By TED CARTER
Cancers don’t fight fair. They can conceal themselves and strike with a suddenness that often leaves physicians in an uphill struggle to save their patients.
This is especially so with inflammatory breast cancer, an exceptionally rare and aggressive disease in which cancer cells block lymph vessels in the skin of the breast. By the time the cancer reveals itself through the swelling and reddening of the victim’s breast, the disease has reached Stage 3 and is poised to spread.
Statistics from the Mississippi Cancer Registry show just how rare instances of inflammatory breast cancer are. In 2015, the last year for which figures are confirmed, 2,593 Mississippi women received a breast cancer diagnosis. Of those cases, 39 were diagnosed as inflammatory carcinoma.
The Stage 3 designation signifies that the cancer is large and has grown into nearby tissues or lymph nodes. The survival challenge is often worsened by primary care physicians who mistake what they’ve seen for a skin infection, says Dr. Shawn McKinney, a breast surgeon and member of the Interdisciplinary Breast Cancer Team at the University of Mississippi Medical Center’s Cancer Institute.
This is why inflammatory breast cancer should be on the radar of every OB-GYN physician, McKinney says. “The issue is there can be a big delay” in starting treatment of a patient with a very aggressive type of breast cancer, she adds.
A lot of women will be checked for a breast rash the size and color of an orange peel. They get antibiotics and may start to get better, according to McKinney. With that, she says, “the doctor may not do the imaging and make sure what is going on.”
The severity of such an oversight should not be underestimated, McKinney adds.
“If not corrected,” she says, “it tends to be an aggressive type of breast cancer. You want to obtain a diagnosis and start treatment as quickly as you can.”
Even if detected timely, the cancer can be inoperable in some instances, according to McKinney. In these cases, the tumor is actually a subtype made different by the makeup of the breast cancer cell. The worst and most aggressive of these is the Triple Negative, McKinney says.
“We have made only minimal strides treating it. It can be hard to find medicine that can be effective in these patients.”
The critical task, she says, is determining “exactly what we can target to get a response.”
A tumor that won’t respond to pre-operative chemotherapy makes surgery to remove it problematic, notes McKinney. “You want to give chemo an opportunity to attack the cancer cells so I am able to cut across good skin.”
Otherwise, the surgeon must cut through the tumor, thus increasing the likelihood of its return, says McKinney, an associate professor of surgery at University of Mississippi Medical Center.
The standard operation for inflammatory breast cancer, or IBC, is a modified radical mastectomy, where the entire breast and the lymph nodes under the arm are removed, the American Cancer Society says.
Because IBC affects so much of the breast and skin, breast-conserving surgery (partial mastectomy or lumpectomy) and skin-sparing mastectomy are not options, according to the Cancer Society.
McKinney says IBC typically requires removing only the tumorous breast. “It usually does not spread to the other breast,” she says. “The biggest concern with breast cancer is it gets into the lymphatic channels and spreads to the other organs.”
If breast radiation isn’t given before surgery, it is given after surgery, even if no cancer is thought to remain, according to the Cancer Society.
“It lowers the chance that the cancer will come back,” the Society says.
Radiation for post-op patients might be delayed until further chemo is administered, depending on how much tumor was found in the breast after surgery.
Chances the IBC tumor will return increase if it is an aggressive subtype. “We keep a very close eye on these patients,” McKinney says.
As a member of the UMMC Cancer Institute’s Interdisciplinary Breast Cancer Team, McKinney has worked with a multitude of patients including many with rare or unusual breast cancers. She rarely encounters inflammatory breast cancer cases, though the Cancer Institute is treating three or four IBC patients at the moment.
Nationally the disease makes up only 2 percent of breast cancer diagnoses. Women diagnosed with IBC, in general, do not survive as long as women diagnosed with other types of breast cancer, the Cancer Society says.
The disease is not hereditary and is not specific to any age groups, McKinney says. “We have young people who present” symptoms of IBC, she adds, citing ages ranges from the 30s through the 60s.
Certain factors – heredity, obesity, nutrition, menstrual history — increase risks for breast cancers of all types, according to McKinney.
“I think identifying whether you are a high-risk breast cancer patient is important,” she says, and suggests close monitoring by medical professionals if you are.
Whether high risk or not, women should have a suspicious nature about breast cancer, McKinney advises. “If there’s a change in your breast, it is always best to get it checked out.”
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