“Can anyone tell me if this looks like the beginning of inflammatory breast cancer?” wrote one MyBCTeam member. “I’ve had swollen lymph nodes … then this little red spot showed up.”

While itching, burning, and discolored spots on the breast may be caused by bugbites or harmless skin conditions, in some cases, these changes may indicate inflammatory breast cancer (IBC).

Many other types of breast cancer can lead to a distinctive lump within the breast tissue. However, people with IBC don’t usually have a lump. Instead, they have a different set of signs and symptoms that may include:

• Red, purple, or dark spots or discoloration on the breast skin (may look different depending on skin tone)
• Pain or tenderness
• Increase in the size of one breast
• Breast itchiness or burning sensations
• Peau d’orange (the skin of the breast looks pitted or dimpled, like the surface of an orange peel)

What Is Inflammatory Breast Cancer?

IBC is a rare type of breast cancer. It leads to unusual symptoms and is more difficult to diagnose than many other types of breast cancer. Symptoms may include skin discoloration (which varies based on skin tone), swelling, tenderness, and dimpling of the skin.

IBC can be misdiagnosed as mastitis, a breast infection common during breastfeeding. IBC grows and spreads fast and needs to be treated quickly.

About 1 percent to 5 percent of people with breast cancer have IBC. According to the American Cancer Society, Black women are more likely than white women to be diagnosed with IBC in the United States. Additionally, people who develop this type of cancer tend to be younger. Across all types of breast cancer, the average age at diagnosis in the U.S. is 62. The average age of IBC diagnosis in the U.S. is 51.

What Causes Inflammatory Breast Cancer?

Any cell in the body can undergo gene changes that turn it cancerous. These changes can make a cell grow out of control. IBC develops when gene changes occur in breast cells, such as those in the lobules (milk-producing glands) or ducts (tubes that carry milk).

As the original cancer cell grows and divides, it creates many more cancer cells that block lymph vessels. Lymph vessels are a part of the lymphatic system — the collection of organs and tissues that fight infection, remove waste, and control levels of fluid around the body. When breast cancer cells block the lymph vessels, lymph fluid can’t properly drain out of the breast. As lymph fluid builds up, the breast swells and changes in shape or texture. These cells can also spread to the skin, causing it to look inflamed.

Inflammatory Breast Cancer Risk Factors

Certain factors can increase a person’s chances of being diagnosed with IBC. These include:

• Having a family history of breast cancer or a personal history of another type of breast cancer
• Having dense breast tissue (with more ducts and supportive tissue and less fatty tissue)
• Starting menstruation before age 12
• Never having been pregnant
• Becoming pregnant for the first time after age 30
• Having a higher body weight
• Receiving radiation therapy treatments for another type of cancer in the past
• Having changes in certain genes, including BRCA1, BRCA2, PALB2, CHEK2, and PTEN

If you’re interested in learning more about your risk of developing IBC, talk with an oncologist or other healthcare provider.

Symptoms of Inflammatory Breast Cancer

IBC typically causes symptoms early in the disease course. For many people, one breast starts to look different over a very short period of time. Apart from the symptoms listed above, you may notice:

• Swelling or heaviness, making one breast suddenly seem larger than the other
• Warmth or heat
• A nipple that looks flat, becomes inverted, or has discharge
• Discoloration covering at least one-third of the breast, which may look like a rash

Some people with IBC also notice swollen lymph nodes. These may feel like hard lumps in the armpit or near the collarbone.

Having breast symptoms doesn’t necessarily mean that you have cancer. Some are also common symptoms of other conditions, such as abscesses, dermatitis (skin irritation), and mastitis (inflammation or an infection of the breast tissue). However, you should see a doctor right away if you notice that one breast suddenly starts to look different or is undergoing skin changes.

How Fast Does an Inflammatory Breast Cancer Rash Spread?

A breast rash is often an early symptom of IBC. A very early IBC rash may look like a discolored spot or skin irritation. But in other people, these rashes could appear more like a bruise.

IBC rashes spread quickly, sometimes appearing overnight with no warning, and other times, they may take up to six months to develop.

Inflammatory Breast Cancer Tests and Diagnosis

If you’re experiencing IBC symptoms, your doctor will likely have you undergo imaging tests, which may include a mammogram, an ultrasound, or an MRI. These imaging tests can help the doctor see inside the breast and identify any problems, such as a tumor.

Unlike other types of breast cancer, IBC often doesn’t form lumps, so it may be difficult to diagnose with standard imaging tests. Doctors need to perform a skin punch biopsy to confirm whether a person has IBC. During a biopsy, the doctor removes a small piece of tissue. This tissue is studied under a microscope to see if there are cancer cells.

If you receive a diagnosis of IBC, your doctor may recommend more imaging tests to see whether cancer cells have spread to other parts of the body. These other imaging tests may include a positron emission tomography (PET) scan, a CT scan, or a combination.

Types of Inflammatory Breast Cancer

When diagnosing breast cancer, including IBC, doctors will determine the molecular subtype of the breast cancer. To do this, doctors perform tests on biopsy samples to see which proteins are found on the surface of cancer cells. This information helps doctors understand how breast cancer cells grow, know which treatments may work best, and estimate prognosis (outlook).

Doctors will test for proteins called hormone receptors, including estrogen receptor (ER) and progesterone receptor (PR), and determine whether cells contain a protein called HER2. If cells lack ER, PR, and HER2, doctors say that the cancer is triple-negative. Triple-negative breast cancer (TNBC) tends to grow faster and are harder to treat. Between 20 percent and 40 percent of people with IBC have TNBC.

Staging Inflammatory Breast Cancer

Tests can also help your doctor determine your cancer stage, which describes how far cancer cells have spread. IBC is always at least stage 3 (sometimes written in Roman numerals as stage III) — it has spread to nearby tissues. Doctors stage IBC as follows:

• Stage 3B — IBC cells have spread to nearby areas, such as the skin or chest wall (the muscles and bones of the chest).
• Stage 3C — IBC cells have spread to other tissues in the area or nearby lymph nodes, or the tumor is larger.
• Stage 4 (also called metastatic breast cancer) — IBC cells have spread to other parts of the body, such as the lungs, liver, or bones.

Treatment of Inflammatory Breast Cancer

Doctors usually recommend an aggressive treatment plan for IBC. Treatment for stage 3 IBC often starts with chemotherapy or other cancer-killing drugs to help shrink the cancer. Next, a person with IBC typically has a mastectomy (surgery to remove the breast) along with surgery to take out nearby lymph nodes. After surgery, radiation therapy or additional drug treatments may be given.

Chemotherapy, targeted therapy, and hormone therapy are the main treatments for stage 4 IBC. Surgery and radiation therapy may be used, but these treatment options are less common for metastatic disease (cancer that has spread to other parts of the body).

What Is the Prognosis for Inflammatory Breast Cancer?

IBC often has a worse outlook than other types of breast cancer. To learn more about your outlook, talk to your doctor, who’s familiar with your overall health and your personal health history.

When estimating prognosis, doctors use studies of large groups of people diagnosed with IBC. Researchers may measure prognosis in several ways. One possibility is the five-year relative survival rate. This number compares people with IBC to people without cancer to estimate how likely they are to live at least five years.

In the U.S., people with IBC are about 40 percent as likely to live for five years or more as people with breast cancer overall, according to the American Cancer Society.

A person’s prognosis depends on the stage of their cancer. The five-year relative survival rate is 53 percent for people with stage 3 IBC and 22 percent for people with stage 4 IBC.

A slightly different way of measuring prognosis is to use a number called the overall survival rate. This number tells you how many people diagnosed with a condition are alive after a certain amount of time.

Various studies have looked at large groups of people with IBC and found the following overall survival statistics: About 71 percent of people with nonmetastatic IBC live for at least five years after being diagnosed. About 39 percent of people with metastatic IBC live for two years or more after diagnosis.

Prognostic Factors

Certain characteristics can raise or lower a person’s chances of having a good outlook. These are called prognostic factors.

Cancer stage is one prognostic factor. People with breast cancer that has begun to spread around the body have a worse prognosis than those who have cancer cells only within the breast.

Additionally, a cancer’s molecular subtype affects outlook. People with IBC who have triple-negative breast cancer have a worse prognosis than people with other subtypes. Those with HER2-positive breast cancer have a better outlook.

Other factors that can affect prognosis include a person’s age, other health conditions, tumor grade (how abnormal cancer cells look and how fast they grow), and treatments received.

Talk With Others Who Understand

On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

If you’ve been diagnosed with breast cancer, what symptoms did you have? Let others know in a comment below.