Inflammatory breast cancer

Inflammatory breast cancer is a rare type of breast cancer that happens when cancer cells block the lymph vessels in the skin of the breast. It causes the skin of the breast to look red or darker than usual and swollen (inflamed).

Inflammatory breast cancer is aggressive, which means that it grows and spreads quickly. In most cases, inflammatory breast cancer has already spread to the lymph nodes or other organs when it is diagnosed.

Inflammatory breast cancer develops more often in younger women and women of African ancestry.

The signs and symptoms of inflammatory breast cancer usually start quickly after the cancer develops. Many of them appear at the same time. Most often there are changes to how one breast looks, especially to the skin of the breast.

It is important to know what is normal for your breasts and to report any changes to your doctor. See your doctor if you have:

• changes to the colour of a breast, such as turning red, purple or darker than usual
• an enlarged or swollen breast
• thickened skin on a breast that looks like the skin of an orange (called peau d’orange)
• a breast that feels warm or heavy
• a nipple that points inward (called an inverted nipple)
• tenderness or pain in the breast or nipple
• a burning feeling in a breast or nearby areas
• swollen lymph nodes in the armpit or near the collarbone

The signs and symptoms of inflammatory breast cancer are very similar to the symptoms of mastitis, which is an infection of the breast. Doctors may first prescribe antibiotics to treat mastitis and see if your symptoms go away.

An important part of diagnosing inflammatory breast cancer is how quickly the signs and symptoms start. Inflammatory breast cancer doesn't usually cause a lump in the breast that can be felt by a doctor or seen with mammography. This can make it hard to diagnose.

The following tests are usually used to rule out or diagnose inflammatory breast cancer.

• physical exam and clinical breast exam
• mammography and other imaging tests, such as a CT scan and MRI
• biopsy

Many of the tests that are used to diagnose cancer are also used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Find out more about diagnosis of breast cancer.

A prognosis is the doctor's best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors. Find out more about prognosis and survival of breast cancer.

Inflammatory breast cancer tends to have a lower survival than other types of breast cancer because it:

• grows and spreads quickly
• has a high risk of coming back early on after treatment (early recurrence)
• is not often found until it is at an advanced stage, which can make it harder to treat

There are no Canadian statistics available for inflammatory breast cancer. According to US statistics, the 5-year relative survival for inflammatory breast cancer is 41%. This means that, on average, people diagnosed with inflammatory breast cancer are 41% as likely to live for at least 5 years after their diagnosis compared to people in the general population.

Survival statistics are very general estimates and must be interpreted very carefully. Treatments and outcomes usually get better over time so your doctor can explain these statistics and what they mean to you.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. Inflammatory breast cancer is often treated like other types of locally advanced or metastatic breast cancer. The following are treatment options for inflammatory breast cancer.

Chemotherapy uses drugs to destroy cancer cells. It is usually the first treatment for inflammatory breast cancer.

Chemotherapy for inflammatory breast cancer is often given as a combination of drugs. It usually includes an anthracycline drug such as doxorubicin or epirubicin and a taxane drug such as paclitaxel.

Find out more about chemotherapy for breast cancer.

Some drugs target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Drugs that target the HER2 protein are given with and after chemotherapy for inflammatory breast cancer that is HER2 positive.

The HER2 gene controls a protein on the surface of breast cells that helps them grow. Sometimes too many copies of the HER2 gene are present in a cancer cell and it makes too much HER2 protein (called HER2 positive). HER2 status testing is done on all breast cancers at the time of diagnosis. The targeted therapy drugs that may be used to treat HER2-positive inflammatory breast cancer are:

• trastuzumab (Herceptin and biosimilars)
• pertuzumab (Perjeta)
• pertuzumab and trastuzumab combined into a single dose (Phesgo)

Find out more about HER2 status tests and targeted therapy for breast cancer.

You may be offered surgery for inflammatory breast cancer if the cancer is only in the breast and the lymph nodes under the arm, and has not spread to other parts of the body. Surgery is usually done after chemotherapy.

A modified radical mastectomy may be used to treat inflammatory breast cancer. An axillary lymph node dissection is also done because inflammatory breast cancer often spreads to nearby lymph nodes.

Breast-conserving surgery may be offered instead of a mastectomy. A few axillary lymph nodes are also removed. This can be a treatment option if chemotherapy and anti-HER2 therapy given before surgery shrink the tumour enough.

Find out more about surgery for breast cancer.

Hormone therapy adds, blocks or removes hormones to slow or stop the growth of cancer cells that need hormones to grow. Hormone therapy is given after surgery for inflammatory breast cancer that is hormone-receptor positive.

Breast cancer tissue is tested to find out if it has hormone receptors. Hormone therapy is only used for breast cancer that is hormone-receptor positive. This means that the cancer cells have receptors for estrogen (ER+) or progesterone (PR+) or both.

The type of hormone therapy offered will depend on whether or not you have reached menopause.

• If you have not reached menopause (you are premenopausal), you will be offered a gonadotropin-releasing hormone (GnRH) agonist, such as leuprolide (Lupron), along with either tamoxifen or an aromatase inhibitor, such as anastrozole (Arimidex).
• If you have reached menopause (you are post-menopausal), you will be offered an aromatase inhibitor.

Find out more about hormone receptor status tests and hormone therapy for breast cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation therapy is offered after surgery for inflammatory breast cancer. It may also be used if you can't have surgery.

External radiation therapy is given to the area where the cancer started and nearby lymph nodes under the arm, in the lower neck and sometimes in the middle of the chest. It helps lower the risk of the cancer coming back.

Find out more about radiation therapy for breast cancer.

Talk to your doctor about clinical trials open to people with inflammatory breast cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.