fully understood. Some factors that can increase risk of developing any type of breast cancer include the following:

Age: the risk of developing breast cancer increases with age.
A family history of breast cancer in a first-degree relative (eg. a parent, sibling or child) doubles or triples a woman's risk of developing the disease. About 5% of women with breast cancer carry one of the two breast cancer genes, BRCA1 or BRCA2. If a relative also carries the gene, she has an increased risk of developing breast cancer.
Women with early menarche (first menstrual period), late menopause, or a late first pregnancy are at increased risk.
Women who use oral contraceptives have a very small increase in their risk of developing breast cancer.
The use of postmenopausal oestrogen replacement therapy also appears to increase the risk modestly, especially after long term use (greater than 5 years). This risk disappears 2 years after stopping hormone therapy.
Environmental factors, such as diet, may play a role in causing or promoting the growth of breast cancers, but conclusive evidence about the effect of a particular diet (eg. one high in fats) is lacking.
Radiation exposure before the age of 30 is also thought to increase risk.

Progression of Breast Cancer

Inflammatory breast cancer is a special type of breast cancer which develops and spreads quite differently from other breast cancers. In most breast cancers, such as ductal or lobular carcinomas, the cancer cells grow and develop as a solid lump in the breast. Inflammatory breast cancer cells develop differently. Instead of as a lump, inflammatory cancer cells grow quickly in the narrow lymph vessels of the breast, spreading along and blocking the flow of lymph. (The lymph vessels are part of the lymphatic system, which is responsible for collecting and filtering out bacteria and any waste materials that accumulate in the body.) The blockage of the lymph vessels is what causes the red, swollen and inflamed appearance of the breast, such as in the image below.

The way the cancer cells grow is also important because it affects how quickly the cancer spreads. In other types of cancer, the cells must first multiply and develop the ability to 'invade' into the lymph vessels or blood vessels before they can spread elsewhere in the body. In inflammatory breast cancer, however, the cancer cells are already growing in the lymph vessels. This allows them to spread far more quickly to lymph nodes in the breast and other parts of the body. This spread is referred to as 'metastasis', and is a poor prognostic factor.

Symptoms of Breast Cancer

Unlike other breast cancers, inflammatory breast cancer does not usually present with a breast lump. Instead, patients may notice one or more of the following:

Sudden swelling of a breast, which may look red, or feel itchy or warm.
Ridges, raised or pitted marks (like the appearance of an orange peel) on the breast surface.
Nipple retraction or discharge.
Swollen lymph nodes in the underarm or above the collarbone.

Any of these changes should be investigated.

How is Breast Cancer Diagnosed?

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Watch a video on Breast Cancer: Diagnosis
© Realtime Health, from the 'Speaking From Experience' series. Contact Tina Campbell.

Any breast symptom, such as a skin change or nipple discharge, is assessed with the 'triple test'. This includes an examination of the breast by the doctor, imaging of the breast through mammography or ultrasound, and sampling of the breast tissue with fine needle aspiration (FNA), core biopsy or open biopsy. Following a diagnosis of breast cancer, blood tests including Full Blood Count and Liver Function Tests may be used to assess the possibility that the cancer may have spread to the liver or bone marrow.

Prognosis of Breast Cancer

In general, inflammatory breast cancer has a poor prognosis compared to other forms of breast cancer. This is because:

It spreads so quickly through the lymphatic system, and
It is difficult to diagnose, so it is often detected at a late stage.

However, even if the cancer has metastasised (spread) to other areas of the body, treatment is available. Currently, patients with inflammatory breast cancer may have a 4-year disease-free survival as high as 54%, with overall 4-year survival of 74%.

How is Breast Cancer Treated?

Because inflammatory breast cancer behaves so differently from other breast cancers, it requires specialised treatment.

Realtime Health Video

Watch a video on Breast Cancer: Surgery and Treatment
© Realtime Health, from the 'Speaking From Experience' series. Contact Tina Campbell.

Chemotherapy is often used as the first treatment. The aim of this therapy is to reduce the number of cancer cells in the body ('debulk' the tumour) to make surgery easier and more likely to succeed.

Surgical treatment usually follows. Most commonly, a modified radical mastectomy is performed. Breast conserving surgery is not usually appropriate in patients with inflammatory breast cancer because the cancer is so widespread in the breast. Radiotherapy is offered after surgery. The aim of this therapy is to kill any remaining cancer cells which were not removed by the surgery, reducing the likelihood that the cancer will recur. If the tumour cells are found to have hormone receptors on their surface, patients may also be offered hormone therapies such as tamoxifen.

More information

For more information on breast cancer, types of breast cancer and its investigations and treatments, as well as some useful videos, see Breast Cancer.

Breast Cancer References

Australian Institute of Health and Welfare & National Breast Cancer Centre 2006. Breast cancer in Australia: an overview, 2006. Cancer series no. 34. cat. no. CAN 29. Canberra: AIHW.
Bennett-Britton TM, Cariati M, Pinder SE, Purushotham AD. ''Inflammatory' breast cancer,' Surgical Oncology. 2005, 14(3):133-143
Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison's Principles of Internal Medicine. 16th Edition. McGraw-Hill. 2001
Bristol IJ, Buchholz TA. 'Inflammatory Breast Cancer: Current Concepts in Local Management,' Breast Disease. 2005, 22(1):75-83
Cristofanilli M, Buzdar AU, Hortobagyi GN. 'Update on the management of inflammatory breast cancer,' The oncologist. 2003, 8(2):141-8
National Breast Cancer Centre. 2001. 'Clinical practice guidelines for the management of early breast cancer:Second edition'. National Breast Cancer Centre, Camperdown,NSW. [online] Available from: http://www.nhmrc.gov.au/publications/synopses/cp74syn.htm
National Breast Cancer Centre. 2001. 'Clinical practice guidelines for the management of advanced breast cancer.' National Breast Cancer Centre, Camperdown,NSW. [online] Available from: http://www.nhmrc.gov.au/publications/synopses/cp76syn.htm
Swain SM, Walshe JM. 'Clinical aspects of inflammatory breast cancer,' Breast Disease. 2005, 22(1):35-44