COMMENTARY

Diagnosing Inflammatory Breast Cancer: Can We Get Everyone on the Same Page?

Kathy D. Miller, MD

Disclosures

September 18, 2018

Hi. This is Dr Kathy Miller from Indiana University, back with you again. Today I want to talk a bit about inflammatory breast cancer.

I'm willing to bet that a scene that played out at our local tumor board a couple of weeks ago will sound familiar to you. The patient had been seen by a medical oncologist, a surgeon, and a radiation oncologist. We had a big discussion—really, an argument—over whether this woman had inflammatory breast cancer. Was the bogginess in her breast just localized swelling because of her extensive nodal disease? Was that sufficient to decide that this was inflammatory? Was the pinkness over enough of the breast or was it only over the area of the tumor, and [could that just have been] direct extension?

I'm going to bet that you all have had that same argument, because inflammatory disease is very much in the eyes of the beholder. It's kind of like our version of pornography: "I can't define it but I know it when I see it," as [Supreme Court] Justice Potter Stewart once said. The problem with that sort of non-definition is that what I know and see may not match what someone else knows and sees. That is a problem for patients, who may struggle to get a rapid and appropriate diagnosis and may then not receive the optimal treatment.

This is also a problem for those of us in the research community. If what I'm studying as inflammatory breast cancer doesn't match what somebody else is studying and calling inflammatory breast cancer, we will not make progress. We are going to have a hard time reconciling and interpreting our data.

Our patient advocates have recognized this problem and, spurred by a patient research group, the Inflammatory Breast Cancer Research Foundation, and with support from Susan G. Komen and the Milburn Foundation, a small group has gotten together to tackle this problem. We are well on our way to proposing a much more objective set of diagnostic criteria for inflammatory breast cancer. We will then work on validating that criteria, looking at whether it truly segregates patients with inflammatory disease from patients with other forms of aggressive or locally advanced breast cancer that are not inflammatory. And is the prognosis really different because of this?

This seems like very foundational work for a disease that has been named for decades, but it has never been done. And that sort of definition will give us real power to advance the field. We have been working on this for about 6 months. We have made significant progress, and we hope to share the proposed diagnostic criteria with the larger community and begin the work on the validation early in 2019. So, stay tuned. Remember us the next time you have that argument at your tumor board. Hopefully, help is on the way for all of us and our patients.

I'll be back again soon to share my thoughts on another important topic. This is Dr Kathy Miller. Thank you.

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