Inflammatory Breast Cancer: Symptoms & Diagnosis

This page is for anyone who has noticed fast changes in one breast, such as redness or swelling. It explains the signs of inflammatory breast cancer, why it gets missed, and how it is diagnosed and treated.

Inflammatory breast cancer is defined partly by speed: it appears over a few weeks to months and mimics infection.

• Call 911 or go to an emergency department if breast redness comes with a very high temperature and shivering, confusion, fast breathing, or blotchy skin. Do not drive yourself.
• Call your care team the same day if the skin of one breast turns pink, reddish-purple, or bruised-looking, or pitted like orange peel.
• Call your care team the same day if one breast rapidly becomes larger, heavier, firmer, hotter, or more tender over weeks.
• Call your care team the same day if a nipple newly turns inward, or lymph nodes swell under the arm or near the collarbone.
• Call your care team the same day if redness persists or worsens after antibiotics. Ask about imaging and a skin biopsy rather than a second course.

When you call, lead with the timeline: how the breast looked two weeks ago versus today.

Inflammatory breast cancer does not usually announce itself with a lump. That is the single most important thing to know about it, because most of us have been taught to check for lumps.

Instead, over a few weeks to months, one breast changes.

• Skin turns pink, red, reddish-purple, or looks bruised, often over a third or more of the breast.
• The breast becomes swollen, heavy, warm, or firm, sometimes noticeably larger than the other.
• Skin looks dimpled or pitted like an orange peel, called peau d'orange.
• Aching, tenderness, or a burning sensation.
• The nipple flattens, turns inward, or pulls to one side.
• Swollen lymph nodes under the arm or near the collarbone.

Not everyone has all of these. The speed of change is the thread that ties them together. A breast that looks and feels different than it did last month is the signal.

These symptoms can look like a breast infection such as mastitis. NCI says symptoms of inflammatory breast cancer come on rapidly and may be confused with an infection or injury. ACS says doctors may first suspect infection and prescribe antibiotics. Symptoms that persist or get worse need more testing.

Do not wait through repeated rounds of antibiotics. It is reasonable to say: "I understand this may be mastitis, but I want inflammatory breast cancer ruled out. Can we arrange imaging and a skin biopsy?"

Two more things make it hard to catch. NCI says it is more common, and diagnosed at a younger age, in Black women. And a recent normal mammogram can falsely reassure you, because NCI says this cancer usually cannot be seen on a mammogram.

NCI lists a physical exam, imaging such as ultrasound and MRI, and a breast or skin biopsy to confirm cancer. ACS describes cancer cells blocking lymph vessels in the skin, which causes the redness and swelling.

NCI says inflammatory breast cancer is stage III or stage IV when diagnosed. Staging tests check whether it has spread.

ACS says stage III disease is typically treated with chemotherapy first, followed by mastectomy and radiation. Stage IV is treated with drug (systemic) therapy chosen for the cancer's features. NCI notes these tumors are often hormone receptor negative.

Your team will explain the plan for your case. Ask what each step is meant to do.

Inflammatory breast cancer is rare and aggressive. Ask your team what your outlook means for you.

Ask about clinical trials. Ask for a copy of your pathology report. If you are still in the stage of trying to be taken seriously, keep dated photographs of the breast. They document how fast things changed, and they are hard to dismiss.

• NCI: Inflammatory Breast Cancer fact sheet.
• American Cancer Society: Inflammatory Breast Cancer.