1814: Sir Charles Bell recognized the seriousness of a breast mass presenting with pain and skin discoloration.
A System of Operative Surgery, Bell C, London, 1814, volume 2, page 136
Also printed by George Goodwin and Sons, Hartford, 1816; “the second American, from the last London Edition“.
Page 136: “When a purple colour is on the skin over the tumor, accompanied by shooting pains, it is a very unpropitious beginning. The operation should not be long delayed.“
Note: The name “inflammatory breast cancer” was not in use in 1814; Bell is simply reporting his observation of a symptom that we may assume was caused by inflammatory breast cancer, and his opinion/recommendation for surgical treatment. Additionally, the standard of care in the 21st Century delays a modified radical mastectomy, if any, until following initial chemotherapy. For some, no surgery is performed.
1869: H. H. Klotz emphasized inflammatory features (mastitis carcinomatosa)
Uber Mastitis Carcinomatosa Gravidarum et Lactantium, Klotz HH; Halle: 1869.
1875: R. von Volkmann noted mastitis carcinomatosa in pregnancy and lactation
Beitraege zur Chirurgie. Volkmann R von; Leipsig: 1875, 319-334.
1887: Thomas Bryant observed dermal lymphatic invasion by carcinoma, suggesting the obstruction could explain the gross inflammatory appearance
Diseases of the Breast, Bryant T., London: Cassell & Co., 1887:171-94.
Also printed in the U.S. in 1889; Woods Medical and Surgical Monographs, New York, 1889, vol. iv, 35-322.
Pages 186-187: “The acute oedematous infiltration of the skin and breast is met with occasionally, and it is without doubt the most acute and fatal form of cancer found in the breast. It may attack the gland much in the same way as the acute tuberculated form which has just been described, but it may do so more insidiously, or rather less actively, and appears more as a rapid oedema of the breast and skin over it, with or without retraction of the nipple, the whole gland and integuments covering it feeling to the hand infiltrated, and perhaps pitting on pressure. There may be no external redness or heat suggestive of inflammation, but only oedema, and this oedematous infiltration will probably be confined to the soft parts over the breast. In exceptional cases it will extend to a wide area. Such cases as these, like the last described, have been mistaken for inflammation, but a knowledge of the probability of this affection being cancerous should prevent such a mistake from being made.
“With this brawny infiltration of the breast and skin over it, there is an allied condition which claims description, and I have been in the habit of describing it at the bedside as one of lymphatic absorption, in which the lymphatics of the skin of the breast appear as swollen white cords radiating from the nipple, with the intermediate skin slightly thickened from oedema, but not sufficiently so to pit. These local symptoms are always associated with rapidly progressing disease, in which the original nidus not only spreads rapidly by infiltration, or “local infection,” but also by “lymphatic infection,” the lymphatics, as described, being apparently filled, if not choked, with the epithelial material which it is conveying to the lymphatic glands.
“This form of carcinoma in its clinical features is not recognised (sic) as it should be. I quote, therefore, some few examples to illustrate its different points. It is to be observed that this variety of carcinoma attacks what appears to be healthy women; indeed, many have a florid aspect of health. It spreads rapidly and kills quickly. Thus, in some cases quoted, the disease ran its course in five months. When complicated with pregnancy or lactation the disease is most active.“
Note: It’s as true today as it was in 1887, over 100 years later “this form of carcinoma in its clinical features is not recognized as it should be.“
