Inflammatory Breast Cancer Explained

M. D. Anderson Cancer Center
Date: October 19, 2009

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NewInflammatory Breast Cancer Explained

Pam Jones, program manager for the inflammatory breast cancer program at M. D. Anderson, discusses the symptoms, risk factors, diagnosis and treatment of this rare but very aggressive form of breast cancer.

Lisa Garvin:

Welcome to Cancer Newsline, a weekly podcast series from the University of Texas, M.D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention, providing the latest information on reducing your family's cancer risk. I'm your host Lisa Garvin. Today in the studio we have Pam Jones. She's the Program Manager for the Inflammatory Breast Cancer Program here at M.D. Anderson. Welcome Pam.

Pam Jones:

Well thank you.

Lisa Garvin:

We'll be talking about inflammatory breast cancer in case you haven't guessed. It's a very unique kind of cancer and a very aggressive kind of cancer. And more people are starting to learn about it. Pam let's first talk about what is inflammatory breast cancer or IBC?

Pam Jones:

Well IBC is very different from your standard cancer that most women are aware of. And I'll frame it by telling you what patients often tell us and that is, "I had this little bug bite. And overnight it exploded on my breast and it just began to cover the whole breast." And so inflammatory breast cancer is a very rapidly growing, very aggressive cancer that actually forms on the surface of the breast: on the skin of the breast. All of those notions that we have about how we're safe from breast cancer if we do out monthly checks, we look for the lump, we get our annual mammogram, those don't apply in this case. And so it's a very different set of symptoms and ways of identifying inflammatory breast cancer.

Garvin:

What is the typical age group? Is it the same as typical breast cancer like starting in the mid-40s and older? Or what is the risk group?

Jones:

Actually inflammatory breast cancer patients are younger by about 5 to 10 years younger than the normal breast cancer patient or the average breast cancer patient. And we have a lot of very young patients. In fact, just last week I believe we had a 21 year old. Our clinic is named for Morgan Welch and Morgan Welch was a patient of Dr. Cristofanilli , one of our physicians - who was actually diagnosed at the age of 22. And unfortunately she was gone by the age of 24 despite all of our current treatment options.

Garvin:

As far as inflammatory breast cancer symptoms are concerned, you said it's different and it often forms. guess the cancer cells form in like sheets rather than a lump?

Jones:

Right.

Garvin:

Tell me about some of the symptoms that women would be looking for.

Jones:

So you would be looking for what looks like a rash. You would look for rapid swelling. Sometimes the breast can actually swell to 2 to 3 times the size of the other breast in just a matter of a week or so. You would -- it might be itchy, hot and painful. Another thing that you hear about breast cancer is that it is not painful, but with inflammatory breast cancer actually it can be painful. You don't have to have all of those symptoms, but any combination of those would indicate a cause for concern at least.

Garvin:

And there's also the look of an orange peel: what we call Code Orange. So there's like a dimpled sometimes effect?

Jones:

Yes, due to the swelling the edema - the skin will sometimes pucker and will have that texture of an orange peel.

Garvin:

Is it your concern though that people may think like you say it's a bug bite or an injury. How often is this seen that these symptoms are passed off as something else?

Jones:

Well you know, we don't want to be alarmists. So if a woman has a concern about a bug bite or an itchy place on her breast, we would say you know, "Use common sense and don't rush off to the oncologist immediately." But we would say if those symptoms progress and you see -- that's what the physicians going to look for. They're going to look for the rapid progression. From a simple bug bite to something that involves the entire breast. And we would probably say "Go to your primary physician initially. Have it checked out." Often it's -- you know it has the same sort of look and feel and mastitis or breast infection, and so it's very common that a round of antibiotics would be prescribed. But if those antibiotics don't work, don't mess around.

Garvin:

Go see a doctor.

Jones:

That's right. Exactly.

Garvin:

Does this often present in just one breast or both or do you see both conditions?

Jones:

Sometimes it's both breasts or bilateral but often it's one breast.

Garvin:

We talked about how doctors would possibly give antibiotics thinking that it's mastitis or an infection. Do we see a lot of misdiagnosis of IBC?

Jones:

Actually we do. What we find here in our clinic is that it is often the woman who diagnoses herself. So self diagnosis is very common. What will happen if you put in swollen red breast into one of the search engines on the internet, you're going to come up with an option of inflammatory breast cancer. Thankfully, there are resources out there and so the information is there and it's often times the woman herself who will say, "Wow, this is what my breast looks like. This is what I have."

Garvin:

M.D. Anderson apparently has kind of led the nation and the world I guess as far as setting up an inflammatory breast cancer clinic?

Jones:

That's correct. We established the clinic 3 years ago. It was officially dedicated to Morgan Welch in 2007. And since that time we have seen a four-fold increase in our number of patients that we see with inflammatory breast cancer. So I think it is safe to say that we are easily the largest inflammatory breast cancer clinic in the nation.

Garvin:

Let's talk about therapy. It sounds like because of the way it presents that surgery is not -- usually mastectomy, lumpectomy is typical with regular breast cancer. What are the treatment options for IBC?

Jones:

That's very true. The treatment options are the same actually at this point for inflammatory breast cancer, but what you see is we do it in a different sequence. So when a woman presents with inflammatory breast cancer, because the cancer is so diffuse over the whole surface of the breast, sometimes involving - already involving - lymph nodes, what we will do is give a chemotherapy to begin with. A round of fairly aggressive chemotherapy hoping then to beat back the cancer from as much of the breast as possible. And it is not unusual if a patient responds to the therapy, it's not unusual that by the end of the chemotherapy they may be no evidence of disease or we may not be able to detect any cancer cells. But don't be mistaken, the next step is a mastectomy and for women with inflammatory breast cancer, because this is such an aggressive little critter, lumpectomy or partial mastectomy or nipple sparing mastectomies are not an option. The whole breast needs to be removed in order to insure the best chance of survival. And then the third stage of treatment would be radiation therapy. Here at M.D. Anderson we usually use twice a day radiation therapy and that is just to make sure that we catch it all. We don't want any chest wall recurrence or any other kind of recurrence in the other breast and so we really try to make sure that we catch it all. And then if the cancer is estrogen receptive positive, then they may go on to a endocrine therapy for long-term: you know, for a year or so after all of this just to make sure that that cancer doesn't come back.

Garvin:

And that's like a hormonal ablation therapy?

Jones:

Yes, exactly.

Garvin:

Okay, are there any new innovations or in screening, prevention, diagnosis or treatment on the horizon?

Jones:

We're working on that and that is exactly the focus of our research program. Screening: one of the things that we're doing is we're looking at the evidence at the cellular level for microscopic disease or micro-metastatic disease. What we're looking for are tumor cells that may be in the bloodstream somewhere that are lurking waiting to come back. So we are developing methods of determining how many of those cells are in the bloodstream and who might be at risk for recurrence of disease. The other thing we are looking at, we have 4 classes of drugs that have been used in other cancers and we are looking at those. We're testing them on IBC cells and we think that they show good promise for working in inflammatory breast cancer. And early next year, we'll be bringing the first of those to trial. And be opening -- it will actually be the first clinical trial particularly designed for inflammatory breast cancer.

Garvin:

That sounds very exciting.

Jones:

It is very exciting.

Garvin:

If there was any take home message for our audience, what would that be? What are your final thoughts about IBC?

Jones:

I think as a take home, I would say be aware. I would say that for any woman or man listening to this broadcast but I would also say that to all of the healthcare professionals. It is relatively rare but it is so aggressive. But knowing the physical characteristics, the presentation of IBC has a tremendous opportunity to save lives.

Garvin:

Great. Thank you very much for being with us today.

Jones:

You're very welcome. Thank you.

Garvin:

If you have questions about anything you've heard today on Cancer Newsline contact Ask M.D. Anderson at 1-877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.

 

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