By Dr. Kathleen Ruddy

Inflammatory breast cancer (IBC) is uncommon, occurring in approximately 5% of cases. It is the most aggressive breast tumor, associated with early recurrence and lower survival compared to other types of breast cancer. Because the symptoms of IBC mimic breast infection, patients are often treated with a series of antibiotics for weeks or months before referral to a breast specialist. Although mammographic findings are often subtle, certain characteristics suggest the diagnosis of IBC and can be helpful in directing subsequent biopsy and pathologic confirmation of the disease.

What are the characteristics found on mammograms in patients with IBC?

Skin thickening is the most common finding found on mammography in patients with IBC. The skin is thickened because tumor cells infiltrate the lymphatics of the skin, blocking the channels and causing the skin to retain fluid.

What other signs of IBC might be seen on mammogram?

Thickening of the substance of the breast, called trabecular or stromal thickening, is also commonly seen in patients with IBC. Tumor cells fill the breast diffusely rather than clumping in one place to form a lump or mass. Streaks of thickened chords of breast tissue may be seen running through the breast on mammogram.

DID YOU KNOW?

The mammographic findings suggestive of IBC are also seen in patients who have primary lymphoma of the breast; however the clinical presentation of IBC, involving rapid onset of redness, swelling, and warmth are typically present only in patients with IBC.

Is there anything else that might be seen on the mammogram in a patient with IBC?

Altogether, the affected breast may appear denser on mammogram than the unaffected, normal breast. It is therefore important that a patient suspected of having IBC have a bilateral mammogram so that the affected breast can be compared to the normal breast. Comparison to prior mammograms is also very helpful.

IBC is the most aggressive form of breast cancer, associated with a high local recurrence rate and low overall mortality. The symptoms of IBC mimic breast infection and include rapid onset of breast redness, swelling, and warmth. A frank breast mass is often absent. A mammogram most commonly demonstrates skin thickening, increased density of the breast, and stromal streaking produced by tumor cells diffusely infiltrating breast tissue and blocking lymphatic drainage.

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