# Inflammatory breast cancer

Source: https://onco.cc/cancers/inflammatory-breast-cancer/  
OnCo record `inflammatory-breast-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Inflammatory breast cancer does not usually form a lump. The breast becomes red, swollen, warm and heavy over weeks, with skin thickened like orange peel, because cancer cells have blocked the lymph channels in the skin. It is often mistaken for infection, is always at least stage III, and needs chemotherapy first, then mastectomy and radiotherapy, with HER2 or immune drugs added by subtype.

## Summary

Inflammatory breast cancer is a clinical diagnosis, staged T4d: rapid onset over six months or less of erythema and oedema covering at least a third of the breast, often with warmth, heaviness and peau d'orange, with or without a palpable mass. Tumour emboli in the dermal lymphatics on a skin punch biopsy support the diagnosis but are not required, and their absence does not exclude it. Because the picture mimics mastitis, women are often given antibiotics first; any presumed infection that does not settle within a week or two in a woman who is not breastfeeding needs imaging and biopsy. Staging includes PET-CT or CT and bone scan, because roughly a third of patients in registry series have distant metastases at diagnosis. Compared with other breast cancers a higher share are HER2-positive or triple-negative and fewer are hormone receptor-positive, and no mutation unique to the inflammatory phenotype has been found.

Treatment is trimodality and the order is fixed. Systemic therapy comes first: an anthracycline and taxane, with trastuzumab and pertuzumab throughout for HER2-positive disease and a pembrolizumab-based regimen for triple-negative disease by extrapolation from KEYNOTE-522, since inflammatory cases were few in the landmark trials. Response on examination and imaging then permits a modified radical mastectomy with axillary dissection; breast conservation, sentinel node biopsy alone, skin-sparing incisions and immediate reconstruction are avoided because the disease is in the skin lymphatics. Post-mastectomy radiotherapy to the chest wall and regional nodes follows in every patient, with bolus to bring the dose to the skin and a higher dose for poor responders. Endocrine therapy, completion of a year of HER2 therapy with trastuzumab emtansine or trastuzumab deruxtecan if disease remained, and olaparib or capecitabine for residual triple-negative disease follow the rules of non-inflammatory cancer.

Outcomes have improved but remain the worst of any breast presentation: before chemotherapy the disease was almost uniformly fatal within a few years of surgery, and even with trimodality treatment well under half of patients are alive at five years in registry series, with pathological complete response the strongest predictor of who will be. The MD Anderson programme that began giving chemotherapy before surgery in the 1970s and the dedicated inflammatory breast cancer clinics that followed have defined the standards, and an international expert consensus in 2011 fixed the diagnostic criteria; trials restricted to inflammatory disease remain scarce, so most evidence is borrowed. Whether immunotherapy and antibody-drug conjugates close the gap, whether radiotherapy can be intensified safely, and what drives the inflammatory phenotype are the open questions.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: IBC; T4d breast cancer; Inflammatory carcinoma of the breast
- Tags: subtype-page
- Group: breast
- Burden: A rare form, about one to five percent of breast cancers in most series but commoner in younger women and in Black women, and responsible for a disproportionate share of breast cancer deaths.
- Subtypes: HER2-positive inflammatory ductal carcinoma (trastuzumab and pertuzumab with chemotherapy); Triple-negative inflammatory breast cancer (chemotherapy with immunotherapy by extrapolation); Hormone receptor-positive inflammatory breast cancer (endocrine therapy after trimodality treatment); Primary inflammatory breast cancer (new diagnosis) and secondary inflammatory recurrence; De novo metastatic inflammatory breast cancer (roughly a third at diagnosis)
- Biomarkers: Clinical criteria: rapid onset, erythema and oedema over at least a third of the breast (T4d); Dermal lymphatic tumour emboli on skin punch biopsy (supportive, not required); Oestrogen receptor, progesterone receptor and HER2 (a higher share are HER2-positive or triple-negative); PET-CT staging for distant disease at diagnosis; Response on examination and imaging after neoadjuvant chemotherapy; Germline BRCA1 and BRCA2 in younger and triple-negative cases

## Standard of care

- Diagnosis and staging: Skin punch biopsy and core biopsy with receptor testing, clinical photography, bilateral mammography and ultrasound, and PET-CT or CT with bone scan because distant spread is common at presentation. ([Core needle biopsy and fine-needle aspiration (FNA)](https://onco.cc/terms/core-needle-biopsy/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/), [Ultrasound](https://onco.cc/technologies/ultrasound/), [PET (positron emission tomography)](https://onco.cc/technologies/pet/))
- Systemic therapy first: Anthracycline and taxane chemotherapy; trastuzumab and pertuzumab throughout for HER2-positive disease; pembrolizumab-based chemotherapy for triple-negative disease by extrapolation from KEYNOTE-522. ([Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Pertuzumab](https://onco.cc/drugs/pertuzumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [KEYNOTE-522](https://onco.cc/trials/keynote-522/))
- Surgery: Modified radical mastectomy with axillary dissection after response to chemotherapy; breast conservation, sentinel node biopsy alone and skin-sparing approaches are avoided, and reconstruction is deferred until after radiotherapy. ([Mastectomy](https://onco.cc/terms/mastectomy/))
- Radiotherapy: Post-mastectomy radiotherapy to the chest wall and regional nodes in every patient, with bolus and often a higher dose for poor responders. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- After trimodality treatment: Endocrine therapy for hormone receptor-positive disease; trastuzumab emtansine or trastuzumab deruxtecan for residual HER2-positive disease (KATHERINE, DESTINY-Breast05); olaparib or capecitabine for residual triple-negative disease as in non-inflammatory cancer. ([Tamoxifen](https://onco.cc/drugs/tamoxifen/), [Letrozole (and other aromatase inhibitors)](https://onco.cc/drugs/letrozole/), [Trastuzumab emtansine](https://onco.cc/drugs/trastuzumab-emtansine/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [KATHERINE](https://onco.cc/trials/katherine/), [DESTINY-Breast05](https://onco.cc/trials/destiny-breast05/), [Olaparib](https://onco.cc/drugs/olaparib/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [OlympiA](https://onco.cc/trials/olympia/))

## State of the art

- Trimodality treatment in a fixed order, chemotherapy then mastectomy then radiotherapy, is the standard everywhere.
- HER2-positive inflammatory disease has gained most from dual antibody therapy and antibody-drug conjugates.
- Dedicated inflammatory breast cancer clinics and an international consensus have standardised diagnosis.
- Inflammatory disease is now written into breast trial eligibility rather than excluded.

## Open problems

- Diagnosis is delayed because the picture is mistaken for infection.
- No molecular driver of the inflammatory phenotype has been found.
- Trials restricted to inflammatory disease are rare, so treatment is extrapolated.
- Local recurrence on the chest wall remains common in poor responders despite radiotherapy.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Inflammatory_breast_cancer
- NCI: inflammatory breast cancer: https://www.cancer.gov/types/breast/ibc-fact-sheet
- International expert panel consensus (Annals of Oncology 2011): https://doi.org/10.1093/annonc/mdq345
- Wikipedia: https://en.wikipedia.org/wiki/Inflammatory_breast_cancer

## Connected records

- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- people: [Gabriel N. Hortobagyi](https://onco.cc/people/gabriel-hortobagyi/), [Massimo Cristofanilli](https://onco.cc/people/massimo-cristofanilli/), [Naoto T. Ueno](https://onco.cc/people/naoto-ueno/)
- bottlenecks: [Rare and paediatric cancers without markets](https://onco.cc/bottlenecks/b-rare-cancers/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Letrozole (and other aromatase inhibitors)](https://onco.cc/drugs/letrozole/), [Olaparib](https://onco.cc/drugs/olaparib/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Pertuzumab](https://onco.cc/drugs/pertuzumab/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/), [Tamoxifen](https://onco.cc/drugs/tamoxifen/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Trastuzumab emtansine](https://onco.cc/drugs/trastuzumab-emtansine/)
- trials: [DESTINY-Breast05](https://onco.cc/trials/destiny-breast05/), [KATHERINE](https://onco.cc/trials/katherine/), [KEYNOTE-522](https://onco.cc/trials/keynote-522/), [OlympiA](https://onco.cc/trials/olympia/)
- technologies: [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [PET (positron emission tomography)](https://onco.cc/technologies/pet/), [Ultrasound](https://onco.cc/technologies/ultrasound/)
- terms: [Core needle biopsy and fine-needle aspiration (FNA)](https://onco.cc/terms/core-needle-biopsy/), [Mastectomy](https://onco.cc/terms/mastectomy/)

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