Inflammatory Breast Cancer in Canada: An Overview

How do I know if I have IBC?

Breast health starts with knowing your breasts so that you are more likely to notice changes that may lead you to get them checked out. Know your body. Know IBC.

Inflammatory Breast Cancer is a rare and aggressive form of breast cancer, believed to account for approximately 1-2% of all breast cancer diagnoses in Canada based on data from other countries like the US and the UK. While specific Canadian statistics are limited, the challenges posed by IBC remain significant due to its aggressive nature and the urgency required for its timely diagnosis and treatment. In most cases, inflammatory breast cancer has already spread to the lymph nodes or other organs when it is diagnosed.

Inflammatory Breast Cancer is characterized by cancer cells blocking lymph vessels in the skin of the breast. This blockage leads to the breast often looking swollen, red, or “inflamed”. These symptoms can easily be mistaken for an infection like mastitis.

Inflammatory Breast Cancer, like other forms of breast cancer, can be classified into three molecular subtypes: HER2-positive, hormone receptor-positive (Estrogen and Progesterone), and triple-negative. These classifications affect how the cancer behaves and responds to treatment. Compared to other types of breast cancer, IBC is more frequently associated with the HER2-positive or triple-negative subtypes, which can influence both the treatment approach and the outlook for patients.

RISK FACTORS

AGE

Breast cancer risk generally increases with age. IBC is typically diagnosed around age 51, which is slightly younger than other types of breast cancer.

 

Obesity

Being overweight, especially after menopause, raises the risk of breast cancer.

 

Dense breast tissue

Dense breast tissue, visible on mammograms, is associated with an increased risk of breast cancer.

 

Genetic mutations

Specific mutations in genes like BRCA1 and BRCA2, can increase the risk of breast cancer. Other mutations in genes like PALB2, CHEK2, and PTEN are also linked to breast cancer risk. While no mutations are specifically associated with IBC, research continues to explore the role of genetics in this form of cancer.

 

Family History

Having a first-degree relative (parent, sibling, or child) with breast cancer increases the likelihood of developing the disease.

 

Early menstruation

Starting menstruation before age 12 raises the risk of breast cancer.

 

Pregnancy history

Women who haven’t had a full-term pregnancy or who had their first full-term pregnancy after age 30 have a higher breast cancer risk.

 

Previous breast cancer

Having had breast cancer previously increases the risk of developing it again.

 

Previous radiation therapy

Radiation treatment to the chest in childhood or early adulthood, while beneficial for treating other conditions, can increase the risk of breast cancer later in life.

 

These factors collectively contribute to the risk profile for developing inflammatory breast cancer. 

Symptoms of Inflammatory Breast Cancer

Unlike other breast cancers, Inflammatory Breast Cancer symptoms are noticeable soon after it develops. It is important to note that many women with IBC do not find a lump.

Common Symptoms of IBC

IBC symptoms can appear suddenly, often within days or weeks, making early detection crucial. IBC symptoms vary between individuals and may include:

Skin changes

One of the most common symptoms is a change in the skin’s color, with the skin on at least one-third of the breast becoming very red or purplish. The skin might also appear dimpled or pitted, resembling the texture of an orange peel, a condition known as peau d’orange.

Breast Swelling

Sudden swelling of the breast, often with one breast becoming much larger than the other.

Thickened Skin or Tissue

The skin or tissue of the breast may feel thicker than usual, or there might be noticeable ridges.

Warmth

The affected breast might feel warm to the touch.

Nipple Changes

The nipple may flatten, retract, or suddenly point inward (a condition known as an inverted nipple).

Tenderness and pain

The breast might be tender or painful, and some may experience itching or burning.

A “bug bite”

or a small pimple or blister like lesion that doesn’t heal

Lump in the Breast, Near the Armpit or Collarbone

While most women with IBC do not find a lump in the breast, it is possible, or a lump may appear in the armpit (axilla) or near the collarbone.

Important Considerations

To be classified as inflammatory breast cancer, though, the skin changes must:  

  • have occurred within the last 6 months, and 
  • involve at least a third of the breast. 

The symptoms of IBC can be easily mistaken for an infection in the breast tissue, known as mastitis, which is more common in breastfeeding women. However, IBC symptoms do not respond to antibiotics. If you experience any of these symptoms, it’s vital to consult your doctor immediately, as waiting for antibiotics to work may delay the diagnosis and treatment of IBC.

IBC is diagnosed at an advanced stage (at least Stage 3B), meaning it has begun to spread into surrounding tissues. Therefore, early recognition and prompt action are key to managing this aggressive cancer.

Diagnosing Inflammatory Breast Cancer

Understanding an IBC Diagnosis

Diagnosing Inflammatory Breast Cancer can be challenging due to its rapid progression and similarity to other conditions. Here’s what you need to know about diagnosing IBC:

Diagnostic Criteria
  • AJCC Staging: IBC is classified as T4d in the American Joint Committee on Cancer (AJCC) Tumor, Node, Metastasis (TNM) staging system. This designation reflects the advanced nature of the disease, indicating significant involvement of the breast tissue and surrounding areas.
Primary vs. Secondary IBC
  • Primary IBC: Refers to cancer that originates in a previously normal breast. This is when the disease develops without any prior history of breast cancer.
  • Secondary IBC: Occurs when inflammatory changes develop in a breast already affected by invasive cancer of following surgery for a non-inflammatory form of breast cancer.
Symptom Overlap with Mastitis
  • IBC symptoms can closely resemble those of mastitis, an infection more common in breastfeeding women. Symptoms such as redness, swelling, and warmth in the breast may lead to confusion between the two conditions.
  • Doctors might initially treat suspected mastitis with antibiotics. However, if these treatments do not resolve the symptoms, it may delay the correct diagnosis of IBC. Timely diagnosis is crucial because IBC progresses rapidly and can significantly impact treatment outcomes.
Recognizing the Rapid Progression
  • IBC is diagnosed at later stages (Stage III or IV) due to its aggressive nature and the difficulty in identifying its symptoms early on. The disease can escalate from a small change in skin appearance to a fully involved breast within weeks, and in some cases, even overnight.
  • Typically classified as locally advanced breast cancer, IBC means that the cancer has spread into nearby tissues but may not have yet reached distant parts of the body. Early and accurate diagnosis is essential for effective treatment.
Importance of Early Detection
  • Awareness and prompt evaluation of any changes in breast appearance are critical. If you notice any unusual symptoms or changes in your breast, seek medical advice without delay. Early detection can greatly improve treatment options and outcomes.
Diagnostic Tests

To diagnose IBC and determine its stage, various tests may be used:

  • Clinical Breast Exam: An initial physical examination to assess any abnormalities in the breast.
  • Diagnostic Mammogram: An X-ray of the breast to look for any unusual changes.
  • Breast Ultrasound: Uses sound waves to create images of the breast tissue.
  • MRI of the Breast: Provides detailed images to assess the extent of the cancer.
  • Digital Mammogram: A more advanced form of mammography that can offer clearer images.
  • Core Biopsy of the Breast: A procedure to remove small samples of breast tissue for analysis.
  • Skin Punch Biopsy: A technique to take a sample of the skin for examination, especially important for diagnosing skin changes in IBC.
  • Hormone Receptor Status Testing: Determines if the cancer cells have hormone receptors, which can influence treatment options.
  • HER2 Status Testing: Identifies if the cancer cells overexpress the HER2 protein, which can guide targeted therapy decisions.
    Challenges in Diagnosis
    • Symptom Overlap: IBC symptoms can closely resemble those of mastitis, an infection more common in breastfeeding women. Symptoms such as redness, swelling, and warmth in the breast can lead to misdiagnosis. Many cases are initially treated as mastitis with antibiotics, which may delay the correct diagnosis if symptoms persist.
    • Screening Limitations: IBC is not easily detected by standard mammograms and often does not present with a palpable lump, making it harder to identify through routine screenings. This can result in prolonged diagnostic journeys, especially in cases where healthcare providers may lack specific training or experience with IBC.
    • Need for Awareness: There is a critical need for improved education and training about IBC among healthcare providers, including midwives, nurse practitioners, and general practitioners to expedite the timeline from diagnosis to treatment. Increased awareness can help in the early and accurate diagnosis of this rapidly progressing cancer.