Ask the expert-- Inflammatory breast cancer
Threasa Frouge, MD, is the medical director of Radiology at Banner Estrella Medical Center and is a physician with Valley Radiologists.
Question: How is inflammatory breast cancer different from other breast cancers? Why is it difficult to detect and diagnose?
Answer: Inflammatory Breast Carcinoma (IBC) is an uncommon, but aggressive type of breast cancer that mimics breast infection or inflammation. Despite its name, this cancer is not caused by infection or inflammation, but by tumor cells that clog the lymph vessels in the skin. There is usually no breast lump. As a result, detection and diagnosis is often delayed.
Typical symptoms of IBC include swelling, itching, skin discoloration (pink, red, purple), skin thickening and dimpling (often compared to the skin of an orange), pain, warmth, retraction or inversion of the nipple, and crusted skin around the nipple. The breast is enlarged and tender.
Since these symptoms can also be seen with mastitis (breast infection); doctors will typically prescribe antibiotics first. If there is no improvement after one week on antibiotics, then a patient should see a breast specialist.
Once suspected, the diagnosis of IBC may be challenging. A punch biopsy of the skin and surrounding tissues is performed. If tumor cells are identified, imaging studies, including MRI and CT/PET may be performed to define the extent of tumor.
Since not all thickened skin contains tumor cells, the initial punch biopsy may be “false” negative. If this happens, imaging studies of the breast, including mammography, ultrasound, and MRI may used to identify a target for additional biopsy.
It is important for a woman and her physician to be persistent in making this diagnosis, if IBC is suspected. Since IBC mimics benign mastitis and has no lump as a target for biopsy, it is not surprising that the diagnosis is delayed in many women. Once the diagnosis is made chemotherapy, surgery, and radiation therapy are used. As with any breast cancer early detection and treatment is the goal.