Anusha Vable

Inflammatory Breast Cancer in North Africa

BACKGROUND: Inflammatory breast cancer (IBC) is a severe form of breast cancer with low rates of survival compared to non-IBC cases. The disease occurs in 1% of all breast cancer cases in the U.S. but occurs at a much higher frequency in North Africa. IBC is diagnosed clinically through presence of redness, hotness, and peau d'orange and has no distinct pathological diagnosis.

OBJECTIVES: To determine the relative frequency and possible risk factors of IBC at the National Cancer Institute (NCI) in Cairo, Egypt, through review of medical records of breast cancer patients seen in 2005.

METHODS: The data for this retrospective, hospital-based, pilot study were collected at NCI-Cairo from May - August 2006. All female, newly-diagnose, breast cancer cases pathologically- diagnosed at NCI-Cairo in 2005 were included in this study. Of 1802 possible cases in 2005, 1382 (76.7%) were determined eligible for inclusion according to our criteria. Variables abstracted from medical records and included in the statistical analysis included age, place of residence (rural or urban), marital status, number of children, BMI, breast feeding history and pregnant or lactating at time of diagnosis, as well as clinical manifestations of the cancer.

RESULTS: Preliminary analysis of clinical symptoms show 134 (9.7%) cases with peau d'orange, 40 (2.9%) with edema, 17 (1.2%) with redness, and 131 (9.5%) with nipple retraction, but only 29 (2.1%) cases where IBC is mentioned in the medical record.

CONCLUSIONS: The disparity between the number of patients with suggestive clinical symptoms and IBC diagnosis indicate that IBC may be under-diagnosed in this population, however, these symptoms can arise from extended neglect of non-IBC masses. Because IBC has no pathological diagnosis, it must be diagnosed clinically, which leads to misclassification of the cancer or misdiagnosis as lactation mastitis. Establishing risk factors is important for detection of this rare, yet highly fatal cancer, especially in North Africa, where prevalence is high.