1997: Mammographic patterns of inflammatory breast carcinoma: a retrospective study of 92 cases.
Eur J Radiol 1997 Feb;24(2):124-30, Tardivon, AA, et al.
“OBJECTIVE: To quantitate initial mammographic signs and to describe post-therapeutic patterns of inflammatory breast cancer. MATERIAL AND METHODS: Two radiologists retrospectively analyzed the initial clinical and mammographic findings of 92 patients with inflammatory breast carcinoma. The post-therapeutic mammogram (n = 75) was considered abnormal when focal opacity and or malignant-type microcalcifications were still visible. RESULTS: Redness of the skin, “peau d’orange’ and increased temperature were the most common findings. A palpable mass was noted in 97% with axillary lymph node involvement in 83% of cases. All initial mammograms were abnormal. Isolated inflammatory signs were observed in 14% and malignant signs in 86% of patients (opacity = 77% and/or malignant-type microcalcifications = 47%). Skin thickening was seen in 93.5%, nipple inversion in 56.5%, increased breast density in 93.5%, stromal coarsening in 85% and hypervascularisation in 32.5% of mammograms. On post-therapeutic mammograms, 35 patients (46.5%) were suspected of having residual disease. During follow-up, 19 patients (25.3%) relapsed locally: 75% had abnormal post-therapeutic mammograms. CONCLUSION: The presence of isolated inflammatory signs on the mammogram is sufficient to suspect inflammatory breast carcinoma and biopsy must be performed in doubtful cases. Radical surgery is indicated when persistent malignant signs are still visible on mammogram after conservative treatment.”
1997: Loss of imprinting of H19 and IGF2 genes is associated with inflammatory breast cancer.
ASCO poster 1954, Ahomadegbe, JC, et al.
“IGF2 and H19 genes which are implicated in fetal growth are submitted to genomic imprinting, an epigenetic process that initiates differential expression of maternal or paternal allele. Loss of imprinting (LOI) of these two genes seems to play an important role in the development of certain cancers. The aim of this study was to determine whether LOI could represent a new type of gene alteration involved in the development and progression of breast cancer (BC). We have analysed the imprinting status of H19 and IGF2 genes in a series of inflammatory BC (IBC) comparatively to non inflammatory BC (NBC). IBC which accounts for 2 to 4% of BC, is exclusively diagnosed from clinical symptoms and is characterized by a rapid tumor growth and development of metastases and a poor prognosis. Tumor specimens from 50 patients including 21 IBC and 29 NBC were analysed for RFLP to select heterozygous patients. Thirty-two patients including 16 patients with IBC (T4d) and 16 patients with NBC (T1,T2, N0, M0) were found to be heterozygous for H19 and/or IGF2 and their tumors were analyzed for transcription polymorphism. LOI of H19 and/or IGF2 was found in 9 of 16 (56%) IBC versus none of 16 (0%) NBC (Fisher’s exact test, p=0.001). It is the first observation showing that a gene alteration is present in IBC and not in NBC although biological and pathological characteristics are identical in both types of BC. Its is possible that LOI affects the cells accompanying inflammatory symptoms.”
1997: Influence of pregnancy on the outcome of breast cancer: a case-control study.
Int J Cancer 1997 Sep 4;72(5):720-7, Bonnier, P, et al.
“The relationship between pregnancy and the outcome of breast cancer remains controversial. The purpose of this study was to determine the prognostic value of pregnancy at the time of diagnosis of primary infiltrating breast cancer. In a retrospective multi-center study we compared a group of 154 patients presenting pregnancy-associated (PA) breast cancer with a control group of 308 patients presenting non-pregnancy-associated (non-PA) breast cancer. Classic prognostic factors, treatment modalities, disease-free survival and overall survival were compared in the 2 groups. The relative importance of pregnancy was assessed by Cox multivariate analysis. There was a significantly higher proportion of inflammatory breast cancer, large tumors and negative receptor status in the PA group. Five-year recurrence-free survival, metastasis-free survival and overall survival were lower both in the whole PA group and in the PA sub-group excluding patients with inflammatory breast cancer than in the corresponding non-PA groups. According to clinical stage, histoprognostic grade and microscopic lymph-node involvement, probability of 5-year metastasis-free survival and overall survival was lower in the PA group. Outcome was significantly poorer after chemotherapy for patients in the PA sub-group than in the non-PA sub-group. Multivariate analysis demonstrated that pregnancy was an independent and significant prognostic factor. Pregnancy has an adverse effect on the outcome of breast cancer. Concurrent or recent pregnancy should be taken into account in the development of new systemic therapies. Our findings have important implications for further research into the basic mechanisms of cancer.”
1997: Inflammatory Carcinoma of the Breast: Characteristic Findings of MR Imaging.
Breast Cancer 1997 Oct 31;4(3):161-169, Yasumura K, et al.
“Inflammatory breast carcinoma (IBC) Shows a unique clinical appearance and has an extremely poor prognosis. Although immediate intensive therapy has been proposed, diagnosis of this disease tends to be delayed as its clinical features can be confused with acute mastitis. The conventional imaging modalities including mammography and ultrasonography are of limited value in the diagnosis of IBC, as it is difficult to delineate specific findings of the swollen dense breast. Recently, magnetic resonance (MR) imaging has been widely applied to breast diseases. One of the excellent features of this modality is its diagnostic ability in dense breasts. However, few trials to evaluate the capability of this new modality for IBC have been documented. In recent years, we found that a characteristic feature in 5 cases of IBC was a strong signal on T2-weighted images (T2WI) of MR imaging at the retromammary and subcutaneous area. Pathological features of the retromammary area showed marked interstitial edema and focal lymphatic involvement by tumor cells. These characteristic images obtained by MR imaging may be suggestive of inflammatroy breast carcinoma. Furthermore, subtracted dynamic MR imaging indicated the site of the tumor. Therefore, the application of MR imaging for swollen breasts would assist in the immediate diagnosis of IBC and would contribute to appropriate and timely therapy.”
1997: Male inflammatory breast cancer.
Surg Today 1997;27(7):669-71, Yamamoto, T, et al.
“We report herein the case of a 68-year-old man diagnosed with inflammatory breast cancer. The patient presented following the rapid onset of redness and swelling over the left anterior chest wall. On examination, the left chest wall and left axilla were extensively hard, and the left upper limb was swollen. Ultrasonography and computed tomography (CT) scanning disclosed a mass in the left breast, about 2 cm in diameter with an unclear margin, and swelling of the major and minor pectoral muscles. Needle biopsy of the breast mass confirmed invasive lobular carcinoma. As a radical operation was considered contraindicated, systemic and intraarterial chemotherapy using 5-fluorouracil (5-FU) and Adriamycin (ADR) were performed. Nevertheless, the patient died of carcinomatous pleurisy 6 months after the initial onset of the disease.”
1998: Inflammatory breast carcinoma: comparison of survival of those diagnosed clinically, pathologically, or with both features.
Am Surg 1998 May;64(5):428-31, Wilke, D, et al.
“There still remains some controversy as to whether or not there is a survival difference in patients with inflammatory breast carcinoma (IBC) with regard to whether they were diagnosed clinically, pathologically, or with both features. We conducted a retrospective chart review of all the patients diagnosed with IBC who were treated at the Nova Scotia Cancer Treatment and Research foundation between the years of 1990 and 1994, inclusive. Fifty-seven patients’ charts were reviewed for recurrence or death up until Feb. 16, 1996. The overall survival of the 57 patients was 32 per cent (confidence interval, 16-48%) and 12 per cent (confidence interval, 0-26%) at 3 and 5 years, respectively. The survival times according to presentation (clinical, pathological, or both) at 3 and 5 years were 31 and 10 per cent for the clinically diagnosed group, 56 per cent at 3 years for the pathologically diagnosed group (5-year survival times could not be calculated), and 34 and 20 per cent for the group diagnosed both clinically and pathologically, respectively. Analysis by the log-rank test revealed that there was no significant difference in survival between these three groups. We conclude that there was no statistically significant difference in survival between those patients who presented clinically, pathologically, or with both features.”
1998: Inflammatory breast carcinoma: a community hospital experience.
J Am Coll Surg 1998 Jun;186(6):622-9, Brooks, HL, et al.
“BACKGROUND: Inflammatory breast cancer (IBC) is a rare form of rapidly progressive breast cancer. We reviewed the diagnosis, treatment, and outcome of IBC in our inner city community-based hospital and compared results with previous published reports. STUDY DESIGN: Twenty-five patients were diagnosed and treated for IBC at the Catholic Medical Center of Brooklyn and Queens during the 6-year period of January 1989 through December 1995. Criteria for inclusion in this study were clinical or histopathologic evidence, or both, of inflammatory carcinoma. RESULTS: IBC comprised 2.0% (25 of 1,257) of all breast cancer patients initially diagnosed during this study. All presented with clinical signs of IBC. Invasion of dermal lymphatics by neoplastic cells was demonstrated in 68% (17 of 25) of biopsy specimens. Sixty-eight percent (17 of 25) of patients presented with metastatic (ie, stage IV) disease and 28% (7 of 25) with stage IIIb; one patient (4%) died before staging. Estrogen and progesterone receptor studies were done on 72% (18 of 25) of all specimens. Of those patients who died, 85% were estrogen and progesterone receptor negative; of those surviving, 60% were estrogen receptor positive. Twenty (80%) of the 25 patients died, after a mean survival of 11.8 months and 5 (20%) remain alive, with a mean survival of 44.8 months. Of those who died, 85% were stage IV at presentation. All five survivors were stage IIIb at presentation. Patients underwent a variety of multimodal therapies. Survival was significantly associated with earlier stage at diagnosis and estrogen receptor positivity. CONCLUSIONS: IBC is characterized by rapid progression and dismal outcome. Earlier stage at diagnosis and positive estrogen receptor status suggest a more favorable prognosis. Neoadjuvant chemotherapy, as part of a multimodal approach, has significantly improved the outcome for IBC, but this is limited to patients with stage IIIb disease. Most of our patients presented with stage IV disease. If improvement is to be realized at the community level, limited health care resources must be directed toward aggressive physician and public education.”
1998: Inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program of the National Cancer Institute, 1975-1992.
Cancer 1998 Jun 15;82(12):2366-72, Chang, S, et al.
“BACKGROUND: Little is known about the cause of inflammatory breast carcinoma (IBC), the most aggressive form of breast cancer. To the authors’ knowledge, no studies have investigated whether IBC risk factors are different from those for breast carcinoma overall, and there has been only one report of IBC incidence and survival patterns. METHODS: The authors used data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute for the period 1975-1992 to calculate age-adjusted incidence and survival rates for 913 white and 121 African American women with IBC involving dermal invasion of lymphatic ducts and 166,375 white and 13,674 African American women with other types of breast carcinoma (non-IBC). RESULTS: Between 1975-1977 and 1990-1992, IBC incidence doubled, increasing among whites from 0.3 to 0.7 cases per 100,000 person-years and among African Americans from 0.6 to 1.1 cases. However, rates for African Americans varied due to the small numbers of IBC cases. The twofold increase in IBC incidence was higher than that observed for non-IBC during the same period (27% for African Americans and 25% for whites). IBC patients were significantly younger at diagnosis than non-IBC patients; and among both IBC and non-IBC patients, African Americans were younger than whites. Overall survival was significantly worse for IBC patients than for non-IBC patients and for African Americans than for whites. Among whites, 3-year survival improved more for IBC patients than for non-IBC patients between 1975-1979 and 1988-1992, increasing from 32% to 42% for IBC patients (P=0.0001) and from 80% to 85% for non-IBC patients (P=0.0001). CONCLUSIONS: The disparities observed in incidence trends and age at diagnosis, particularly according to race, highlight the need for further investigation of the differences between IBC and non-IBC incidence.”
1998: A case control study on risk factors involved in inflammatory breast recurrence after breast-conserving surgery.
Oncology 1998 Sep-Oct;55(5):391-9, Nishimura, R, et al.
“Recurrence that poses the biggest problem after breast-conserving surgery is local recurrence. Particularly, in the case of inflammatory breast recurrence which is rare but has a specific pathologic nature, it is important to elucidate the pathology and risk factors and to consider appropriate countermeasures. In the present study, we classified 133 cases of recurrence following breast-conserving surgery, collected from 18 key hospitals/institutes in Japan. Recurrence types were divided into three groups, namely, inflammatory breast recurrence, noninflammatory breast recurrence and distant metastasis only, and the risk factors involved in recurrence were investigated by the case control study allotting 2 controls to each case. The study population consisted of 9 cases of the inflammatory type, 64 cases of the noninflammatory type and 60 cases of distant metastasis. The significant risk factor for inflammatory breast recurrence was positive lymph node metastasis, which was significantly more frequent in lymphatic invasion-positive cases unlike in the distant metastasis group. The positive surgical margin and nonradiation therapy which have been shown to be significant risk factors for noninflammatory breast recurrence were entirely unrelated with inflammatory breast recurrence. In addition, the inflammatory-type recurrence time was as short as about 12 months irrespective of whether radiation therapy was performed or not. The inflammatory type was accompanied with local wide extension (cancerous embolus of the dermal lymphatic vessels), and distant metastasis (lymphangitis carcinomatosa) at the time of recurrence, and further surgery was impossible in most cases, with a significantly poorer prognosis than the other recurrence types. These findings suggest that this recurrence corresponds to the so-called ‘occult’ case of primary inflammatory breast carcinoma. We think it important to predict this recurrence by close pathological examination, particularly in patients with lymph node metastasis, and to consider appropriate measures.”
1998: Inflammatory breast cancer and body mass index.
J Clin Oncol 1998 Dec;16(12):3731-5, Chang, S, et al.
“PURPOSE: No studies have investigated the etiology of inflammatory breast cancer (IBC), the most lethal form of breast cancer. Because high body mass index (BMI) is associated with decreased risk of premenopausal breast cancer but increased risk of postmenopausal breast cancer, we evaluated whether high BMI was a risk factor for IBC. PATIENTS AND METHODS: In a case-comparison study, we matched by ethnicity and registration date 68 IBC patients treated at The University of Texas M.D. Anderson Cancer Center from 1985 to 1996 with 143 patients with non-IBC and 134 patients with cancer at sites other than the breast or reproductive tract (non-breast cancer). The non-breast cancer group was used in lieu of a population-based, healthy control group, which was not available. RESULTS: IBC patients were younger at menarche and the time of their first live birth than non-IBC and non-breast cancer patients. The proportion of premenopausal IBC patients was higher than the proportion of premenopausal women in the comparison groups, although differences were not significant. There were no differences in height, but IBC patients were heavier (77.6 kg) than non-IBC (70.0 kg) and non-breast cancer patients (68.0 kg). After adjusting for other factors, women in the highest BMI tertile (BMI > 26.65 kg/m2) relative to the lowest tertile (BMI < 22.27) had significantly increased IBC risk (IBC v non-IBC, odds ratio [OR] = 2.45, 95% confidence interval [CI] = 1.05 to 5.73; IBC v non-breast cancer, OR = 4.52, 95% CI = 1.85 to 11.04). This association was not significantly modified by menopausal status and was independent of age at menarche, family history of breast cancer, gravidity, smoking status, and alcohol use. CONCLUSION: Our investigation showed that high BMI was significantly associated with an increased risk of IBC. This association did not vary by menopausal status, although IBC patients were more likely to be premenopausal. Confirming our findings and identifying other IBC risk factors may provide directions for future research on the aggressive nature of IBC.“
