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My breast is red and hot. OMG! Dr. Google says I have Inflammatory Breast Cancer.  Do I?

Dr. Google may be brilliant, but Dr. Google never graduated from medical school, where a student learns the fine art of the physical examination. Dr. Google never learned how to perform a physical examination and has never actually examined anyone. Dr. Google doesn’t always know what he’s talking about.

Many women will experience breast infections, which the body fights by initiating an inflammatory response.  The inflammatory response is an epic battle of good versus evil, in which the body builds new roads to transport the equipment and material used to destroy the evil infection. Once the battle is won, the remnants of the battle must be removed and processed by the lymph nodes and the liver. Finally, the scar team arrives to rebuild the healthy tissue with even more equipment and additional material.  The new roads are new blood vessels, developed by the body to facilitate the response to infection. And because of all the new blood and material brought in to the infection, infections will become red, swollen, warm and tender. For most infections, the body requires outside assistance in the form of antibiotics and may also need lancing, or surgical drainage.

Inflammatory Breast Cancer is a rare form of breast cancer that is characterized by an inflammatory reaction and can therefore present and look like a breast infection. An infection of the breast will respond to antibiotics, whereas an Inflammatory Breast Cancer will not.  Any breast that is inflamed, i.e. red, hot, swollen and tender, should be treated with antibiotics for two weeks. If there is not significant response, then evaluation by a breast surgeon is required.

An infection is usually a localized red, swollen area that is quite tender and painful.  Inflammatory Breast Cancer has generalized redness over a large area of the breast. The whole breast will also be edematous and feels rock hard, although generally not tender.  Inflammatory Breast Cancer is very aggressive and treatment needs to be aggressive. A prompt diagnosis is very important.

Most women with a red breast will not have Inflammatory Breast Cancer, but will have a breast infection (mastitis).  Sometimes the infection and its associated redness will spread to incorporate much of the breast, but the breast remains soft and supple.  A trial of antibiotics for two weeks is indicated but if the redness does not resolve or respond, then a breast surgeon needs to be consulted. Most likely the breast will exhibit an abscess (a pocket of pus) that needs to be lanced (surgically drained). But an Inflammatory Breast Cancer needs to be excluded and an experienced Breast Surgeon can usually tell the difference between mastitis and Inflammatory Breast Cancer based on a physical examination, something Dr. Google cannot perform. If the breast surgeon is concerned about Inflammatory Breast Cancer, a small skin biopsy will be performed in the office.

Inflammatory Breast Cancer is a rare form of breast cancer, in which cancer cells will invade the skin and plug the dermal lymphatics. But, Inflammatory Breast Cancer is a clinical diagnosis, i.e. the diagnosis is made based on the clinical breast examination and not by a skin biopsy. The skin biopsy will confirm that cancer cells are in the skin, but the diagnosis of Inflammatory Breast Cancer is made by the breast surgeon.  We say it is a clinical diagnosis.

Inflammatory Breast Cancer is very aggressive and needs prompt, aggressive therapy. Chemotherapy, i.e. systemic cytotoxic chemotherapy, will be administered first.  Referral to a medical oncologist and placement of a central venous access port will commence quickly.  Treatments will usually start within 2 weeks after a metastatic evaluation and cardiac evaluation are completed. Chemotherapy will usually take 4-6 months at which point a modified radical mastectomy is performed. A modified radical mastectomy removes all the breast and all the axillary lymph nodes but none of the pectoralis major muscle. Approximately 4-5 weeks after surgery, Post Mastectomy Radiotherapy will be needed. Post Post Mastectomy Radiotherapy will radiate the chest wall, mastectomy flaps, and lymph node bearing regions over a period of 8-9 weeks.

Hundreds of scientists and thousands of physicians are studying day and night to understand Inflammatory Breast Cancer and to develop more effective treatments in hopes of finding a cure.  But until then, redness of the breast, especially over large area, should not be ignored.  Antibiotics should be the initial treatment, but if there is no response then evaluation by a breast surgeon is needed.  Most often the red breast will have a deep abscess that needs to be drained and only rarely will a diffusely red breast truly be an Inflammatory Breast Cancer.

Dr. Google can get you a quick answer, but Dr. Google cannot examine you. And Dr. Google cannot treat you. But Dr. Google is really good at making you worry.