Inflammatory Breast Cancer

What is inflammatory breast cancer (IBC)?

Inflammatory breast cancer (IBC) is a rare type of cancer that spreads quickly. Unlike most breast cancers, IBC doesn’t usually cause lumps in breast tissue. Instead, it appears as a rash, creating skin texture on the affected breast similar to an orange peel. IBC causes pain, redness, swelling and dimpling on the affected breast.

IBC results when cancer cells block lymph vessels — the small, hollow tubes that allow lymph fluid to drain out of your breast. The blockage leads to inflammation, causing symptoms that make it easy to mistake IBC for an infection.

IBC grows fast and requires immediate treatment. Healthcare providers usually treat IBC with chemotherapy, surgery and radiation therapy.

Who is likely to have inflammatory breast cancer (IBC)?

Anyone can develop inflammatory breast cancer, but certain factors may raise your risk.

• Gender: IBC can affect people of all genders, but it’s more common in women and people assigned female at birth (AFAB).
• Age: People with IBC tend to be younger than people with other forms of breast cancer. Inflammatory breast cancer is most commonly diagnosed in women and people AFAB who are younger than 40. The median age of diagnosis is 57.
• Race: People who are Black are more likely to get diagnosed with IBC than people who are white.
• Weight: People with obesity or overweight are more likely to get diagnosed than people with a BMI that falls within the normal range.

How often does inflammatory breast cancer (IBC) occur?

Inflammatory breast cancer occurs at different rates worldwide. It’s most common in North Africa. It accounts for as few as 4% of breast cancer cases in Tunisia and up to 11% of breast cancer diagnoses in Egypt. IBC is rare in the United States, making up only 1% to 5% of breast cancer cases.

What are the first signs of inflammatory breast cancer (IBC)?

Inflammatory breast cancer can be challenging to catch because it doesn’t often cause a lump like more common forms of breast cancer. Instead, the first signs are related to inflammation (redness, swelling, pain) in your affected breast. These symptoms make it easy to confuse IBC for a less serious condition, like an infection.

What are the symptoms of inflammatory breast cancer (IBC)?

Symptoms of IBC progress quickly, over three to six weeks, and may include:

• Areas of discoloration (red, pink or purple), a bruise or rash spread over one-third of your breast.
• Dimpling, pitting or thickening of your breast skin that resembles an orange peel.
• Pain, swelling, itchiness, firmness or tenderness in one breast.
• Warmth, burning, heaviness or enlargement of one breast.
• Inverted or retracted nipple (a nipple that points inward).
• Swollen lymph nodes near your collarbone or under your arm.

What causes inflammatory breast cancer (IBC)?

Most inflammatory breast cancer is considered invasive ductal carcinoma. “Ductal” carcinoma is cancer that forms from cells lining your milk ducts. An “invasive” ductal carcinoma is cancer that spreads beyond your milk ducts, invading healthy tissue. Researchers don’t know what causes these cells to become malignant (cancerous).

Inflammatory breast cancer develops when cancer cells block lymph vessels. Lymph vessels are hollow tubes in your lymphatic system that allow lymph fluid to drain out of your breast. The blockage causes your breast to become red, swollen and inflamed. In most cases of IBC, cancer cells spread outward (metastasize) from your lymph vessels. Cancer that has metastasized affects your other organs and is harder to treat.

How is inflammatory breast cancer (IBC) diagnosed and staged?

Inflammatory breast cancer is rare, with symptoms similar to a more common condition — breast infections (mastitis). Your healthcare provider may prescribe antibiotics and see if it resolves your symptoms to rule out an infection. If they suspect IBC, they’ll order a biopsy to confirm the diagnosis and additional tests to see if the cancer’s spread beyond your breast.

Diagnosing inflammatory breast cancer (IBC)

Diagnosis involves a physical examination, imaging studies and a biopsy.

• Physical exam: Lumps don’t usually form with inflammatory breast cancer, making the condition hard to diagnose. In some cases, your healthcare provider may rule out conditions that may cause similar changes to your breast’s appearance, like mastitis.
• Imaging: A mammogram uses low-energy X-rays to create a picture of the inside of your breast. Mammograms allow your healthcare provider to look for signs of breast cancer, like lumps, breast calcifications or skin thickening. Breast ultrasounds use sound waves to create pictures of the inside of your breasts, nearby tissue and lymph nodes. Ultrasounds allow your provider to see if cancer from your breast has spread to nearby tissue. Unfortunately, IBC and breast infections often look similar on imaging.
• Biopsy: A biopsy is the only way to confirm an IBC diagnosis. During a biopsy, your healthcare provider removes a tissue sample from your breast. A specialist called a pathologist tests the sample in a lab to see if it’s cancer. Biopsy results also help your provider discover whether specific targeted therapies or drugs may be effective treatments for your cancer.

Staging inflammatory breast cancer (IBC)

Biopsy results can help your healthcare provider stage the cancer, or determine whether it’s spread outside of your breast tissue. By the time IBC is diagnosed, it’s either stage III or stage IV. Stage III cancer has only spread to your breast tissue skin. Stage IV cancer has spread to other organs.

Your healthcare provider may order any of the following tests to determine if your cancer’s spread:

• Computed tomography (CT scan): A CT scan takes several X-rays of your chest, abdomen and pelvis and compiles them into a single image. This image allows your healthcare provider to look for signs of cancer in bones and soft tissue.
• Bone scan: A bone scan uses a small amount of a radioactive substance to provide images of your bones. These images can show parts of your bone that have been damaged, potentially due to cancer spread.
• Magnetic resonance imaging (MRI): An MRI uses radio waves, magnets and a computer to create detailed images of the inside of your body.
• Positron emission tomography (PET scan): A PET scan uses dye containing radioactive drugs (tracers) to create an image of internal structures in your body.

How is inflammatory breast cancer (IBC) treated?

Inflammatory breast cancer treatments use a combination of chemotherapy, surgery and radiation.

• Chemotherapy: Chemotherapy for breast cancer uses drugs to kill cancer cells. You may receive chemo intravenously (through a vein) or as a pill. Chemotherapy shrinks cancer cells so they’re easier to remove during surgery. You may also receive chemotherapy after surgery to destroy any cancer cells that may remain after surgery.
• Surgery: Surgery removes your entire affected breast (mastectomy) and nearby lymph nodes. More conservative treatments that remove tissue while sparing your breast aren’t effective with IBC. The cancer spreads too quickly.
• Radiation therapy: Radiation therapy uses a machine to direct energy toward the cancer, destroying the cancer cells. After surgery, you may receive radiation to kill any remaining cancer cells that surgery may have missed.

Depending on the characteristics of your cancer cells (discovered during the biopsy), you may receive treatments like targeted therapy, hormone therapy or immunotherapy.

• Targeted therapy: Targeted therapy zeroes in on specific weaknesses in cancer cells. It targets those weaknesses to destroy the cancer. For example, a protein called HER2 on the cancer cells helps IBC grow and spread. Targeted therapy destroys this protein, making it harder for cancer cells to thrive.
• Hormone therapy: Some types of cancer cells have hormone receptors that cause the cancer to grow in the presence of estrogen and progesterone. If your cancer cells have hormone receptors, your provider may prescribe treatments that block these hormones.
• Immunotherapy: Immunotherapy helps your body’s immune system identify and fight cancer cells. Studies have shown that some types of immunotherapy can improve the effectiveness of other IBC treatments, like chemotherapy. Research is ongoing.

Your healthcare provider may also recommend that you take part in a clinical trial. A clinical trial is a study that tests the safety and effectiveness of new cancer treatments. Treatments that are successful in clinical trials often become the standard treatment approaches.

What complications are associated with inflammatory breast cancer (IBC)?

Treatment for IBC may cause complications, such as lymphedema (pooling of lymphatic fluid) after surgery removing your lymph nodes.

Because IBC develops so quickly, the cancer has usually spread to other tissues (metastasis) by the time it’s diagnosed. You may need additional treatments if the cancer spreads to other parts of your body.

Can inflammatory breast cancer (IBC) be prevented?

You can’t prevent inflammatory breast cancer. For the best outcomes, seek treatment early. Let your healthcare provider know about any breast changes as soon as possible.

How quickly does inflammatory breast cancer (IBC) progress?

IBC is considered a fast-growing (aggressive) cancer. It only takes a few weeks or months to progress. By the time it’s diagnosed, it’s already spread to your breast skin, making it at least a stage III cancer.

What is the prognosis (outlook) for people with inflammatory breast cancer (IBC)?

IBC usually develops quickly and spreads to other tissues outside of your breast. It often returns (recurs) after treatment. Early diagnosis and treatment are vital to managing the condition as effectively as possible.

Because IBC spreads quickly and is found later than other cancers, the outlook for people with this condition is generally not as good as for different types of breast cancer. Still, some people live many years after an IBC diagnosis. Your healthcare provider can explain your prognosis to you.

When should I call my doctor if I am concerned about inflammatory breast cancer (IBC)?

Contact your healthcare provider immediately if you notice any changes to your breast, even if you don’t feel a lump. With further testing, your provider can determine whether IBC may be a concern.

Contact your provider if you’re taking antibiotics for a breast infection — especially if you have the symptoms of IBC — and your symptoms don’t improve within a week.

What questions should I ask my doctor?

Ask your healthcare provider about what your cancer diagnosis means for your treatment options and likely outcomes. Questions to ask include:

• What stage is my breast cancer?
• Which specialists will be involved in my care?
• What treatment options would you recommend?
• What outcomes should I expect from treatment?
• What are potential side effects or complications related to treatment?
• Can you connect me with resources (support groups, palliative care, etc.)?

A note from Cleveland Clinic

Inflammatory breast cancer (IBC) is a rare type of cancer that spreads quickly. Schedule an appointment with your healthcare provider immediately if you notice changes in your breasts, especially a change in one breast but not the other. The changes may be a sign of a less serious condition, like an infection. Still, IBC spreads fast. If your symptoms are a sign of inflammatory breast cancer, you’ll want to begin treatment as early as possible. Don’t delay seeking care that can potentially improve your prognosis.