IBC : Introduction to Research
Inflammatory breast cancer (IBC) is the most aggressive form of breast cancer. In the United States, IBC affects younger women disproportionately and African-American women are diagnosed with IBC at significantly younger ages than Caucasian-American women 1;2. IBC is characterized by extremely poor survival. Although 3-year survival from IBC has improved from 32% in 1975-1979 to 42% in 1988-1992 from the use of combined treatment modalities 2, women with IBC still have far worse survival than those with other types of breast cancer (all stages and non-IBC histopathological types combined, 3-year survival=85% in 1988-1992) 2. Moreover, in an analysis of the trends and patterns in IBC incidence and survival using data from the National Cancer Institute’s Surveillance, Epidemiologic and End Results (SEER) Program, a doubling of IBC incidence in the United States was reported over the past 15 years 2.
Accurate and rapid diagnosis of individual IBC cases remains problematic for several reasons. Diagnosis of IBC is not based on histopathological characteristics, as it is for other types of breast cancer, but on a combination of clinical symptoms (e.g., erythema, skin edema, and peau d’orange) and pathologic characteristics (i.e., dermal invasion of breast lymphatic ducts) 7. Moreover, the clinical and pathologic features are not uniformly observed among all patients with IBC; some IBC patients have both breast inflammation and dermal invasion of lymphatic ducts, whereas others have only one or the other 8. Thus, by using a combination of these criteria, IBC can be defined in different ways, a point that is not widely recognized. Recently, anecdotal reports suggest that IBC patients may experience specific symptoms associated with IBC that have not yet been recognized as characteristics that could be used to improve IBC diagnosis (see Symptoms of IBC). Unfortunately, the lack of uniformity in criteria for IBC diagnosis can result in misdiagnosis of IBC as other breast conditions 9 and treatment delay
Laboratory-based research on IBC has been limited because little, if any, pre-treatment tumor tissue is available for research. While at many institutions specimens that are collected for diagnosis are not available for research, residual tissues can be used for research. However, because IBC diagnosis is usually accomplished through needle biopsy, which yields few tumor cells, or skin biopsy, little or no tissue is available for research. Moreover, because current standard of care recommends neoadjuvant therapy followed by surgery, any tissue retrieved after surgery is likely to be altered by adjuvant chemotherapy. The research that has used IBC specimens has focused primarily upon identifying prognostic factors more than evaluating molecular alterations associated with disease development.
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