Inflammatory breast cancer (IBC) is not only the rarest form of breast cancer; it is also the deadliest. Treatment is different from other breast cancers and requires an experienced team of specialists well-versed in its details. Because the disease is uncommon, however, there is a dearth of experts.
To bring such a resource to more patients and their physicians in Wisconsin, the Froedtert & the Medical College of Wisconsin Breast Cancer Program at Froedtert Hospital joined MD Anderson’s IBC Connect Consortium.
The 13-member collaborative broadens the base of experience for a cancer that providers will likely see only infrequently. IBC accounts for only 2-4% of breast cancers, though it results in 10% of U.S. breast cancer deaths.
“Unfortunately, it is the most aggressive breast cancer,” said Yee Chung Cheng, MD, medical oncologist and MCW faculty member. “It doesn’t form a mass but just keeps spreading.”
A Challenging Diagnosis
IBC grows rapidly. It can mimic less serious diagnoses like mastitis and thus complicate diagnosis.
“The whole breast becomes red, swollen, warm to the touch, with no mass,” Dr. Cheng said. “Almost 90% of patients think they just have an infection and need treatment with antibiotics.”
Providers should check for firm axillary lymph nodes, a sign of IBC in the presence of the other symptoms. “They also have to look at the extent of the redness,” Dr. Cheng said. “With IBC, redness occupies at least one-third of the breast.”
The patient’s history is another important clue because the symptoms and disease progression of IBC occur quickly.
“With IBC, everything happens within six months,” Dr. Cheng said. “When did the patient first notice a change in the appearance of her breast? If it happened a year ago, it’s not IBC.”
Biopsies of the skin and breast are essential for confirming the diagnosis of IBC, and if they are positive, the cancer is already considered to be at least stage III.
“There is no stage I or II with IBC,” Dr. Cheng said. “Even if we make the diagnosis very early, it is at least automatically stage III.”
The IBC Connect Consortium aims to support providers in managing this severe form of breast cancer. Its goals are to improve IBC survival; make expert IBC care more accessible to patients through multiple partners; and offer education, clinical trials and referral and consultation connections for referring physicians.
“We see fewer than 10 cases of IBC a year, whereas MD Anderson sees 200,” Dr. Cheng said. “Now, our patients have access to that large base of expertise and can participate in any of their clinical trials without having to travel to Houston.”
Multidisciplinary Treatment in the Right Sequence
Treatment of IBC requires a comprehensive, multidisciplinary approach. In addition to Dr. Cheng, who leads the program at Froedtert Hospital, the team includes Shadie Majidi, MD, radiologist; Amanda Kong, MD, MS, surgical oncologist; Adam Currey, MD, radiation oncologist; and Julie Jorns, MD, pathologist.
The treatment begins with chemotherapy, followed by surgery and then radiation therapy.
“We do chemotherapy first because IBC is so aggressive and spreads,” Dr. Cheng said. “Surgery is major and if we would operate first, the time of surgery to the time we can give chemotherapy would be at least six weeks because we would wait for the wound to heal. We cannot wait that long to begin chemotherapy since it has a vital role in targeting cancer cells throughout the body and containing them to the breast.”
After five months of chemotherapy, surgeons perform a mastectomy. Then, the patient receives radiation therapy directed at the chest and armpit to kill any remaining cancer cells.
Collaboration Is Key for Progress
“Because IBC is so rare, a provider might be inclined to manage it like other breast cancers,” Dr. Cheng said. “If it is undertreated or the treatment is delayed, it will affect the patient’s survival. Because of our connection to MD Anderson, we’re offering state-of-the-art treatment at this moment.”
IBC is still a perilous diagnosis, but progress is evident.
“We’ve gone from a five-year survival of less than 10% to about 50%, ranging up to 70%,” Dr. Cheng said. “That’s why it’s very important to us to do research, join forces with MD Anderson, share knowledge and enroll patients in trials. We are accomplishing together what we could not do as a single institution.”
Dr. Cheng also emphasized the collaboration that the IBC team at Froedtert Hospital extends to community physicians when they encounter a suspected case of this rare disease.
“When a patient with an inflamed breast does not respond to antibiotics and the physician decides it’s time to bring in a specialist, we’re happy to take the referral,” he said. “We’ll provide the initial treatment, then return the patient to her physician for ongoing care. We want to work as a team.”
