Breast Cancer Research and Treatment

, Volume 117, Issue 3, pp 631–641 | Cite as

A comprehensive evaluation of outcomes for inflammatory breast cancer

  • Relin Yang
  • Michael C. Cheung
  • Judith Hurley
  • Margaret M. Byrne
  • Youjie Huang
  • Teresa A. Zimmers
  • Leonidas G. KoniarisEmail author


Objective Inflammatory breast cancer (IBC) remains the breast malignancy with the worst prognosis. We sought to determine the effects of race, socioeconomic status and treatment on outcomes for women with IBC. Study design The Florida cancer registry, inpatient and ambulatory data were queried for patients diagnosed from 1998 to 2002. Results A total of 935 patients with IBC were identified (1.5% of all breast cancers). Overall, 83.1% were Caucasian, 13.9% African American (AA), and 15.7% Hispanic. The mean age of diagnosis was 57 years old. AA patients presented at a younger age, with higher tumor grade, and were less likely to undergo surgical therapy than their Caucasian counterparts. Median survival time (MST) for the entire cohort was 32 months, while MST for AA patients was 20 months. Patients who received chemotherapy before surgery, surgery without chemotherapy, and surgery before chemotherapy demonstrated an independent, significantly improved outcome in comparison to patients who underwent chemotherapy without surgical extirpation. The administration of radiation therapy did not demonstrate an improvement in survival. By multivariate analysis, AA race (HR = 2.19) and failure to provide surgery (HR = 2.3) were independent predictors of worse prognosis. No effect of poverty or ethnicity on outcome was observed. Conclusions IBC carries a poor prognosis for all patients with significantly worse outcomes for AA women. Multimodality therapy provided the best survival rates.


Breast cancer Disparity Outcomes Race Socioeconomic status 

Supplementary material

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  1. 1.
    American Cancer Society, Inc (2004) Cancer facts and figures 2004. American Cancer Society, Inc. Atlanta, GAGoogle Scholar
  2. 2.
    Chang S, Parker SL, Pham T, Buzdar AU, Hursting SD (1998) Inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program of the National Cancer Institute, 1975–1992. Cancer 82(12):2366–2372. doi: 10.1002/(SICI)1097-0142(19980615)82:12<2366::AID-CNCR10>3.0.CO;2-N PubMedCrossRefGoogle Scholar
  3. 3.
    Levine PH, Steinhorn SC, Ries LG, Aron JL (1985) Inflammatory breast cancer: the experience of the surveillance, epidemiology, and end results (SEER) program. J Natl Cancer Inst 74(2):291–297PubMedGoogle Scholar
  4. 4.
    Yang R, Cheung MC, Franceschi D, Hurley J, Huang Y, Livingstone AS, Koniaris LG African American and low socioeconomic status patients have a worse prognosis for invasive ductal and lobular breast carcinoma: do screening criteria need to change? J Am Coll Surg (in press)Google Scholar
  5. 5.
    Campbell JB (2002) Breast cancer-race, ethnicity, and survival: a literature review. Breast Cancer Res Treat 74(2):187–192. doi: 10.1023/A:1016178415129 PubMedCrossRefGoogle Scholar
  6. 6.
    Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK (2002) Cancer survival among US whites and minorities: a SEER (surveillance, epidemiology, and end results) program population-based study. Arch Intern Med 162(17):1985–1993. doi: 10.1001/archinte.162.17.1985 PubMedCrossRefGoogle Scholar
  7. 7.
    Eley JW, Hill HA, Chen VW, Austin DF, Wesley MN, Muss HB, Greenberg RS, Coates RJ, Correa P, Redmond CK et al (1994) Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA 272(12):947–954. doi: 10.1001/jama.272.12.947 PubMedCrossRefGoogle Scholar
  8. 8.
    Ghafoor A, Jemal A, Ward E, Cokkinides V, Smith R, Thun M (2003) Trends in breast cancer by race and ethnicity. CA Cancer J Clin 53(6):342–355PubMedCrossRefGoogle Scholar
  9. 9.
    Joslyn SA (2002) Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 95(8):1759–1766. doi: 10.1002/cncr.10827 PubMedCrossRefGoogle Scholar
  10. 10.
    Li CI (2005) Racial and ethnic disparities in breast cancer stage, treatment, and survival in the United States. Ethn Dis 15((2 Suppl 2)):S5–S9PubMedGoogle Scholar
  11. 11.
    Hance KW, Anderson WF, Devesa SS, Young HA, Levine PH (2005) Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst 97(13):966–975PubMedCrossRefGoogle Scholar
  12. 12.
    DeNavas-Walt C, Proctor BD, Mill R (2007) Current population reports. US Census Bureau: P60-226.
  13. 13.
    Surveillance Epidemiology, and End Results (SEER) Program ( Limited-Use Data (1973–2005), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2008, based on the November 2007 submission
  14. 14.
    United States Census Bureau (2001) Profile of general demographic characteristics: 2000. Accessed 15 Nov 2008
  15. 15.
    Kell MR, Morrow M (2005) Surgical aspects of inflammatory breast cancer. Breast Dis 22:67–73PubMedGoogle Scholar
  16. 16.
    Buzdar AU, Montague ED, Barker JL, Hortobagyi GN, Blumenschein GR (1981) Management of inflammatory carcinoma of breast with combined modality approach—an update. Cancer 47(11):2537–2542. doi: 10.1002/1097-0142(19810601)47:11<2537::AID-CNCR2820471102>3.0.CO;2-X PubMedCrossRefGoogle Scholar
  17. 17.
    Knight CD Jr, Martin JK Jr, Welch JS, Ingle JN, Gaffey TA, Martinez A (1986) Surgical considerations after chemotherapy and radiation therapy for inflammatory breast cancer. Surgery 99(4):385–391PubMedGoogle Scholar
  18. 18.
    Zylberberg B, Salat-Baroux J, Ravina JH, Dormont D, Amiel JP, Diebold P, Izrael V (1982) Initial chemoimmunotherapy in inflammatory carcinoma of the breast. Cancer 49(8):1537–1543. doi: 10.1002/1097-0142(19820415)49:8<1537::AID-CNCR2820490805>3.0.CO;2-E PubMedCrossRefGoogle Scholar
  19. 19.
    Black MM, Speer FD (1957) Nuclear structure in cancer tissues. Surg Gynecol Obstet 105(1):97–102PubMedGoogle Scholar
  20. 20.
    Cristofanilli M, Buzdar AU, Hortobagyi GN (2003) Update on the management of inflammatory breast cancer. Oncologist 8(2):141–148. doi: 10.1634/theoncologist.8-2-141 PubMedCrossRefGoogle Scholar
  21. 21.
    Panades M, Olivotto IA, Speers CH, Shenkier T, Olivotto TA, Weir L, Allan SJ, Truong PT (2005) Evolving treatment strategies for inflammatory breast cancer: a population-based survival analysis. J Clin Oncol 23(9):1941–1950. doi: 10.1200/JCO.2005.06.233 PubMedCrossRefGoogle Scholar
  22. 22.
    Morris DM (1983) Mastectomy in the management of patients with inflammatory breast cancer. J Surg Oncol 23(4):255–258. doi: 10.1002/jso.2930230408 PubMedCrossRefGoogle Scholar
  23. 23.
    Fleming RY, Asmar L, Buzdar AU, McNeese MD, Ames FC, Ross MI, Singletary SE (1997) Effectiveness of mastectomy by response to induction chemotherapy for control in inflammatory breast carcinoma. Ann Surg Oncol 4(6):452–461. doi: 10.1007/BF02303668 PubMedCrossRefGoogle Scholar
  24. 24.
    Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239(6):818–825. doi: 10.1097/01.sla.0000128305.90650.71 (discussion 817–825)PubMedCrossRefGoogle Scholar
  25. 25.
    Dauplat J, Le Bouedec G, Pomel C, Scherer C (2000) Cytoreductive surgery for advanced stages of ovarian cancer. Semin Surg Oncol 19(1):42–48. doi: 10.1002/1098-2388(200007/08)19:1<42::AID-SSU7>3.0.CO;2-M PubMedCrossRefGoogle Scholar
  26. 26.
    Goldie JH, Coldman AJ (1979) A mathematic model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep 63(11–12):1727–1733PubMedGoogle Scholar
  27. 27.
    Hallissey MT, Allum WH, Roginski C, Fielding JW (1988) Palliative surgery for gastric cancer. Cancer 62(2):440–444. doi: 10.1002/1097-0142(19880715)62:2<440::AID-CNCR2820620232<3.0.CO;2-N PubMedCrossRefGoogle Scholar
  28. 28.
    Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R, Jarnagin W, Blumgart L (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197(2):233–241. doi: 10.1016/S1072-7515(03)00390-9 (discussion 232–241)PubMedCrossRefGoogle Scholar
  29. 29.
    Rosen SA, Buell JF, Yoshida A, Kazsuba S, Hurst R, Michelassi F, Millis JM, Posner MC (2000) Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg 135(5):530–534. doi: 10.1001/archsurg.135.5.530 (discussion 534–535)PubMedCrossRefGoogle Scholar
  30. 30.
    Tanaka K, Shimada H, Matsuo K, Nagano Y, Endo I, Sekido H, Togo S (2004) Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery 136(3):650–659. doi: 10.1016/j.surg.2004.02.012 PubMedCrossRefGoogle Scholar
  31. 31.
    Gnerlich J, Jeffe DB, Deshpande AD, Beers C, Zander C, Margenthaler JA (2007) Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Ann Surg Oncol 14(8):2187–2194. doi: 10.1245/s10434-007-9438-0 PubMedCrossRefGoogle Scholar
  32. 32.
    Giordano SH, Hortobagyi GN (2003) Inflammatory breast cancer: clinical progress and the main problems that must be addressed. Breast Cancer Res 5(6):284–288. doi: 10.1186/bcr608 PubMedCrossRefGoogle Scholar
  33. 33.
    Lee BTN (1924) Inflammatory carcinoma of the breast: a report of twenty-eight cases from the breast clinic of Memorial Hospital. Surg Gynecol Obstet 39:580–595Google Scholar
  34. 34.
    Greene FL (2002) The American Joint Committee on Cancer: updating the strategies in cancer staging. Bull Am Coll Surg 87(7):13–15PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Relin Yang
    • 1
  • Michael C. Cheung
    • 1
  • Judith Hurley
    • 2
  • Margaret M. Byrne
    • 3
  • Youjie Huang
    • 4
  • Teresa A. Zimmers
    • 1
  • Leonidas G. Koniaris
    • 1
    Email author
  1. 1.DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, Alan Livingstone Chair in Surgical OncologyUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Braman Family Breast Cancer Institute, Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Department of EpidemiologyUniversity of Miami Miller School of MedicineMiamiUSA
  4. 4.Bureau of EpidemiologyFlorida Department of HealthTallahasseeUSA

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