Inflammatory Breast Cancer (IBC)

What is inflammatory breast cancer?

Inflammatory breast cancer (IBC) is a rare but aggressive form of breast cancer that blocks the lymph vessels in the skin of the breast, causing symptoms that resemble inflammation. It accounts for around 1–5% of breast cancer cases but disproportionately affects outcomes due to rapid progression and frequent misdiagnosis as mastitis (breast infection).

Symptoms of IBC

• Rapid onset of breast swelling, warmth and redness
• Skin that looks pitted or ridged — like an orange peel (peau d'orange)
• The affected breast may feel heavy, tender or itchy
• The nipple may flatten or turn inward
• Swollen lymph nodes in the armpit or collarbone
• No distinct lump — this is what makes IBC easy to miss

Why it is misdiagnosed

Because IBC often presents without a lump and the symptoms resemble a breast infection, it is sometimes initially treated with antibiotics. If symptoms do not improve within a week of antibiotic treatment, urgent referral to a breast specialist is essential. Any suspicion of IBC should be treated as a medical emergency.

Treatment

Because IBC is locally advanced at diagnosis, treatment typically follows this sequence: neoadjuvant chemotherapy first (to reduce the disease burden), followed by surgery (mastectomy is usually required), then radiotherapy, and then ongoing systemic treatment (hormone therapy, targeted therapy or immunotherapy depending on receptor status). IBC is rarely suitable for breast-conserving surgery.