Symptoms of Inflammatory Breast Cancer
Inflammatory breast cancer (IBC) presents with rapid onset of breast erythema, edema and/or peau d'orange, and/or warm breast, with or without an underlying palpable mass, typically affecting at least one-third of the breast and developing within 6 months. 1, 2
Key Clinical Features
The diagnosis of IBC is primarily clinical, with the following characteristic symptoms:
- Rapid onset (less than 6 months) of symptoms 1
- Erythema (redness) occupying at least one-third of the breast 1, 2
- Edema of the breast tissue 1, 3
- Peau d'orange (orange peel appearance of the skin) 1, 3
- Breast warmth 1, 3
- With or without an underlying palpable mass 1
- Possible nipple inversion 3
Distinguishing Features from Mastitis
IBC is frequently misdiagnosed as mastitis or other benign breast conditions, leading to critical delays in diagnosis and treatment 3, 4. Key distinguishing features include:
- Persistence of symptoms despite antibiotic treatment 4
- Rapid progression of symptoms 1
- More extensive erythema (affecting at least one-third of the breast) 1
- No response to standard mastitis treatments 3
Demographic Considerations
- IBC typically presents at a younger age than non-inflammatory breast cancer, often in the fourth and fifth decades of life 5, 3
- African American race and obesity are known risk factors 3
Diagnostic Confirmation
While symptoms are the primary means of identification, diagnosis must be confirmed by:
- Pathological confirmation of invasive carcinoma via core biopsy 1, 2
- Skin punch biopsy (at least two) is strongly recommended to look for dermal lymphovascular tumor emboli, which is pathognomonic but not required for diagnosis 1, 2
Imaging Findings
Although imaging is not sufficient for diagnosis, common findings include:
- Skin thickening
- Diffusely increased density
- Trabecular thickening
- Masses (when present) 2
Common Pitfalls in Diagnosis
- Misdiagnosis as infection (mastitis) is the most common error, leading to treatment delays 5, 3, 4
- Confusion with dermatologic disorders can occur 5
- Benign imaging findings may be present despite aggressive disease 4
- Postpartum presentation can be particularly challenging to diagnose due to concurrent breastfeeding and expected breast changes 4
Early recognition of these symptoms is critical for prompt diagnosis and initiation of appropriate treatment, which significantly impacts survival outcomes for this aggressive form of breast cancer 3.