Inflammatory Breast Cancer (IBC)

Inflammatory breast cancer (IBC) is a rare type of breast cancer. About 1 in 100 to 1 in 20 breast cancer cases in the U.S. are this type. It is very fast-growing (aggressive) and can be hard to detect. When it is detected, treatment starts right away. IBC is more common in Black women than white women. This sheet tells you more about IBC and how it is treated.

How IBC is different from other breast cancers

Symptoms of IBC are different from those of other breast cancers. The main differences are:

• Breast cancer cells typically form a lump. But with IBC, lumps are rare. As a result, the cancer may not be noticed on a routine mammogram. This makes early diagnosis harder than with other breast cancers.

• IBC cells block vessels in the skin called lymph vessels. These vessels are part of the immune system. This causes swelling and warmth in the breast. These symptoms can look and feel like infection or inflammation. If IBC is mistaken for other, more common problems, it can take longer to diagnose IBC and can delay cancer treatment.

• IBC grows more quickly and tends to spread faster than other breast cancers.

• IBC is more common in younger women.

Because of these differences, IBC is often advanced by the time it is diagnosed. As a result, it can be harder to treat than other breast cancers.

Symptoms of IBC

Unlike the symptoms of other breast cancers, IBC’s symptoms are most often changes in the skin of the breast.

IBC symptoms develop quickly, often over a few weeks or months. Symptoms can include:

• Sudden swelling of the breast

• Warmth in the breast

• A red, pink, reddish-purple, or bruised appearance

• Skin that has ridges or appears pitted, like the peel of an orange

• Itching of the breast or nipple

• An inverted nipple

• Swollen lymph nodes under the arm or above the collarbone

• Breast pain or tenderness

Diagnosis and staging

To decide the best course of treatment for you, your healthcare team needs to know as much as they can about the cancer. This may involve getting some tests and working with more than 1 healthcare provider. And you may decide that you want to get a second opinion to help you choose a treatment.

IBC is most often diagnosed with a physical exam by your healthcare provider. Certain tests will also be done. These confirm a diagnosis and help with staging. Staging is the process of finding out how much cancer there is and where it has spread. Staging helps the healthcare team plan treatment. IBC is classified as either stage III or stage IV breast cancer on a 0 to IV scale. This is because it has usually spread beyond the breast (advanced) by the time it’s found.

Tests that may be done include:

• Mammogram. This type of X-ray creates pictures of the inside of the breast.

• Ultrasound. This test uses sound waves to create images of the inside of the breast.

• CT or MRI. These imaging tests create detailed images of the inside of the breast and other areas of your body to determine if and where the cancer has spread. A CT uses X-rays. An MRI uses magnets and radio waves.

• PET scan. PET shows areas of cancer by creating images of the areas where there is more cell activity. This is because cancer cells are more active than normal cells.

• Biopsy. A tissue sample is removed. The sample is sent to a lab and checked for cancer. There are several types of breast biopsy. These include fine needle aspiration, punch biopsy, and large-core biopsy. Your healthcare provider will explain the type that you will have. A biopsy is the only way to know for sure that the breast changes you have are cancer.

• Bone scan. This test helps check if cancer has spread to the bones. A safe radioactive material (tracer) is sent through the bloodstream. A scan of the body is then done to see how much tracer collects in the bones.

Treatment of IBC

Once IBC is diagnosed and staged, treatment begins right away. Cancer is treated using different methods. For other breast cancers, surgery is typically done first. But with IBC, treatment starts with chemotherapy.

Stage III IBC

1. Chemotherapy. This treatment uses certain medicines given through a vein to attack the growth of cancer cells. You will likely get at least 2 different kinds of medicine.

2. Surgery. This is done if the cancer has not spread too far. A modified radical mastectomy is most often done. This means the entire breast and the lymph nodes under the arm are removed.

3. Radiation. This treatment may be given after surgery. It targets X-rays on the chest area to destroy remaining cancer cells.

After these, you may have additional treatments. They may include:

• Hormone therapy. Medicines are used to prevent certain hormones in your body from helping cancer cells grow.

• Targeted therapy. Medicines are used to block growth of cancer cells that make certain proteins.

• Supportive care. This is care that helps improve the quality of life. For instance, it may help ease disease symptoms or side effects of treatments. It can also involve support to help you cope with the emotional and mental strain of having cancer.

Stage IV IBC

Because stage IV IBC has spread beyond the breast to other parts of your body, treatment needs to work throughout your body. Most often chemotherapy is used. You may also get hormonal and targeted therapy. Supportive care is given, too.

Talk with your healthcare team about what treatments are best for you. Make sure you ask how the treatment will change your daily life, including your diet, and how you will look and feel after treatment. Ask how successful the treatment is expected to be, and what the risks and possible side effects are.

Your prognosis

Prognosis means the likely outcome of the disease. A prognosis is a calculated guess. It's a question many people have when they learn they have cancer. Each person's situation is unique. Talk with your healthcare team about your individual condition.

Clinical trials

If you are interested, talk with your healthcare provider about taking part in a clinical trial. Clinical trials are ways to test new, and maybe better, treatments before they’re available to the public. Because IBC is so rare, it’s hard for researchers to find enough patients to study. So the National Cancer Institute encourages patients with IBC to take part in clinical trials. For more information on clinical trials, visit www.cancer.gov/clinicaltrials.