The latest breast cancer awareness mantra, “You don’t have to have a lump to have breast cancer,” is a warning for one of the rarest forms of breast cancer, inflammatory breast cancer, which usually presents with signs and symptoms more closely resembling a benign breast infection like mastitis.
You Don’t Have to Have a Lump to Have Breast Cancer
By Tawnee Isbell Stimson
On the Inflammatory Breast Cancer Research Foundation’s website, one woman laments about the diagnostic process: “When I first experienced pain in my breast, I made an appointment with my internist and my OB/GYN. I found comfort when, after both examinations, both doctors separately told me, ‘The good news is that cancer doesn’t hurt.’ I held on to those words for five months before the pain and breast became worse, and I was diagnosed with inflammatory breast cancer.”
As if breast cancer is not complicated enough, inflammatory breast cancer evades typical breast cancer symptoms. The symptoms and appearance of inflammatory breast cancer mimic a breast infection, so physicians will usually prescribe antibiotics initially. Also, inflammatory breast cancer is not always perceptible by mammography. Diagnostic data indicates that only 23% of IBC cases may have malignant-appearing calcifications and another 15% presents with masses perceptible by mammography. During a breast exam, there is generally no detectable lump to indicate breast cancer.
“Inflammatory breast cancer is very often treated initially as an infection,” says Dr. Vaishali Doshi, an oncologist/hematologist with Dr. Gandhi’s Digital Mammography/Bone Density Center, which opened in Chattanooga this May. “Inflammatory breast cancer is a clinical diagnosis – the clinical suspicion and exam are a very important start. Whoever sees the patient for the first time should have a strong index of suspicion. It is serious enough for everyone to know about and understand that it mimics an infection.”
Fortunately, inflammatory breast cancer is rare. According to Dr. Lori Emerson, a pathologist with Parkridge Medical Center and Southern Pathology Associates, less than 5 percent of all the breast cancer cases she sees in Chattanooga are inflammatory breast cancer.
“In the spectrum of cancer, inflammatory breast cancer is uncommon,” says Dr. Emerson. However, it is important for women to be aware of the symptoms of inflammatory breast cancer, and most importantly, to see a doctor at the first sign of changes to a breast.
Symptoms of IBC
According to the American Cancer Society, an estimated 184,450 new cases of invasive breast cancer occurred in 2008 in the United States, including 1,990 cases in men. The average age of women diagnosed with inflammatory breast cancer is 59 – about three to seven years younger than the average age of women diagnosed with other types of breast cancer. Additionally, although the reason is unknown, inflammatory breast cancer is seen more often in African American women.
Inflammatory breast cancer results when breast cancer cells invade the dermal lymphatic system. The cancer cells divide into sheets across the breast, where they rapidly infiltrate and plug the lymphatic vessels within the skin of the patient’s breast. The obstructed lymph channels become engorged and produce skin changes characteristic of IBC.
Patients with inflammatory breast cancer typically experience:
• One breast suddenly becoming much larger than the other.
• The breast feeling warm and very firm to the touch, yet it is also tender and painful.
• Pink, red or purple patches appearing on the breast and/or by the collar bone. Patches may resemble a rash, or be more intense, like bruising.
• Changes occurring in the color of the areola (the dark skin that surrounds the nipple).
• Swollen lymph nodes in the neck or under the arm.
• Continual itching or pain in the breast.
• Dimpling of the breast skin that resembles an orange peel (called peau d’orange).
• Ridges or thickened areas in the skin of the breast.
• Nipple discharge.
• Nipple retraction or flattening.
If a woman – or man – experiences any skin changes or abnormalities on the skin of the breast, such as swelling, tenderness, redness, pain, or change in texture of the skin, Dr. Doshi urges seeking immediate medical attention by a breast specialist, gynecologist, oncologist or primary care physician. “You may not feel a mass in the breast, but that does not procure the diagnosis,” she says.
Suspicion of inflammatory breast cancer is based primarily on the results of a doctor’s clinical examination. Biopsy, mammogram and breast ultrasound are used for a definitive diagnosis.
Dr. Maurice Rawlings Jr., an oncology surgeon and medical director of the MaryEllen Locher Breast Center at Memorial Hospital, stresses that early diagnosis and treatment of inflammatory breast cancer are crucial for positive patient outcomes.
“Initially, a week of antibiotics is appropriate if a primary care physician believes the symptoms are from infection,” says Dr. Rawlings. “However, if breast inflammation doesn’t improve within seven days of antibiotic use – and cancer will not be altered at all by antibiotics – then the patient’s next immediate step should be a consultation with a surgical oncologist for a biopsy. A biopsy is the only definitive way to diagnose any cancer, really, but certainly inflammatory breast cancer.”
Once inflammatory breast cancer is confirmed, additional tests such as a chest X-ray, CT scan, bone scan and a liver function test are administered to determine to what extent the cancer has spread beyond the breast. This information is used for identifying the severity of the cancer, which will affect treatment decisions.
According to Dr. Larry Samuels, a radiologist with Battlefield Imaging, most doctors in the Chattanooga area are aware of the symptoms of inflammatory breast cancer, and that most take any changes in the breast very seriously. “It would be very unusual for a woman to have symptoms of inflammatory breast cancer that were dismissed without a thorough investigation, including a biopsy,” says Dr. Samuels. “Most of the time, when women come in with complaints about a breast lump or inflammatory changes in the breast, these complaints are not dismissed – they are taken very seriously.”
However, Dr. Samuels emphasizes that it is important for women to maintain regular screening mammograms and checkups with doctors. “Recent technologies that are helping to detect all types of breast cancer – in dense breasts particularly – are digital mammography, breast MRI, and increased use of high-resolution ultrasound,” he says.
Many doctors feel that early detection tests for breast cancers save thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests. Following the American Cancer Society’s guidelines for the early detection of breast cancer improves the chances that breast cancer can be diagnosed at an early stage and treated successfully.
Tawnee Isbell Stimson has lived in the Chattanooga area for 28 years. She studied psychology and screenwriting at the University of Arizona and UCLA respectively. She is the President of Tawnee Stimson Designs and Essence in a Bucket Greeting Cards.