• 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.

• 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.

• 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.

• 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.

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.

Inflammatory Breast Cancer, like other forms of breast cancer, can be classified into four molecular subtypes based on hormone receptor status, HER2 expression, and proliferation rate (how quickly cancer cells are dividing and growing), based on the AJCC molecular classification, as summarized in the American Journal of Roentgenology (AJR, 2020):

• Luminal A: High estrogen (ER) and progesterone (PR) receptor expression, low proliferation rate, and usually HER2-negative. This subtype generally has the most favorable prognosis.
• Luminal B: Lower ER/PR expression with a higher proliferation rate, meaning it grows more aggressively. It is usually HER2-negative, but about 30% of cases are HER2-positive.
• HER2-enriched: HER2-positive with either positive or negative hormone receptor status. These cancers are typically high-grade with a high proliferation rate, but HER2-targeted therapies, such as trastuzumab, have significantly improved outcomes. (HER2-positive means the cancer has too much HER2 protein, while HER2-enriched is a specific molecular subtype that tends to grow faster. Not all HER2-positive cancers are HER2-enriched.)
• Basal-like (often Triple-Negative): Lacks ER, PR, and HER2 expression and has a high proliferation rate, making it one of the most aggressive subtypes with fewer targeted treatment options.

Compared to other types of breast cancer, IBC is more frequently associated with the HER2-enriched or basal-like (triple-negative) subtypes, which influences both treatment options and prognosis.

• 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.