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One deadly form hardest to diagnose


Bristol Herald Courier (VA)

05-13-13

May 13--BRISTOL, Tenn. -- Nearly all forms of breast cancer can be detected by a mammogram but the rarest and most aggressive form is also among the hardest to diagnose -- and the deadliest.

Inflammatory breast cancer resembles an infection or bruising to the surface of the breast. The disease occurs in only about two of every 100,000 breast cancer cases nationwide and is almost always diagnosed in later stages, according to medical oncologist Dr. Sue Prill, who will manage the new breast cancer treatment center at Bristol Regional Medical Center.

"Inflammatory breast cancer is one we fortunately don't see very often. Up until a few years ago, it was considered 100 percent fatal," Prill said. "It has very bad characteristics and it's very aggressive."

Doctors sometimes mistake the disease for something else.

"People present with what looks like an infected breast. It will be red and hot and swollen. There's a lot of times a delay in the diagnosis because people don't recognize what it is because it is so rare," Prill said.

"They'll treat with antibiotics and it doesn't get any better so they'll send them to a surgeon or to me. Inflammatory breast cancer you need to be on quickly. It grows rapidly. People will go in to their doctor and say, 'It wasn't there two months ago.' It's a cancer that invades the skin overlying the breast so there's not really a distinct mass and it usually doesn't show up on a mammogram," she added.

Inflammatory breast cancer represents between 1 percent to 6 percent of all forms of breast cancer, according to the National Institutes of Health. The disparity relates to confusion about its diagnosis. Because it is so aggressive and nearly never caught before stage III, IBC may account for about 10 percent of the 39,500 annual U.S. deaths attributed to all breast cancers.

IBC forms when cancer cells block lymph vessels in the skin of the breast, which often makes it appear red or inflamed. Most inflammatory breast cancers are invasive ductal carcinomas, which means they developed from cells that line the milk ducts of the breast and then spread beyond the ducts, according to the National Cancer Institute.

Like any cancer, the key to survival is early detection and treatment, Prill said. Since mammograms are often ineffective, women must be aware of the symptoms.

"Signs are changes in the skin, skin that puckers or looks like an orange peel. A very tender, swollen, hot breast may be an infection and may be inflammatory breast cancer," Prill said. "We do see inflammatory breast cancer show up in pregnancy. In pregnant women, it usually is a delayed diagnosis, because they can develop mastitis but it's really a problem with pregnant women."

If the cancer hasn't spread -- or metastasized -- to other organs, doctors can use chemotherapy to shrink any tumor then surgically remove it and treat the area with radiation, Prill said.

Patients diagnosed at stage IV, which means it has spread to other organs, typically receive chemotherapy and sometimes radiation, but surgery isn't normally done.

The five-year relative survival rate for IBC patients ranged up to 49 percent compared to almost 90 percent for all breast cancers, according to the American Society of Clinical Oncology. That rate varied depending on the stage, tumor grade, properties of the cancer and types of treatment used.

Between 1998 and 2001, the average IBC patient lived 18 months past diagnosis and the average five-year relative survival rate was 34 percent. Among patients whose cancer was found at stage IV, only about 11 percent survived five years past diagnosis.

But those numbers are improving, thanks to greater awareness and drugs that attack cancer cells while leaving healthy cells unharmed, Prill said. Doctors typically use the "targeted agents" in conjunction with traditional chemotherapy to treat IBC.

"It's very controllable now with our medications. Many of the medications that work for standard therapy work for this, but it is more aggressive so you have to be more aggressive with chemotherapy," Prill said.

Research continues at sites that specialize in this disease, including the University of Texas M.D. Anderson Cancer Center in Houston and Fox Chase Cancer Center in Philadelphia.

dmcgee@bristolnews.com -- 276-645-2532

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(c)2013 the Bristol Herald Courier (Bristol, Va.)

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Copyright Bristol Herald Courier (VA) 2013

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