Key takeaways:

• Inflammatory breast cancer is an aggressive form of breast cancer that rapidly progresses over weeks to months.

• It causes pain and changes in the appearance of your breast such as redness, swelling, and dimpling of the skin.

• Treatment usually involves a combination of surgery, radiation, and medication.

Inflammatory breast cancer (IBC) is a rare subtype of breast cancer that accounts for fewer than 5% of all people diagnosed with breast cancer. It’s very different from other types of breast cancer in the way it shows up, so it can be confused with other conditions of the breast. Unfortunately, it’s also highly aggressive. It’s important to be aware of these differences, because what most people know about breast cancer may not apply to IBC. Let’s take a closer look at what makes it different from other breast cancers and how it’s treated.

How is inflammatory breast cancer different from other types of breast cancer?

IBC is the most aggressive subtype of breast cancer, meaning it grows and spreads quickly. IBC is also difficult to study because it’s rare in comparison to other types. That said, there are differences in its risk factors, symptoms, and behavior.

A few risk factors have been linked with the development of IBC, including:

• Race: IBC is 50% to 70% more common in Black people than in white people.

• Body mass index (BMI): Increased body weight, or obesity, has been linked with the development of all breast cancers, including IBC.

• Age: IBC affects younger women compared with other types of breast cancer. The median age is 57 at diagnosis, but it often occurs in women under the age of 40.

What are the symptoms of inflammatory breast cancer?

IBC is different from other breast cancers because it does not form a mass or a lump in the breast. It usually looks like a rash on the breast, which can make it harder to diagnose. Symptoms are caused by cancer cells that block lymph vessels in the skin, which causes the breast to look “inflamed.”

Sudden changes in the appearance of the breast include:

• Swelling

• Redness that affects at least one-third of the breast

• Itching

• Dimpling of the skin — this has been likened to the appearance of an orange peel

• Warmth

• Heaviness

Symptoms start suddenly and worsen within weeks to a few months. Unfortunately, because IBC develops so quickly, it has usually spread to other organs or tissues by the time of diagnosis. These tissues include:

• Lymph nodes

• Lungs

• Liver

• Bone

If IBC has spread, other symptoms may include swollen lymph nodes in your underarm, shortness of breath, and bone pain.

How is inflammatory breast cancer diagnosed?

Early diagnosis is important so treatment can begin as soon as possible. Don’t wait to contact your provider if you see any changes in your breast, even if there is no lump. Your provider may order the following tests for further evaluation:

• Mammogram: Inflammatory breast cancer may not be picked up by a mammogram due to the lack of a lump or mass — this can make it difficult to diagnose.

• Biopsy: The only way to confirm the diagnosis is by performing a biopsy — this consists of removing a tissue sample with a needle to test for cancer cells.

• Ultrasound: This type of imaging can help guide biopsies within the breast and surrounding lymph nodes.

• Magnetic Resonance Imaging (MRI): This is the most accurate imaging technique to detect the tumor within the breast in IBC. It may also help to guide biopsy.

• Hormone receptor testing: IBC often lacks hormone receptors, making it less likely to respond to hormone therapies.

Your provider may order other tests to look for whether the cancer has spread outside the breast to other parts of the body. These include computerized tomography (CT) scan, bone scan, and PET/CT scan.

How do you treat inflammatory breast cancer?

The treatment of IBC depends on its stage. The stage of a cancer refers to how much cancer is present in the body, including if and where it has spread (metastasized). This helps providers to figure out how serious it is and what the best treatment would be. Breast cancers are staged from 0 through 4. A higher number indicates that the cancer is larger and may have spread. Stage 0 breast cancer is considered noninvasive cancer or “precancer,” and it doesn’t spread. Stage 4 means that the cancer has spread to other organs like the lungs, liver, or bones.

IBC is automatically categorized as at least stage 3 — based on involvement of the skin. IBC will have metastasized to other tissues in the body in one-third of cases at the time of diagnosis. It is then categorized as stage 4, or metastatic breast cancer.

Because IBC is highly aggressive, intensive therapy should be started as soon as possible.

People with IBC usually receive “trimodal” therapy with chemotherapy, surgery, and radiation. The specific mode of treatment depends on whether a person has stage 3 or stage 4 disease:

For nonmetastatic (stage 3) IBC, the standard treatment is neoadjuvant chemotherapy followed by surgery and radiation. This is followed by other systemic treatments, which may include:

• Neoadjuvant chemotherapy: This is administered before a planned surgery. It helps to decrease the size of the cancer and makes surgical removal easier. If this treatment works to shrink the tumor, it indicates that the treatment can also be used after surgery.

• Modified radical mastectomy: This is the surgical procedure used in IBC, which involves the removal of the entire breast and lymph nodes in the underarm on the same side.

• Local radiation therapy: A specialist called a radiation oncologist prescribes this.

• Systemic treatments: After surgery, other systemic treatments such as hormonal therapies are administered as well as chemotherapy — if not given before surgery.

Surgery is not usually recommended for people with metastatic (stage 4) IBC. Systemic therapies are the main treatment in this scenario.

Treatment strategies are also tailored based on the characteristics of each person’s cancer, such as hormone receptor expression. These new targeted treatment strategies have improved survival rates in IBC. However, survival times with IBC remain much lower when compared with other breast cancers.

What other conditions can cause a painful red rash over the breast?

Other conditions can cause changes in the appearance of the breast that can be confused with IBC. These include:

• Mastitis: This is a bacterial infection of the breast that is treated with antibiotics. It also presents with redness and swelling of the breast. You may also have fevers and chills. Your provider may prescribe antibiotics if they suspect an infection. If your symptoms do not go away, make sure to let your provider know.

• Noninflammatory breast cancer: Other types of breast cancer may also involve the skin. They can cause a similar appearance with dimpling and swelling. This is why a biopsy is crucial to make the diagnosis.

• Ductal ectasia: This is a noncancerous condition due to blocked and swollen milk ducts in the breasts.