When a Red Breast Means Cancer

Since When Cancer Hits Home was published 4 months ago, I have had the good fortune to interact with many people who’ve enlightened and inspired me. One of those folks is Jan Stagner. From our e-mail conversations, I’ve learned that both Jan & her daughter have battled breast cancer & are survivors. Her daughter had an extremely aggressive type called inflammatory breast cancer (IBC). You can read Jan’s blog at: http://kickincancersass.blogspot.com/2010/11/still-kicking-cancer-in-butt.html

The following is a post that I wrote specifically as a result of my correspondence with Jan. Hopefully, it’ll further raise awareness about IBC.

WHEN A RED BREAST MEANS CANCER

Possibilities

There are several reasons why a person can develop acute (fairly sudden onset of) breast redness. Infection and inflammation are the two most common causes. Both of these conditions need to be treated in a timely fashion in order to improve health & minimize pain. They usually resolve over a week or two. However, there is one cause of breast redness that is always life-threatening: inflammatory breast cancer (IBC).

Warning Signs

IBC is a particularly aggressive form of breast cancer. Among every 100 patients diagnosed with breast cancer, about 2 – 5 will have IBC. It’s more commonly diagnosed in younger women and the redness can come on literally over a few days. While most people who develop a red breast will NOT have IBC, both patients and their primary doctors need to be aware of the possibility. This diagnosis should be particularly suspected in patients who still have a red breast after treatment with antibiotics or anti-inflammatories for a presumed infection or inflammation. The classic description of the appearance of IBC is peau d’orange (orange peel) skin.

Diagnosis & Staging

The diagnosis is confirmed by biopsy of the breast skin, usually by a breast surgeon or radiologist. Pathologists, the specially trained doctors who look at the biopsy tissue under the microscope, will usually describe tumor cells in the lymphatic channels of the breast tissue and breast skin. The blockage of these channels is usually the cause of the breast redness in IBC. Often there is no specific mass or lump in the breast, only diffuse red, thickened breast skin. Evaluation of the breast itself should include mammogram, often ultrasound (if a mass is felt), and sometimes MRI. All patients with IBC are considered to have aggressive disease. In that regard, unless the patient is in very poor condition and would not tolerate treatment, staging studies should be performed to assess whether the cancer has visibly spread elsewhere. These scans would include PET/CT or CT of chest and abdomen and bone scan. Patients with symptoms such as severe headache, nausea, and vomiting should also have MRI of the brain.

Treatment & Outcome

As with all breast cancers, the treatment for IBC can be broken down into two categories: locoregional (breast and lymph nodes) and systemic (throughout the body). A common mistake that a surgeon can make is to recommend a mastectomy (removal of the breast) first. Patients who are in reasonable medical condition should almost always have chemotherapy first, then mastectomy, then radiation therapy (RT) to the chestwall and regional lymph nodes. All three treatments, chemotherapy, surgery, and RT, are required in order to provide the best chance for cure. Hormonal and targeted therapies (such as Herceptin) may be recommended also, depending on the specific tumor biology. Among patients who have no evidence of metastasis (disease spread to distant areas in the body) at the time of diagnosis and are potentially curable, 40-50% are alive 5 years later. Awareness about this particularly aggressive form of breast cancer and its treatment is critical to ensure the best chance for cure.

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