Getting The Facts: Inflammatory Breast Cancer

McClatchy-Tribune Information Services -- Unrestricted

October 20, 2009

October is Breast Cancer Awareness Month, and while it is critically important to raise awareness of breast cancer prevention in general; it is also a particularly important time for us ALL -- whether we are physicians, research scientists, women, or men -- to become acutely aware of a relatively rare, but all too often, poorly understood cancer known as Inflammatory Breast Cancer, or IBC.

WHY TALK ABOUT IBC, IF IT IS INDEED RARE?

The answer of course, is simple. First, every life matters, and education and awareness saves lives. And, second, precisely because IBC is relatively rare (It accounts for 1 to 5% of all breast cancer cases in the US (1), it is frequently not "caught" early by patients, and is further often misdiagnosed or even completely missed by physicians. The delay caused in obtaining prompt and necessary treatment by the combination of these two factors is simply too costly, as this disease progresses rapidly and can become lethal in a very short period of time.

GETTING THE FACTS

IBC is a type of breast cancer in which cancer cells block the lymph vessels in the skin of the breast. This cancer is referred to as "Inflammatory" because the breast can look externally swollen, red or inflamed. One of the main reasons why this cancer often goes undiagnosed is because women relate only the presence of a "lump" to breast cancer. However, it is crucially important for all women (and even some physicians) to know that a breast lump is NOT a necessary pre-condition for breast cancer, and this is especially true in the case of IBC. Generally, IBC tends to grow in "nests" or "sheets" rather than as a solid tumor. Here are additional symptoms that are typical of IBC:

--An unexpected pink, red or dark colored area on the breast, usually accompanied with itching or discomfort.

--Swelling of the breast, often up to a cup size or more very rapidly.

--Thickening of breast tissue or ridges on the skin

--Retraction of the nipple

--Discharge from the nipple -- may or may not be bloody

--Sharp or stabbing pains in the breast, or a perceptible ache in the breast area

--Breast may feel warm to touch

--Alteration in color or texture of the areola (area surrounding the nipple)

--Swollen lymph nodes under the arm or above the collar bone (or in BOTH places)

The median age at time of diagnosis of IBC is 56 years, relative to about 62 years for non-IBC breast cancer.

LEARNING MORE ABOUT IBC DIAGNOSIS

The presence of IBC is confirmed by clinical examination, usually a biopsy, mammogram, and ultrasound. IBC is generally diagnosed as Stage IIIB or Stage IV breast cancer. Stage IIIB refers to cancer that is locally advanced, and Stage IV refers to cancer that has metastasized to other organs of the body. The resources provided at the bottom of this post are valuable for learning more on IBC Staging.

TREATMENT

IBC treatment generally consists of chemotherapy, surgery, radiation, and hormonal therapy. Chemotherapy with anti-cancer drugs is generally the first line of treatment for most patients with IBC (It is often referred to as Neoadjuvant therapy). Post-chemotherapy, patients may undergo surgery or radiation therapy to the chest wall. Additionally, IBC patients may receive more treatments (such as additional chemo- or hormone-therapy) to help prevent cancer recurrence. Hormonal therapy is generally geared to reduce the effects of the hormone estrogen that can promote cancer growth.

IBC PROGNOSIS

As IBC is more likely to have metastasized (that is, spread to other parts of the body) at the time of diagnosis, relative to non-IBC cases (2), the 5-year survival rate for IBC patients is generally between 25 and 50%. These figures are significantly lower than the survival rates for patients with non-IBC breast cancer. However, as with all statistics, average survival figures cannot be applied to predicting the prognosis for any particular individual.

CURRENT RESEARCH AND NEW TREATMENT PROSPECTS

IBC has only recently been recognized as a unique and genetically distinct form of breast cancer (3). Recently, scientists from the The Cancer Institute at NYU Langone Medical Center identified a key gene -- eIF4G1 -- that is over expressed in the majority of cases of IBC, allowing cells to form highly mobile clusters that are responsible for the rapid metastasis that makes IBC an effective killer. It is anticipated that this finding will lead to the identification of new approaches, therapies and a new class of drugs to target and treat IBC. This may be a promising development as IBC generally responds poorly to chemotherapy, radiation, and other current treatments for breast cancer.

PREVENTING TRAGEDIES & UNDERSTANDING THE CRITICALLY IMPORTANT ROLE OF EDUCATION AND AWARENESS

Perhaps the most unfortunate tragedy associated with IBC is that the absence of a typical "lump" in the breast causes this cancer to be frequently misdiagnosed and misclassified. Due to the fact that IBC symptoms are often erroneously mistaken for an infection, physicians tend to prescribe antibiotics to patients -- which results in unintentional, but a potentially fatal delay in treatment. Due to the fact that IBC is an extremely aggressive cancer, it can often cause death within 18 to 24 months of diagnosis.

WHAT YOU CAN DO: EDUCATE YOURSELF AND OTHERS ABOUT IBC

Here are some simple action steps you can take to help increase awareness of IBC, and promote education about this deadly cancer:

1. If this is the first time you have read or learnt about IBC, please recognize that there are numerous others for whom knowledge of this disease would be new as well. Please pass on this post to ALL those it may benefit.

2. Utilize the selected important resource links at the end of this post to learn more about IBC. Share these links with others as well.

3. This post will be made available at The Prevention Revolution on Facebook. If you have a question you may want to discuss or share an important comment, please join us on that site.

4. Finally, help us SAVE LIVES by joining the cause of EDUCATION OF INFLAMMATORY BREAST CANCER. Consider inviting your friends and family to support this effort.

Together, we CAN and SHOULD do more to stop this deadly killer.

NOTES

1. Merajver SD, Sabel MS. Inflammatory breast cancer. In: Harris JR, Lippman ME, Morrow M, Osborne CK, editors. Diseases of the Breast. 3rd ed. Philadelphia: Lippincott Williams and Wilkins, 2004.

2. Chittoor SR, Swain SM. Locally advanced breast cancer: Role of medical oncology. In: Bland KI, Copeland EM, editors. The Breast: Comprehensive Management of Benign and Malignant Diseases. Vol. 2. 2nd ed. Philadelphia: W.B. Saunders Company, 1998.

3. Key gene in deadly breast cancer identified (Science Daily -- June 2009)

Desiree Jones, PhD is a Doctor of Epidemiology, who speaks and writes on cutting-edge issues pertaining to chronic disease prevention in the Western, and the newly Westernizing nations. She has worked collaboratively with researchers at The University of Texas, Baylor College of Medicine, and Harvard University. Her first book is expected to arrive on the market by Spring 2010, and is entitled, HALTING THE DEATH MARCH -- Why America and The Westernized World are Dying from Heart Disease, Cancer, Diabetes, and Other Chronic Diseases, And How to Stop It. Dr. Jones is the Founder of the blog site, The Prevention Revolution. This site brings medical/nutritional research and informed opinion on critical health-care issues to individuals and physicians, as well as to corporations facing high health-care costs. Dr. Jones focuses on translating evidence-based research into real-life choices pertaining to food and lifestyle that can help prevent deadly chronic diseases, and create lasting health.

Inflammatory Breast Cancer (IBC) Represents 1-5% Cases In U.S.

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