Inflammatory breast cancer (IBC), which is characterized by involvement of the skin, is rare, accounting for approximately 3% of breast cancers. The "inflammation" in IBC is not caused by activation of the immune system as is classic inflammation. Rather, it results from blockage of dermal lymphatic ducts by tumor cells. Inflammatory breast cancer is more likely to be HER2/neu overexpressing (HER2+) than are ductal or lobular breast cancer, the most common types of invasive breast cancer.
Patients with inflammatory breast cancer tend to be younger than patients with other types of breast cancer (the majority are 40 to 59 years old at diagnosis) and they are also somewhat more likely to be African American or pregnant at the time of diagnosis.
Low socioeconomic status is associated with increased risk of inflammatory breast cancer even after adjusting for age and race/ethnicity. Women with inflammatory breast cancer are more likely to develop contralateral breast cancer (cancer in the initially non-cancerous breast) than women with comparably staged non-inflammatory breast cancer.
Onset of inflammatory breast cancer can be rapid
Women with IBC typically present with a history of less than six months of rapid breast enlargement and redness of the skin. Other possible symptoms include breast or underarm pain, a sensation of heat in the breast, skin ridging, and an orange peel-like appearance of the overlying skin. There may or may not be an underlying mass that can be felt by hand. Women with inflammatory breast cancer often have the experience of being prescribed a course of antibiotics for breast infection.
Survival rates vary and have been improving
The prognosis for inflammatory breast cancer patients is not favorable—the disease accounts for approximately 10% of breast cancer-specific deaths in the U.S. However, survival rates have shown some improvement over time. Approximately one third of women with inflammatory breast cancer present with distant metastases. Surgery to remove the tumor has been shown to have a survival benefit, as has radiotherapy. Because this cancer is rare and difficult to treat, it is important for inflammatory breast cancer patients to obtain treatment at a breast cancer center with experience in its management. Time is of the essence in this type of breast cancer - treatment should be swift and aggressive.
One clinical trial with a median follow-up period of 20 years demonstrated that relatively good survival and local control can be achieved in inflammatory breast cancer patients with an aggressive schedule of alternating chemotherapy and radiation treatments. The metastases-free survival rates were 45% (five-year), 30% (10-year), and 20% (20-year). Recent research suggests that statins (used to lower cholesterol), can improve progression-free survival in women with inflammatory breast cancer.
Immune system processes are distorted in inflammatory breast cancer
Women with inflammatory breast cancer have been shown to have significant reductions in immune cells responsible for adaptive immunity. Furthermore, stage IV inflammatory breast cancer patients are more immunocompromised than non-metastatic inflammatory breast cancer patients. Inflammatory conditions created by cells of the innate immune system, including natural killer and dendritic cells, appear to promote metastasis in inflammatory breast cancer. Immune activation (as evidenced by dendritic cell pro-inflammatory cytokine production, expression of costimulatory molecules, and increased natural killer counts) is associated with poor prognosis.
Breast cancer virus may contribute to inflammatory breast cancer
Retroviral sequences similar to mouse mammary tumor virus have been found in 40% of nonfamilial breast cancers in U.S. women and an even higher proportion in cases of inflammatory breast cancer and pregnancy-related breast cancer. Mammary tumor virus sequences have not been detected in normal breast tissue or other tumors. Inflammatory breast cancer in U.S. women has been found to have a higher incidence of viral sequences (71%) than other sporadic breast cancers. However, causality has not been proven and research is at an early stage — treatments based on these findings are nonexistent.
IBC survival rates
In this section, we summarize available data published during the past five years concerning risk of recurrence for early-stage IBC. However, please note that recent improvements in the treatment of IBC mean that these statistics likely are less favorable than the actual outcomes of current IBC patients. Also, outcomes can vary greatly depending on numerous factors, including those described above, as well as diet and other lifestyle choices.
In addition, the data below represents snapshots from studies that were conducted using different populations under a variety of circumstances. Therefore, the numbers are somewhat inconsistent and far from definitive and should not be used to calculate your likely recurrence-free survival. However, the data is useful in getting a general idea of IBC prognosis and to compare outcomes depending on treatment and other factors.
Patient and treatment characteristics → Likelihood of progression-free or overall survival
Progression-free survival means that no recurrence, metastasis or breast cancer-related death took place during the specified period. Overall survival means no death occurred from any cause (including non-breast cancer-specific causes).
- Neoadjuvant chemotherapy + surgery + radiotherapy: Five-year overall survival → 69%
- Mastectomy followed by radiotherapy: Three-year progression-free survival → 82%
- Mastectomy, no radiotherapy: Three-year progression-free survival → 59%
- Chemotherapy: Two-year progression-free survival → 46%
- No chemotherapy: Two-year progression-free survival → 22%
- Lumpectomy in carefully-selected patients: Five-year overall survival → 70%
Breast cancer characteristics
- ER+/PR+/HER2- stage III disease, neoadjuvant chemotherapy + surgery + radiotherapy: Five-year overall survival → 75%
- ER+/PR+/HER2- stage III disease, other treatment: Five-year overall survival → 46%
- ER+/PR+/HER2+ stage III disease, neoadjuvant chemotherapy + surgery + radiotherapy: Five-year overall survival → 80%
- ER+/PR+/HER2+ stage III disease, other treatment: Five-year overall survival → 53%
- ER-/PR-/HER2+ stage III disease, neoadjuvant chemotherapy + surgery + radiotherapy: Five-year overall survival → 76%
- ER-/PR-/HER2+ stage III disease, other treatment: Five-year overall survival → 30%
- ER-/PR-/HER2- stage III disease, neoadjuvant chemotherapy + surgery + radiotherapy: Five-year overall survival → 48%
- ER-/PR-/HER2- stage III disease, other treatment: Five-year overall survival → 28%
Other prognostic factors
- Married at diagnosis: Five-year progression-free survival → 75%
- Unmarried at diagnosis: Five-year progression-free survival → 66%
Please also see our article on breast cancer diet for IBC. Inflammatory breast cancer patients and survivors might also benefit from our articles concerning breast cancer subtypes (e.g., triple negative, ER+/PR+, HER2+).
Below are links to recent studies on this topic. For a more complete list of studies, please click on IBC.