"But IBC is fatal," a doctor once told me when I mentioned that I am an inflammatory breast cancer survivor as she took my medical history.  An article titled "Inflammatory Breast Cancer: What Progress Have We Made?" by Shaheenah Dawood and Massimo Cristofanilli reviews thirty years of progress that proves just how wrong that doctor was.  Here are some highlights of their article published March 21, 2011, on-line at Cancer Network.

Better imaging techniques are leading to better diagnosis and treatment of IBC.  You may have heard of IBC as the breast cancer that does not show up on a mammogram.  Although it is true that most IBC patients do not have a lump,  the new digital mammograms are better at identifying the skin thickening and changes in breast density that are often present in IBC.  Breast MRI's can help the doctor determine where to biopsy, a problem when there is no solid lump.  Improved sonograms, MRI's, PET and CT scans are picking up the problems with lymph nodes and distant metastases common in IBC much earlier leading to more effective treatment.

Preoperative chemotherapy is saving lives.  While Dawood and Christofanelli want to see more studies to determine the best chemotherapy drugs for IBC, the switch from doing chemo after surgery to doing it before surgery has been a major factor in increasing the average  median overall survival from 15 to 40 months.  First, it helps doctors to be able to see whether the chemo is working by gauging changes in the breast over the course of the treatment.  The doctor can change drugs if the first does not work.  It is also important to start chemo before surgery because the cancer is already in the lymph system where it may easily travel to other parts of the body.  A systemic treatment like chemo helps to kill any cancer cells that have already metastasized.

So far the data show that IBC patients should have their chemo drugs chosen from two families:  the anthracyclines and the taxanes.  Combining these types of drugs has significantly improved survival rates with many more patients now living for years past the median survival rate.

Targeted therapies are often helpful for IBC patients.  As scientists learn more about the molecular differences in types of tumors, they are devising drugs that target specific factors.  Dawood and Cristofanilli say,  "Our deeper understanding of the molecular biology of IBC has led to the identification of several prime molecular targets that may help with the development of therapeutic agents, with the goal of further improving prognostic outcomes."

Having a Her2 positive tumor is more common among IBC patients, so trastuzumab (Herceptin) has improved survival among those IBC patients who overexpress Her2.  In one study, researchers found a 3-year event-free survival of 71% in the women who received trastuzumab and of 56% in those who did not.  Trastuzumab also seems to make pre-operative chemotherapy drugs more effective.