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Epidemiologic Factors Associated with Inflammatory Breast Cancer - An Analysis of the Inflammatory Breast Cancer Registry at the University of Texas M.D. Anderson Cancer Center

Authors:
Tamer M Fouad
Tamer M Fouad
Tamer M Fouad
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Naoto T Ueno at University of Texas MD Anderson Cancer Center
Naoto T Ueno
Joe Edward Ensor at Houston Methodist Research Institute
Joe Edward Ensor
  • Houston Methodist Research Institute
Mirtha Sayonara Lopez at University of Texas MD Anderson Cancer Center
Mirtha Sayonara Lopez
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Abstract

Background: Inflammatory breast cancer (IBC) is a rare disease (2%-6% of all breast cancer). This has challenged our ability to study the epidemiologic factors associated with the disease etiology. The IBC Registry at The University of Texas MD Anderson Cancer Center (MDACC) was established to prospectively collect detailed clinical and epidemiological data from patients diagnosed with IBC. The primary objective of this study is to determine the association between epidemiologic factors and development of IBC. Patient and Methods: A total of 253 IBC patients were included in this study. Patients were consecutively diagnosed between November 2006 and April 2013 and were prospectively enrolled in MDACC’s IBC Registry. Inclusion criteria for enrollment in the IBC Registry included: a new diagnosis of primary IBC, no prior surgery, be at least 18 years of age and an informed consent. Patients with diagnosis of secondary IBC were excluded from this analysis. Results: The mean age at diagnosis is 51.1 +/- 11.6 SD years. The median follow up is 21.1 months. The vast majority of patients were White (77%), followed by Hispanic (11%), African Americans (9%) and Asian (6%) ethnicity. There were differences in age distribution among different ethnicities. Approximately 50% of tumors were hormone receptor positive while 39.00% were HER2 overexpressed and 24.5% presented with triple negative IBC. The vast majority of patients (80%) had a BMI of 25 or higher. More than 40% of patients had a history of smoking while 76% had a history of alcohol exposure. We were able to identify several epidemiologic characteristics with distinct behavioral patterns (e.g. smoking, obesity, breast feeding, hormone replacement therapy), demographic profiles, pathologic subtypes, family history as well as outcome. Conclusion: In our study population, we were able to identify several profiles in association with distinct behavioral patterns in terms of smoking, obesity, breast feeding and hormone replacement therapy. Our results suggest that there are distinct epidemiologic profiles associated with the development of IBC. This could lead to a new paradigm in understanding the mechanisms that underlie this heterogeneous disease as well as targeting patients with specific preventive strategies based on their behavioral patterns.
Inflammatory breast cancer appearance at presentation is associated with overall survival
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  • Jul 2021
Background Inflammatory breast cancer (IBC) is a clinical diagnosis. Here, we examined the association of a “classic” triad of clinical signs, swollen involved breast, nipple change, and diffuse skin change, with overall survival (OS). Method Breast medical photographs from patients enrolled on a prospective IBC registry were scored by two independent reviewers as classic (triad above), not classic, and difficult to assign. Chi-squared test, Fisher's exact test, and Wilcoxon rank-sum test were used to assess differences between patient groups. Kaplan–Meier estimates and the log-rank test and Cox proportional hazard regression were used to assess the OS. Results We analyzed 245 IBC patients with median age 54 (range 26–81), M0 versus M1 status (157 and 88 patients, respectively). The classic triad was significantly associated with smoking, post-menopausal status, and metastatic disease at presentation (p = 0.002, 0.013, and 0.035, respectively). Ten-year actuarial OS for not classic and difficult to assign were not significantly different and were grouped for further analyses. Ten-year OS was 29.7% among patients with the classic sign triad versus 57.2% for non-classic (p < 0.0001). The multivariate Cox regression model adjusting for clinical staging (p < 0.0001) and TNBC status (<0.0001) demonstrated classic presentation score significantly associated with poorer OS time (HR 2.6, 95% CI 1.7–3.9, p < 0.0001). Conclusions A triad of classic IBC signs independently predicted OS in patients diagnosed with IBC. Further work is warranted to understand the biology related to clinical signs and further extend the understanding of physical examination findings in IBC.
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