Journal
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Volume 225, Issue 4, Pages 392-396Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.ajog.2021.04.217
Keywords
breast erythema; IBC diagnosis; inflammatory breast cancer; mastitis; peau d' orange; trimodality therapy; tumor emboli
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Inflammatory breast cancer is a rare and aggressive malignancy often misdiagnosed initially. Symptoms include erythema, skin changes, edema, and warmth of the affected breast. Treatment involves trimodal therapy with chemotherapy, surgery, and radiation, with an aggressive surgical approach enhancing survival outcomes. Early diagnosis is crucial for a favorable locoregional control rate in patients who complete trimodal therapy.
Inflammatory breast cancer is a rare and aggressive malignancy that is often initially misdiagnosed because of its similar presentation to more benign breast pathologies such as mastitis, resulting in treatment delays. Presenting symptoms of inflammatory breast cancer include erythema, skin changes such as peau d' orange or nipple inversion, edema, and warmth of the affected breast. The average age at diagnosis is younger than in noninflammatory breast cancer cases. Known risk factors include African American race and obesity. Diagnostic criteria include erythema occupying at least one-third of the breast, edema, peau d' orange, and/or warmth, with or without an underlying mass; a rapid onset of <3 months; and pathologic confirmation of invasive carcinoma. Treatment of inflammatory breast cancer includes trimodal therapy with chemotherapy, surgery, and radiation. An aggressive surgical approach that includes a modified radical mas-tectomy enhances survival outcomes. Although the outcomes for patients with inflam-matory breast cancer are poor compared with those of patients with noninflammatory breast cancer, patients with inflammatory breast cancer who complete trimodal therapy have a favorable locoregional control rate, underscoring the importance of a prompt diagnosis of this serious but treatable disease. Obstetrician-gynecologists and other primary care providers must recognize the signs and symptoms of inflammatory breast cancer to make a timely diagnosis and referral for specialized care.
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