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Doctor, Doctor: Focus on inflammatory breast cancer

Network - Summer 2012

Naoto Ueno, M.D., Ph.D.

We asked Naoto Ueno, M.D., Ph.D., professor in the Department of Breast Medical Oncology and executive director of the Morgan Welch Inflammatory Breast Cancer Clinic, to help us understand the basics of inflammatory breast cancer.

How does inflammatory breast cancer (IBC) differ from other types of breast cancer? 

Patients with IBC present with red (erythematous), inflamed (engorged) breast tissue. The breast may not have a mass. Thus, looking for a mass — as we do for other types of breast cancer — is often not the best way to detect the disease early.

IBC is the most lethal and aggressive form of breast cancer. Despite progress in the development of treatments, especially combined-modality treatments (using a combination of chemotherapy, surgery and radiation therapy), the long-term outlook for most patients with IBC remains bleak: only 40%-50% of patients survive at least five years after diagnosis.

In comparison, in non-IBC breast cancer, five-year survival rates are as high as 60% to 70% for locally advanced cancer.

How rare is it? How many cases does MD Anderson see a year?

IBC represents just 2% to 5% of breast cancer diagnoses, but causes 8% to 10% of breast cancer-related deaths in the United States. We see about 100 cases per year at the Morgan Welch Inflammatory Breast Cancer Clinic.

Why is IBC so aggressive? Is it because it’s usually diagnosed at a late stage?

The high risk of developing distant metastases (disease going to other organs) and lack of effective targeted therapies may partly explain the poor outcomes associated with IBC.

Also, because the disease presents as red, inflamed breast tissue instead of as a mass, it’s often misdiagnosed as a breast infection (mastitis). Patients may then receive prolonged treatment with antibiotics before a correct diagnosis is made.

By the time patients with IBC arrive at our clinic, 30% of them have developed metastases.

This is why there’s an urgent need for more research into the molecular mechanisms of IBC. Improving our understanding of how the disease starts and spreads at the molecular level may lead to developing more effective treatments.

Also, understanding the molecular mechanisms of IBC metastasis should help us understand the metastatic processes of non-IBC breast cancers as well.

Have there been treatment advances in IBC?

Yes, research has uncovered several potential molecular therapeutic targets. These molecular mechanisms are known to increase proliferation (rapid reproduction), promote metastasis and contribute to drug resistance in cancer cells. We’re conducting five clinical trials with treatments targeting these mechanisms to determine whether they’ll improve the outcome of patients with IBC.

What spurs you to do research on this rare cancer?

My mission is to reduce the suffering brought on by advanced breast cancer. I specialize in metastatic breast cancer and IBC. Unfortunately, most patients die from metastasis.

Of course, screening is important to detect breast cancer early, but I felt I needed to do something for those already suffering with aggressive disease. I committed myself to IBC because it’s the most aggressive form of breast cancer. I truly believe that by understanding the molecular processes of IBC metastasis, we’ll also gain knowledge that will help patients suffering from other types of advanced breast cancer.

© 2015 The University of Texas MD Anderson Cancer Center