By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

RAPID BREAST ENLARGEMENT, REDNESS, WARMTH COULD SIGNAL CANCER

Question: A friend of mine was diagnosed with inflammatory breast cancer.  Luckily it was caught early because she went to the doctor when she first noticed a funny discoloration on one of her breasts.  What I don’t understand is that she told me that this kind of breast cancer can’t be detected by mammograms and has different symptoms from other types of breast cancer.  Can you tell me more about this type of breast cancer and what women should do to protect themselves against it?

Answer: The information that your friend has given you about inflammatory breast cancer (IBC) is correct. It does not start out as a lump in the breast, which is why mammograms and ultrasounds don’t find it. The first symptoms of IBC are usually changes in one breast such as redness, increased warmth or rapid enlargement over a few days.

IBC can also cause the breast skin to become pitted like the rind of an orange (peau d’orange) and discolored. These changes occur because cancer cells block the lymph vessels in the skin of the breast. Enlarged lymph nodes in the armpit or above the collarbone can also be a sign of IBC.

Since this cancer frequently occurs in younger women, including pregnant or nursing women, it is commonly diagnosed initially as mastitis or a breast infection. The signs and symptoms are very similar, but generally mastitis causes more tenderness in the breast than IBC.

Most patients with a swollen, red, warm breast are diagnosed with mastitis and started on antibiotics. If you are being treated for mastitis and there is not dramatic improvement within a week, you should ask about having a biopsy done. While you might just have a tough-to-treat breast infection, a timely biopsy could identify a case of IBC in its early stages. As with any cancer, early diagnosis is the key to survival.

Early diagnosis can be difficult, though, because IBC is a highly invasive type of cancer. This means that it progresses rapidly and can quickly spread to other parts of the body. Therefore, by the time most women see their doctors, the cancer is already quite advanced. Fortunately, IBC accounts for only about 1 to 4 percent of all breast cancers.

Many cases of IBC have been successfully treated using some combination of chemotherapy, surgery and radiation. In part because of the frequent initial misdiagnosis of IBC that I mentioned earlier, the current five-year survival rate is only about 40 percent. The silver lining is that after five years, there are relatively few recurrences. Also, on a positive note, new treatments are being developed and a number clinical trials are currently underway.

One way to greatly enhance your chances of being a survivor if you should ever get IBC is through monthly self breast examination. A good home breast exam not only should include feeling the breasts for lumps, but it should also include a mirror exam. There you look for any changes in the way your breasts look. Specifically, look for any redness, dimpling of the skin, changes in the nipple or visible lumps. Also, compare both breasts and look for asymmetry. That is, does the contour or size of one breast differ from the other. Many women do not do this visual examination of the breast, but it should be done monthly as well.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.