Podcast: Inflammatory breast cancer - Know the symptoms

/Home/b. About Breast Cancer/Breast Cancer Types/Invasive Breast Cancer/Inflammatory Breast Cancer

Podcast: Inflammatory breast cancer - Know the symptoms

Transcript
Welcome to Mayo Clinic's podcast. Our topic today is inflammatory breast cancer. I'm your host, Rich Dietman.

In today's podcast we're talking about inflammatory breast cancer, a particularly rare, aggressive and dangerous form of breast cancer. My guest is Mayo Clinic cancer specialist, Dr. Tim Moynihan. Dr. Moynihan practices in the Department of Medical Oncology at Mayo, and he's also cancer medical editor for MayoClinic.com. Dr. Moynihan, thanks for being with us today.

Dr. Moynihan: Thanks for having me.

Rich Dietman: Most women associate breast cancer with finding a lump in their breast, but inflammatory breast cancer often doesn't produce a lump. What are the symptoms of this cancer?

Dr. Moynihan: Typical symptoms for inflammatory breast cancer is often the breast may become very enlarged or engorged, it often gets very red, sometimes very warm and tender to the touch. And usually there's not a lump associated with it, but the entire breast may swell.

Rich Dietman: Now, inflammatory breast cancer has symptoms that are very similar to a common breast infection called mastitis, isn't that right?

Dr. Moynihan: Absolutely, and it's very often mistaken for mastitis, which is a much more common condition. And mastitis usually responds fairly promptly to antibiotics, whereas the inflammatory breast cancer will usually not respond to that, and it's one of the tip-offs that something else is going on. If an infection of the breast is not getting better after just a couple days, I'd suspect something else is happening there.

Rich Dietman: So one of the keys is how it responds or doesn't respond to antibiotics?

Dr. Moynihan: Absolutely. And with mastitis, you'd be more likely to have a fever. Although fevers can occur with inflammatory breast cancer, that would be much less likely than with mastitis.

Rich Dietman: Although inflammatory breast cancer is a relatively rare cancer, it's a particularly dangerous one, isn't it?

Dr. Moynihan: It does tend to be relatively aggressive. For some reason it tends to spread more rapidly and go to the lymph nodes much more quickly. It also tends to be a much more rapidly growing form of cancer. Now, the good news is that it often responds fairly well to our treatments, particularly initially, but it is more likely to spread and cause trouble in the future.

Rich Dietman: Who's at highest risk for inflammatory breast cancer?

Dr. Moynihan: Of course, women are at much higher risk than men, but men can get inflammatory breast cancer, although it's really quite rare. The women who are at the highest risk for this are women who may have a predisposing factor toward breast cancer. Although a minority of people with breast cancer have a gene mutation that predisposes them to that, we see more of those gene mutations in women with inflammatory breast cancer. Also, black women may be at slightly higher risk for inflammatory breast cancer than white. And there are some geographic variations throughout the world. For example, there are some islands down in the South Pacific where the majority of breast cancer is actually inflammatory, as opposed to here, where a vast minority are inflammatory breast cancer. So we don't understand all of the factors that are involved there, and there's no one particular group that's at much higher risk than others.

Rich Dietman: If a woman develops a rash or an area of redness on her breast, should she have it checked out right away by her doctor? Some women, I can see, would look at it and consider that it's a pretty routine kind of thing and do nothing. How should a woman go about that?

Dr. Moynihan: Absolutely. Rashes can occur anywhere on the skin for any one of a large number of reasons, minor allergic reaction, minor topical irritation. If it is something that is very minor, very small in character and goes away in a day or two or three days, it would be nothing to worry about. If, however, it's persistent, if it's painful, if it's rapidly increasing, all of those would be signs that it needs more prompt attention.

Rich Dietman: And along those same lines, what kind of a doctor should a woman consider seeing if she thinks she might have the symptoms of inflammatory breast cancer? Can a family medicine doctor or internist recognize the symptoms, considering they're so rare?

Dr. Moynihan: I think that's always the place to start, especially if you have a well-established relationship with a physician, somebody who knows you, who's examined you before, that's probably the best, ideal place to start. You're absolutely right in that many physicians may not be familiar with inflammatory breast cancer because it is relatively rare, but most physicians should at least have an inkling of this and know that if things are not improving, they need to look further. If your physician is seeing this and things are not getting better, then to go to a breast health specialist, and there are many clinics out there that specialize in breast health. That would be the next step.

Rich Dietman: What kinds of tests might a doctor recommend if inflammatory breast cancer is suspected?

Dr. Moynihan: Well, we virtually always start off with a good history and physical exam. And if breast cancer is suspected, we always go to a mammogram first because that still can provide very valuable information. However, the only test that actually tells us that there's cancer there is a biopsy, and we always will need a biopsy. We'd like to have the mammogram, possibly an ultrasound, and now possibly an MRI scan of the breast to help guide that biopsy. All of those tests are not absolutely necessary; it depends on the individual patient's situation at the time. The only test that's an absolute if we're really concerned about inflammatory breast cancer is the biopsy because that's the only way we can tell that that's truly what it is.

Rich Dietman: Dr. Moynihan, you mentioned biopsy with this diagnosis process. Because there isn't a lump often with inflammatory breast cancer, how is a biopsy done?

Dr. Moynihan: Absolutely. This is where it is important to have the other imaging tests, such as the mammogram, because sometimes we do find a lump and we know what to biopsy. However, if no lump is seen, then we take a biopsy of the skin and some of the underlying breast tissue because we often can see the tumor within the skin and plugging the little lymphatic channels within the skin. That's actually the process that gives the swelling and the redness to the breast because the tumor cells go and plug up those little lymph channels in the skin so the skin cannot drain its lymph fluid normally. And we would see the tumor there, so a skin biopsy can be very helpful in this setting.

Rich Dietman: What about treatment? Is it very different from treating other forms of breast cancer?

Dr. Moynihan: Yes, it absolutely is. Many of the principles stay the same, but we often do it in different sequence. For most breast cancer the first thing we do is an operation to remove the cancer itself. However, with inflammatory breast cancer, that is a very difficult thing to do because the skin is not in good shape in order to tolerate an operation, so virtually always when we see inflammatory breast cancer, we almost always start out with chemotherapy to try and shrink the tumor, clear up the skin problem before an operation does occur. In addition, in many women with breast cancer now, we always try to spare the breast and just remove the breast tumor. In most of the cases of inflammatory breast cancer, we usually have to remove the entire breast. That is not always true, but that is many times the case. And then lastly, if we do remove the entire breast, even if that happens, with inflammatory breast cancer you still do need radiation even with a mastectomy, whereas with regular breast cancer we can often just — if we remove the entire breast, we do not need to add radiation on top of that.

Rich Dietman: And why is that?

Dr. Moynihan: Because with inflammatory breast cancer, because of the way it affects the skin, it has a higher chance of coming back in the local region even if we do a mastectomy, and by adding the radiation we can decrease the chance of it coming back within the local area.

Rich Dietman: Thanks very much, Dr. Moynihan. We've been talking with Dr. Tim Moynihan, a cancer specialist at Mayo Clinic and cancer editor for MayoClinic.com. You've been listening to Mayo Clinic podcast. I'm Rich Dietman.

© 1998-2009 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.