Anderson WF, Chu KC, Chang SInflammatory breast carcinoma and noninflammatory locally advanced breast carcinoma: distinct clinicopathologic entities? J Clin Oncol 21: 2254-2259
National Cancer Institute, Division of Cancer Prevention, EPN, Room 2144, 6130 Executive Blvd, Bethesda, MD 20892-7317, USA. Journal of Clinical Oncology
(Impact Factor: 18.43).
06/2003; 21(12):2254-9. DOI: 10.1200/JCO.2003.07.082
Inflammatory breast carcinoma (IBC) and noninflammatory locally advanced breast carcinoma (LABC) are both associated with poor prognosis; however, whether they are distinct clinicopathologic entities remains controversial.
To determine whether IBC and LABC were different, we compared tumor characteristics, prognosis, and age-specific incidence rate patterns in the Surveillance, Epidemiology, and End-Results program. An age of 50 years served as a surrogate marker for menopause.
Younger age at diagnosis, poorer tumor grade, and negative estrogen receptors (ERs) were more predictive of IBC (n = 2,237) than of LABC (n = 7,985). Breast carcinoma survival was worse for patients with IBC than for those with LABC (log-rank test, P <.0001). Age-specific incidence rates for IBC increased until 50 years and then flattened, whereas rates for LABC increased for all ages. When rates for LABC were stratified by estrogen receptor-positive (ERP) and -negative (ERN) expression, rates for ERP and ERN diverged; that is, rates for ERP increased with advancing age, whereas rates for ERN flattened after 50 years. When rates for IBC were stratified by ER expression, rates for both ERP and ERN flattened after 50 years of age.
IBC and LABC seemed to be distinct biologic entities, as indicated by different prognostic factor profiles and age-specific incidence rate patterns. Rates that increased before 50 years and then stabilized, possibly indicated that premenopausal exposures had a greater effect on maintaining rates for IBC than for LABC.
Available from: Wendy Ann Woodward
- "(Early Breast Cancer Trialists' Collaborative Group 1988, 1998; Gonzalez-Angulo et al. 2007) These values stand in stark contrast to the 5 year OS of 79.2% reported for a contemporary population of non-metastatic breast cancer patients treated with multimodality therapy (Greenbaum et al. 2010). Although IBC is still considered to be the most aggressive form of breast cancer, there have clearly been improvements in treatment paradigms over the decades (Anderson et al. 2003). However, given the relative rarity of IBC (1–3% of breast cancers), there is limited data on stage IV (de novo) IBC at presentation, and essentially none on the role of aggressive radiation therapy in this setting (Wingo et al. 2004). "
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ABSTRACT: Definitive locoregional therapy including surgery and post-mastectomy radiation therapy (PMRT) has been offered to select IBC patients with de novo metastatic disease. Herein we examined predictive factors for progression-free survival after comprehensive PMRT radiation +/- locoregional treatment of metastatic sites.
Charts of T4d, any N, M1 (de novo) patients who completed PMRT to ≥ 50 Gy from 2006-2011 were reviewed. Patients who received doses <50Gy to the primary site, received radiation at another facility or were treated pre-operatively were excluded. The remaining 36 patients formed the study cohort. Progression-free survival post-PMRT (PFSx) was assessed from the last day of radiation. Median dose to primary fields was 51 Gy. Boost doses ranged from 6-16 Gy.
Median age at diagnosis was 54 (range 33-70). Median follow up from primary irradiation completion was 31 months. Sixteen patients were Stage IV NED at last follow-up (IR 37-60 mo). Fifteen patients died of disease. Five patients experienced an in-field recurrence, three of which resulted from local recurrence at the medial edge of the field. Actuarial 5 year locoregional control (LRC) was 86%. Median PFSx was 20 months. All sites of gross disease were treated with radiation in 21/36 patients. Location of metastatic disease had no correlation with PFSx. Estrogen receptor (ER)- patients had shorter 5-yr actuarial PFSx (28% vs. 66%, P = 0.03) and 5 year actuarial OSx (37% vs 71%, P = 0.02). Nine patients (25%) developed a pathological complete response (pCR) after chemotherapy and with a median follow-up of 59 months, 7 remained without evidence of disease.
Despite the poor prognosis associated with metastatic IBC, our data suggest that select patients may be appropriate candidates for locoregional therapy. Patients who achieve a pCR or those with ER + disease have a favorable PFSx. It remains unclear whether all gross disease needs to be addressed with locoregional therapy to provide benefit.
Available from: John J Graff
- "Therefore, we stratified our hierarchical model by derived menopausal status to evaluate whether menopause modified the association between race and IBC. Our derived menopausal status variable has been shown to be a robust indicator of actual menopausal status (Phipps et al. 2010; Morabia & Flandre 1992), and has been utilized in several population-based studies on breast cancer (Anderson et al. 2003; Anderson et al. 2004). Stratifying our results for the effect of race on IBC, we found that menopausal status did not significantly modify the effect of race on IBC (data not shown); however, we did find significant differences in disease characteristics between pre-menopausal and post-menopausal IBC cases. "
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Inflammatory breast cancer (IBC) is characterized by an apparent geographical distribution in incidence, being more common in North Africa than other parts of the world. Despite the rapid growth of immigrants to the United States from Arab nations, little is known about disease patterns among Arab Americans because a racial category is rarely considered for this group. The aim of this study was to advance our understanding of the burden of IBC in Arab ethnic populations by describing the proportion of IBC among different racial groups, including Arab Americans from the Detroit, New Jersey and California Surveillance, Epidemiology and End Results (SEER) registries.
We utilized a validated Arab surname algorithm to identify women of Arab descent from the SEER registries. Differences in the proportion of IBC out of all breast cancer and IBC characteristics by race and menopausal status were evaluated using chi-square tests for categorical variables, t-tests and ANOVA tests for continuous variables, and log-rank tests for survival data. We modeled the association between race and IBC among all women with breast cancer using hierarchical logistic regression models, adjusting for individual and census tract-level variables.
Statistically significant differences in the proportion of IBC out of all breast cancers by race were evident. In a hierarchical model, adjusting for age, estrogen and progesterone receptor, human epidermal growth receptor 2, registry and census-tract level education, Arab-Americans (OR=1.5, 95% CI=1.2,1.9), Hispanics (OR=1.2, 95% CI=1.1,1.3), Non-Hispanic Blacks (OR=1.3, 95% CI=1.2, 1.4), and American Indians/Alaskans (OR=1.9, 95% CI=1.1, 3.4) had increased odds of IBC, while Asians (OR=0.6, 95% CI=0.6, 0.7) had decreased odds of IBC as compared to Non-Hispanic Whites.
IBC may be more common among certain minority groups, including Arab American women. Understanding the descriptive epidemiology of IBC by race may generate hypotheses about risk factors for this aggressive disease. Future research should focus on etiologic factors that may explain these differences.
Available from: Dédée F Murrell
- "Median disease-free survival is poor, at less than 2.5 years with multimodality treatment . Poorer prognostic factors are axillary nodal involvement , younger age at diagnosis , African-American ethnicity , and negative hormone receptor status  . Of note, the histology of cases 3 and 4 showed a " basal subtype " or " triple negative " (TN) breast cancer which is oestrogen receptor (ER), progesterone receptor (PR), and HER2 negative. "
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ABSTRACT: Inflammatory breast carcinoma is a rare form of advanced breast cancer which carries a poor prognosis, even with treatment. Diagnosis is reached on clinical and pathological grounds; however, due to its propensity to mimic other conditions, it may often be delayed or missed by attending physicians. This case series describes four patients seen at our institution with a diagnosis of inflammatory breast cancer; 3 patients had a history of previously treated breast malignancy. In these cases, the emergence of a new breast lesion evaded initial diagnosis due to incomplete initial physical examination, falsely reassuring imaging results, lack of recognition that a cellulitis picture can resemble metastatic carcinoma, and inconclusive initial biopsy sections. These obstacles to achieve diagnosis serve to further worsen the prognosis by delaying the initiation of multimodality treatment which can improve survival. The purpose of our paper is to increase awareness among breast cancer specialists of the importance of undressing the patient for basic clinical examination of the breasts, recognition of the appearances of this type of local recurrence of breast cancer, and not to rely purely on ultrasound and mammography due to delay in diagnosis in some of our local cases. Sometimes deeper sections and repeat biopsies are needed to make the diagnosis.
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