International Expert Panel on Inflammatory Breast Cancer

From Annals of Oncology

Consensus Statement for Standardized Diagnosis and Treatment

S. Dawood; S. D. Merajver; P. Viens; P. B. Vermeulen; S. M. Swain; T. A. Buchholz; L. Y. Dirix; P. H. Levine; A. Lucci; S. Krishnamurthy; F. M. Robertson; W. A. Woodward; W. T. Yang; N. T. Ueno; M. Cristofanilli

Abstract

Background:
Inflammatory breast cancer (IBC) represents the most aggressive presentation of breast cancer.
Women diagnosed with IBC typically have a poorer prognosis compared with those diagnosed with non-IBC tumors.
Recommendations and guidelines published to date on the diagnosis, management, and follow-up of women with breast cancer have focused primarily on non-IBC tumors. Establishing a minimum standard for clinical diagnosis and treatment of IBC is needed.

Methods:
Recognizing IBC to be a distinct entity, a group of international experts met in December 2008 at the First International Conference on Inflammatory Breast Cancer to develop guidelines for the management of IBC.

Results:
The panel of leading IBC experts formed a consensus on the minimum requirements to accurately diagnose IBC, supported by pathological confirmation.
In addition, the panel emphasized a multimodality approach of systemic chemotherapy, surgery, and radiation therapy.

Conclusions:
The goal of these guidelines, based on an expert consensus after careful review of published data, is to help the clinical diagnosis of this rare disease and to standardize management of IBC among treating physicians in both the academic and community settings.

Introduction

Inflammatory breast cancer (IBC), a term first introduced by Lee and Tannenbaum, represents the most aggressive presentation of breast cancer. The incidence in the United States ranges from 1% to 5%. The epidemiological study of this disease has been greatly hampered by use of inconsistent diagnostic criteria. Women diagnosed with IBC are also known to have poorer survival outcomes compared with those with non-IBC tumors. Published guidelines have focused on non-IBC tumors primarily due to the scarcity of data and experience in the field of IBC. This paper summarizes guideline recommendations based on the consensus of a panel of recognized international experts that met during the First International Conference on Inflammatory Breast Cancer. The panel focused primarily on minimum requirements for appropriate diagnostic work-up and therapeutic management of the disease. Additionally, critical areas of research to be supported and developed in the following years were identified.

Recommendations for the Management of IBC

The panel recommends a multidisciplinary approach for women with IBC. Primary systemic chemotherapy, surgery, and radiation therapy should all be included in the treatment plan. The panel's recommendations on the individual components are given in the following sections.

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