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When women examine their breasts, they are feeling for a lump. That’s because breast cancer usually manifests as a solid mass or lump within the breast.

But there’s another form of breast cancer that women should be aware of—a type of cancer that even a physician may overlook. It’s called inflammatory breast cancer or IBC, an uncommon type of breast cancer. It occurs when cancer cells block the lymph vessels in the skin of the breast, causing the breast to become red and swollen. This cancer accounts for about 3 percent of breast cancers.

While IBC is the least common type of breast cancer, it’s the most aggressive. It usually grows rapidly and often spreads to other parts of the body. IBC usually appears in just one breast.

“When a woman with IBC examines her breast, she may or may not feel a mass,” said Alonzo Walker, MD, Medical College of Wisconsin surgical oncologist and director of the Breast Cancer Program at Froedtert & the Medical College of Wisconsin. “What she will notice is redness, a thickening of the skin on the breast and increased firmness. She should be able to compare the firmness of the affected breast with a softer feeling in her other breast. In some cases, the nipple in the affected breast may be inverted as well. The skin of the breast may also show a pitted appearance called peau d’orange (like the skin of an orange).

Inflammatory breast cancer may occur in women at any age, and there are no identified risk factors for who is more likely to get it, according to Dr. Walker.

“A woman who notices symptoms—redness and firmness in her breast—should visit her doctor as soon as possible,” Dr. Walker said.

Redness in the skin of the breast may lead a physician to suspect an infection in the breast, and he or she may prescribe antibiotics. If the symptoms do not improve within three days, however, further investigation is needed. The physician should consider that there is cancer in the breast and refer the woman to a surgeon who specializes in breast care for evaluation. In turn, the surgeon should communicate the possibility of IBC to a radiologist, who will do imaging studies of the breast. This will ensure that the radiologist views the breast images with inflammatory breast cancer in mind.

The radiologist may see diffuse microcalcifications, increased density of the entire breast tissue or a large, ill-defined mass, all suggesting IBC. A biopsy must be done to confirm the presence of cancer, and the other breast will also be examined for disease. If cancer is confirmed, additional imaging will determine if the cancer has spread to other parts of the body.

Treatment for Inflammatory Breast Cancer

Because this type of cancer is diffuse (rather than confined to one area) in the breast, the first course of treatment is chemotherapy, a systemic treatment (affecting the entire body) to kill cancer cells.

If the swelling in the breast decreases after chemotherapy, the next step is to surgically remove the breast. If the swelling persists after chemotherapy, surgery cannot be done. In that case, the next course of treatment will be radiation therapy targeted at the cancer in the breast and the affected chest wall. This will be followed by an evaluation for surgical removal of the breast. After each treatment step, the cancer is staged to determine the extent and severity of the disease.

Women Need to Be Proactive

It is important for women to protect themselves against all forms of breast cancer by following recommendations for early detection, including mammography and clinical breast examination, and by notifying their physicians of changes in their breasts, including skin changes as well as lumps.

IBC is a very aggressive disease, and women need to be proactive to obtain an accurate diagnosis and appropriate treatment. During a breast self-exam, women should compare the look and feel of each breast, looking for redness, swelling and unusual firmness. If these symptoms are present, they should seek immediate medical care.

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