Inflammatory breast cancer

Everyone knows to be concerned about a lump as a sign of breast cancer. But there's another type of breast cancer - much more rare and much more lethal – that has as its primary sign redness, sometimes without any lump.

Inflammatory breast cancer represents up to 3 percent of breast cancer diagnoses in the United States, but it is a particularly aggressive form of the disease that can be fatal in a few months if untreated.

“This disease needs immediate diagnosis to save lives. The mortality is high, but there's a lot that can be done. You can live 10 to 20 years or longer with treatment,” says Sofia Merajver, M.D., Ph.D., co-director of the Breast Oncology Program at the University of Michigan Comprehensive Cancer Center.

Merajver, internationally known for her research into this rare type of cancer, will direct a new clinic at the U-M Comprehensive Cancer Center specifically for inflammatory breast cancer. The clinic will allow women to receive state-of-the-art care and research opportunities. It is one of only a handful of sites in the country to specialize in inflammatory breast cancer, and the only site in Michigan.

Inflammatory breast cancer is a very aggressive type of cancer in which the cancerous cells move rapidly throughout the breast and clog the lymph vessels in the skin, causing the breast to look swollen, red, itchy or inflamed. It's often mistaken for a rash or infection and many women are initially treated with antibiotics or steroids.

“There are many options for treating this disease. In many cases, the treatment is going to be on and off for life. There will be times of remission, but this is a serious disease that has a high chance of recurring,” says Merajver, a professor of internal medicine at the U-M Medical School.

Because the disease tends to come back, it's important to have continuity of care and for doctors to know what treatments have already been tried or have failed. The new U-M clinic will allow for this type of record-keeping, even if patients are treated by their community physicians or at other centers.

“The U-M Inflammatory Breast Cancer Clinic will be a clearinghouse where we can provide tertiary care and advice,” Merajver says. She currently consults with oncologists from around the world about patients with inflammatory breast cancer and expects to continue this practice.

U-M already treats women with inflammatory breast cancer, but the new dedicated clinic will ensure coordinated care, as well as more research opportunities. The Cancer Center expects to see about 80 patients per year at this clinic. About a quarter of those patients will come only for consultations and will eventually be treated in their community; the remainder will receive treatment at U-M.

In addition, Merajver hopes to collect tissue samples to further her research into inflammatory breast cancer. About 10 years ago, Merajver and her colleagues identified alterations in two genes that were present in 90 percent of inflammatory breast cancers that weren't common in similarly advanced non-inflammatory breast cancers. This discovery laid the groundwork for the research that has followed.

Continued research will look at the molecular genetics of inflammatory breast cancer, testing potential markers that can be used to help diagnose the disease or determine the best treatment. Testing of new therapies, as well as research into quality of life and lifestyle changes will also be part of the new clinic.

About inflammatory breast cancer

• Represents 3 percent to 6 percent of the 180,000 women diagnosed with breast cancer each year.
• With treatment, 20 percent to 40 percent of patients survive 10 years. This is up from 5 percent to 10 percent 20 years ago.
• Characterized by redness, warmth or an orange-skin appearance on the skin of the breast. A persistent red breast should be biopsied promptly.
• May or may not cause a lump or mass.
• Treatment includes aggressive chemotherapy, followed by surgery and radiation therapy.

Any woman with persistent signs of redness or inflammation on the breast that does not go away with antibiotics should be seen by the inflammatory breast cancer clinic. For an appointment or questions about inflammatory breast cancer, call the U-M Cancer AnswerLine at 800-865-1125.