Dr. Tina Hicken: 'Inflammatory Breast Cancer' Appears Without a Lump, Symptoms Mimic Infections

Dr. Wala Hafez: A lump in the breast may be a warning sign of breast cancer, but some types can develop without a clear lump. Among these is inflammatory breast cancer, which is characterized by rapid progression and can cause swift changes in the skin of one breast, according to Tina Hicken, a surgical oncologist at the Mayo Clinic Comprehensive Cancer Center. Its symptoms may resemble those of mastitis, including changes in skin color to red, purple, or pink, or a bruise-like appearance, along with unusual warmth in the breast and a skin texture resembling an orange peel. These symptoms can lead to inflammatory breast cancer being misdiagnosed as mastitis, cellulitis, or another less serious condition. Although inflammatory breast cancer accounts for about 1 to 5 percent of diagnosed breast cancer cases, it is associated with approximately 10 percent of breast cancer deaths, according to statistics cited in the text.

Warning sign: Dr. Hicken stated, “When changes occur on the breast skin, especially in non-breastfeeding women, and are not related to redness caused by breastfeeding, these changes may represent a warning sign that warrants medical evaluation.” She added that symptoms of inflammatory breast cancer can appear within a few months, noting, “This differs from discovering a breast lump, followed by gradual skin changes over a year or more.” She explained that abnormal cells in this type of cancer spread through the lymphatic vessels in the skin and soft tissues, which explains the changes in breast skin.

“Systemic treatment”: Dr. Hicken said that treatment for inflammatory breast cancer typically begins with systemic therapy, meaning drug treatment that works throughout the body rather than solely at the tumor site, and may be administered intravenously or orally depending on the type. Treatment is determined based on the tumor’s biological characteristics and subtype, including estrogen and progesterone receptor status and HER2 protein levels. Systemic treatment may include:

- Chemotherapy: Targets rapidly dividing cells.

- Targeted therapy: Targets cells that overproduce HER2 protein.

- Immunotherapy: Helps the immune system fight cancer and may be used in some cases of triple-negative breast cancer, whose cells lack estrogen and progesterone receptors and do not have high levels of HER2 protein.

The treatment plan may also include breast and nearby lymph node surgery, followed by radiation therapy to the area, depending on the medical team’s assessment and the patient’s response. Dr. Hicken emphasized that combining systemic therapy, surgery, and radiation is essential to control the disease due to the high risk of it spreading to other parts of the body or recurring in the breast and surrounding area. Other, more common types of breast cancer may not require combining all these treatment options.

Important developments: Treatment for inflammatory breast cancer has seen significant advances, most notably the selection of therapy based on the tumor subtype, which helps improve treatment response rates. Dr. Hicken noted that identifying the cancer subtype from the outset, along with advances in imaging techniques, have contributed to improved treatment and better assessment of disease spread beyond the breast and nearby lymph nodes. She pointed to notable progress in treating HER2-positive inflammatory breast cancer through the combination of two drugs that work via complementary mechanisms to reduce the impact of this protein, which some cancer cells produce in large amounts.

This approach has contributed to improved treatment outcomes for women. Dr. Hicken noted that targeted therapies have emerged for patients who do not achieve a complete response to drug therapy before surgery; these newer targeted treatments can be used postoperatively, tailored to each patient’s condition. Another recent development is intensity-modulated radiation therapy (IMRT), which enables more precise targeting of radiation by using computed tomography (CT) imaging to create a three-dimensional image of the patient’s body and delineate the target area. This helps reduce radiation exposure to healthy tissues and minimize side effects, employing techniques such as breath-hold training during treatment sessions or prone positioning in certain cases. Dr. Hicken concluded by emphasizing that ongoing research and clinical experience continue to enhance understanding of the disease and improve treatment approaches.