Inflammatory breast cancer: the experience of Baylor University Medical Center at Dallas.

I t is estimated that 207,090 women will be diagnosed with and 39,840 women will die of breast cancer in 2010 in the United States. Infl ammatory breast cancer (IBC) accounts for approximately 1% to 6% of all breast cancer cases in the US (1, 2). Th is rare and aggressive form of breast cancer is diagnosed clinically by the rapid onset of diff use erythema and edema (peau d’orange) of at least a third of the skin overlying the breast (3) (Figure 1). Tumor emboli blocking dermal lymphatic channels lead to the characteristic “infl ammatory” skin changes; however, this is not necessary to make the diagnosis (4). Th e primary tumor of IBC is classifi ed as T4d by defi nition, even if no underlying palpable mass is present in the breast. Women diagnosed with IBC have inferior survival outcomes compared with women with other forms of breast cancer. IBC patients tend to be younger, and IBC tumors are more likely to overexpress HER2 than non-IBC tumors (5). Hormone receptor negativity also occurs at a higher frequency in IBC tumors (6). At presentation, most women with IBC have lymph node involvement, and approximately one third have distant sites of disease (7, 8). Historically, attempts to treat IBC with surgery alone or surgery combined with radiation therapy resulted in median overall survival times of less than 15 months and local recurrence rates as high as 50% (9).