Recently we have received questions and concerns about one of our video interviews regarding inflammatory breast cancer which featured Dr. Jay Harness, a breast cancer specialist. Please see his response below.
Thank you,
Pat Elliott
EmpowHER Cancer Guide
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Response by Dr.Jay Harness to concerns about his video statements on IBC:
Inflammatory breast cancer (IBC) is one of the rarest forms of breast cancer. IBC has a characteristic clinical presentation of skin changes and breast enlargement that may occur rapidly. It can often be confused with ordinary mastitis of the breast. The diagnosis of IBC may also be confused with locally advanced breast cancer (LABC). LABC can also present with some of the same physical findings as IBC.
Classic IBC often arises quickly, in three months or less. Its cause is unknown. There is usually dermal lymphatic involvement which gives rise to the "inflammatory" appearance (bright redness) of the skin of the breast. There may not be a palpable breast mass. IBC often occurs in younger patients who present with a high incidence of positive lymph node involvement. Punch biopsies of the breast skin in the area of erythema (redness) demonstrates involvement of the subdermal lymphatics by breast cancer cells. Most IBC cancers are ER and PR negative and are often HER-2/neu-positive. Angiogenesis and lymphangiogenesis are usually increased. Overall survival is approximately 40 percent at five years.
Locally advanced breast cancers (LABC) usually arise over a longer time period, often greater than three months. Its cause is a possible delay in diagnosis or a possible patient delay in responding to symptoms, like a mass. Dermal lymphatic involvement is usually not seen with LABC, but may be present. A palpable mass is usually detected by the patient and many patients are older. Lymph node involvement may or may not be increased. These tumors are often ER and PR positive. They may or may not be HER-2/neu-positive. Five-year survivals ranged from a low of 45 percent to as high as 80 percent. The incidence of LABC increases with increasing age of the patient.
What I have just described is a very brief synopsis of the typical differences between IBC and LABC. LABC can present with the same physical findings as IBC. The real-time distinction between IBC and LABC may be quite difficult. Even among experienced breast cancer professionals, there can be real differences of opinion as to whether an individual case is inflammatory breast cancer versus locally advanced breast cancer.
It is important to remember that mastitis responds well to antibiotics. Therefore, any suspected mastitis (redness of the breast) that persists longer than two weeks or that does not respond to antibiotics must be considered as a possible case of IBC. A punch biopsy of the skin in this setting can be definitive in establishing a diagnosis of IBC.
I felt the purpose of my EmpowHer video was to give a layman's brief overview (55 seconds) of advanced breast cancer which could be either the more typical locally advanced breast cancer or the rarer inflammatory breast cancer. The video was not done from a script, but instead was done spontaneously. While the question asked me in the video was about “the cause of inflammatory breast cancer”, I chose to focus my answer on LABC, which is far more common than IBC. LABC is preventable (in most cases) with the early detection of the underlying breast cancer. Because of this focus on my part, I recommended to EmpowHer that the video be pulled. The video is really about LABC and not IBC.
For the record, I was the founding medical director of the nation’s first university-based multidisciplinary breast center at the University of Michigan in 1985. Subsequently, I have founded two additional multidisciplinary breast centers, one in Boston and one in Orange, California. I have spent the last 25 years of my career with a major focus on breast cancer. I have treated over 2,000 women with breast cancer and numerous women with locally advanced breast cancer, including inflammatory breast cancer. I am a past-President of the American Society of Breast Surgeons. I am the current President of Breast Surgery International. I have written nearly 100 articles and book chapters in the medical literature. I am the lead editor of 2 medical textbooks, including the book "Breast Cancer-Collaborative Management".