Women with a rare type of breast cancer should be offered less invasive surgery where appropriate, according to new guidelines presented at the Inflammatory Breast Cancer Symposium in Birmingham, UK.

Inflammatory breast cancer (IBC) is a rare sub-type of the disease with poor survival rates that is thought to affect up to 1,000 women in the UK each year.

It gets its name from the red and swollen appearance of the breast’s skin.

In this particularly aggressive and rapidly appearing type of cancer, the lymph drainage system within the breast, which usually drains away waste products from cells, can be disrupted by tumour cells. 

As the lymph vessels become blocked, the drainage fluid (known as lymph) builds up causing swelling and redness. 

Whilst previous guidelines recommended that a mastectomy was always required for inflammatory breast cancer patients, these new UK-led clinical recommendations encourage a localised, breast-conserving approach where possible.

Providing that the cancer has not spread and that the cells surrounding the tumour, taken out during surgery, are confirmed as non-cancerous (known as “clear margins”), there is no evidence to show that breast conservation surgery is any less safe than a mastectomy for this group of patients.

These new guidelines also represent the first time that a group of UK clinicians and researchers have agreed a specific definition of inflammatory breast cancer.

It is hoped that this will offer much-needed clarity to clinicians and patients alike, reducing possible delays in reaching a diagnosis at what is already a difficult and distressing time for patients.

Experts believe that the establishment of clear national guidelines for IBC will better standardise both diagnostic and treatment decisions.

The knock-on effect of this, according to the group behind the guidelines, will be a better environment in the UK for collecting standardised information and tissue samples from IBC patients, fostering vital research interest and progression in this under-researched area.

Other recommendations for best practice proposed in the guidelines include the routine use of skin biopsies to identify the presence of dermal lymphovascular invasion, using clinical photography to capture more detail in diagnostic descriptions of breast appearance; using a combination of mammography and ultrasound as minimum requirements in breast imaging and an endorsement of the combination of chemotherapy herceptin with another biological therapy such as pertuzumab (Perjeta), where available, for use in treatment of HER-2 positive IBC.

The guidelines were formulated and presented by the UK Inflammatory Breast Cancer Working Group following a series of workshops, sponsored by leading research charity Breast Cancer Campaign and Breakthrough Breast Cancer.

Dr Daniel Rea, Reader and Consultant in Medical Oncology at the School of Cancer Sciences, University of Birmingham and UK Inflammatory Breast Cancer Working Group clinical lead, commented:

“These new guidelines represent a real step forward not only for clinicians but, more importantly, for women with inflammatory breast cancer in the UK.

“Treatment options that specifically target this rare breast cancer do not exist, and we need a concerted research effort to fix that. These new recommendations will allow some inflammatory breast cancer patients to be spared a more invasive mastectomy, and as treatments improve we hope that a breast conservation approach will become increasingly common.”

Baroness Delyth Morgan, Chief Executive at Breast Cancer Campaign and Breakthrough Breast Cancer, said:

“These desperately-needed guidelines will lead mean a better future for women with inflammatory breast cancer. With up to 1,000 women diagnosed with the disease in the UK each year, many of whom could be spared more gruelling surgery, the needs in this critically under-researched area must be met. Collecting tissue samples from women with IBC into our Tissue Bank will allow researchers around the world to help more women outlive this aggressive disease sooner.

“These new guidelines represent the fruit of collaborative research that we are very proud to support. We look forward to further work in this area that will give women with inflammatory breast cancer new options.”

Dr Fedor Berditchevski, Group Leader at the School of Cancer Sciences, University of Birmingham and UK Inflammatory Breast Cancer Working Group academic lead, said:

“We hope publication of these guidelines will be a trigger, building much-needed momentum for academic and translational research into inflammatory breast cancer in the UK. It’s only through the coordinated and concerted efforts of scientists and clinicians from various disciplines in this area that we will be able to better understand the biology of this condition and ultimately save the lives of more women.”

Reference

1. Rea, D. et al (2015) Inflammatory breast cancer: Time to standardise diagnosis assessment and management, and for the joining of forces to facilitate effective research, British Journal of Cancer

Source: Breast Cancer Campaign