Redness and inflammation are common signs of an infection or injury, but when these symptoms occur in the breast, it may signal an unusual type of breast cancer. Inflammatory breast cancer is among the most aggressive types of breast cancer, and it requires immediate diagnosis and care. However, all too often this cancer, which can progress in a matter of weeks to months, isn’t diagnosed until later stages when it’s harder to treat.
Inflammatory breast cancer is rare. It accounts for 1 to 5% of all breast cancer cases, and as with all cases of breast cancer, it occurs less frequently in men. It develops when cancer cells block the lymph vessels, which are small tubes located in the skin that drain waste and infection from the body, leading to symptoms including redness, swelling, and warmth in the breast.
Most inflammatory breast cancers are invasive ductal carcinomas, which develop in the milk ducts and invade the surrounding breast tissue. Inflammatory breast cancer is particularly difficult to treat because these tumors are usually hormone receptor negative, meaning they do not need hormones such as estrogen or progesterone to grow. That means that these tumors aren’t helped by medications (such as a hormonal therapy called tamoxifen) that reduce the levels of hormones in the body.
“The first line of treatment for inflammatory breast cancer is chemotherapy,” says Brigid Killelea, MD, MPH, director of Breast Surgery for Yale Medicine. “It is important to begin treatment shortly after diagnosis to limit the spread of cancer as much as possible. After chemo, mastectomy and removal of the lymph nodes under the arm are performed, usually followed by radiation.”
What are the symptoms of inflammatory breast cancer?
If you notice that your breast looks red (erythema) and inflamed (edema), see a doctor. You’ll be evaluated for mastitis, a breast infection that usually occurs in lactating women (puerperal mastitits)—non-breastfeeding women can sometimes develop periductal mastitis. Doctors also consider the possibility of a breast injury. Below are other symptoms that could point to inflammatory breast cancer:
- One-third or more of the breast is red and swollen
- Discoloration (pink, purplish-red, or black and blue)
- Pitting of the skin around the nipple or breast
- Ridges in the breast tissue
- Peau d’orange (dimpled skin that resembles an orange peel)
- Rapid increase in breast size
- Heavy-feeling breast
- Breast warmth or heat, despite lack of fever
- Breast tenderness
- Inverted nipple
- Swollen lymph nodes in the underarms or near the collarbone
How is inflammatory breast cancer diagnosed?
Inflammatory breast cancer is notoriously difficult to diagnose. One reason is because with this cancer often a breast lump cannot be felt.
This type of cancer can also be hard to see on screening mammograms, especially in women who have dense breast tissue, which is common. Dense breasts are normal (about half of women have them), but sometimes an extra screening test is needed (a breast ultrasound) to detect cancer.
The other challenge with diagnosing inflammatory breast cancer is that because of its aggressive nature, it can appear and quickly progress between annual screening mammograms.
If breast cancer is suspected following a diagnostic mammogram, your doctor may order more imaging tests such as an ultrasound or breast MRI. In addition, a breast biopsy will be performed to determine if the sample contains cancer cells and if those cells have hormone receptors or not. Further imaging (a CT scan, bone scan, and/or PET scan) may be needed to determine if cancer has spread (or metastasized) to other areas of the body.
How is inflammatory breast cancer treated?
Inflammatory breast cancer is treated with a multi-pronged approach. The first step is chemotherapy (called neoadjuvant chemotherapy) to help reduce inflammation and shrink tumors before surgery.
Next, breast surgery (a modified radical mastectomy) is performed and axiliary lymph nodes are removed (dissected) to determine if the cancer has spread. For most cancers that do not involve the skin, immediate breast reconstruction is offered at the time of surgery. Because inflammatory breast cancer involves the skin, surgeons typically remove as much skin as possible, and do not recommend immediate reconstruction so that radiation can be performed without delay. Breast radiation therapy is performed to eliminate any microscopic, remaining cancer cells that were not removed with surgery. Lastly, additional chemotherapy, and/or hormonal therapy (if the cancer cells contain hormone receptors), and other targeted therapies may also be prescribed.
What is the prognosis for people diagnosed with inflammatory breast cancer?
The outcome for people diagnosed with this cancer largely depends on when it’s diagnosed (the earlier, the better), the stage of the cancer (the extent that a cancer has grown or spread), and the person’s overall health.
Active research is underway to find new treatment options for inflammatory breast cancer. Women with inflammatory breast cancer should ask their oncologist about the possibility of clinical trials. For more information about clinical trials, click here.
What is unique about Yale Medicine’s approach to treating inflammatory breast cancer?
Yale Medicine doctors see patients at the Breast Center at Smilow Cancer Hospital, which provides advanced care for breast cancer. Our surgeons are leaders in the field, fellowship-trained, and exclusively focused on performing (and teaching others to perform) breast surgery. The Breast Center is accredited by the National Accreditation Program for Breast Centers and was the first National Cancer Institute Comprehensive Cancer Center in the Northeast to hold this designation.
“At the Breast Center, patients with inflammatory breast cancer see a medical oncologist and a surgical oncologist on the same day, at their initial visit,” says Dr. Killelea. “This multidisciplinary approach avoids treatment delays, and ensures that everyone—doctors, patients, and support staff—is on the same page, and is able to coordinate the best care for each patient.”