The drug Herceptin has understandably grabbed the headlines for helping many young women with early-stage (HER2 positive) breast cancer. This is not the only form of breast cancer that can attack young people, however, and there is now an innovative treatment that can be successful with others.
Delegates to the Atlanta conference of the American Society of Clinical Ontology (ASCO) considered the case of a young woman who had complained that one of her breasts was inflamed, itchy and increasing in size. The skin over the whole of the breast was irritated, and was blotchy as if bruised. Her nipple area was excruciatingly itchy, inflamed and scaly.
The breast felt firmer and warmer than its companion and was growing by the day. There were no distinct lumps in her breast, though the skin was becoming dimpled like that of an orange. The breast was exquisitely tender, and there were enlarged veins coursing over its surface, betraying the activity in the tissue lying beneath them.
Her doctor could find no lump but sent her for a mammogram. This was pronounced negative and she was sent home. When she returned a week or two later, her affected breast was even larger and more inflamed, and she had a swollen gland under her arm. Her doctor immediately realised that his initial anxieties were justified. This patient was not suffering from some simple, late-adolescent mastitis but, most likely, from the dreaded inflammatory breast cancer.
The thickening of the skin and the swelling of the breast was the result of the blocking of its lymphatic drainage by cancerous cells. Meanwhile, the swollen lump beneath her arm was the result of the cancer spreading from her breast to her lymphatic nodes.
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A punch biopsy that went into the tissue below the skin, together with an MRI scan, confirmed this diagnosis. Mammograms are frequently inefficient when diagnosing inflammatory breast disease, and biopsies are worthwhile only if the doctor taking them makes certain that the specimens collected include tissue from beneath the skin.
Inflammatory breast cancer accounts for about 1 per cent of all breast cancers. The disease predominantly affects young women, even teenagers, but not necessarily pregnant ones. It usually spreads in sheets or nests rather than from a solid tumour, so it is often initially impossible to detect a lump.
In any case of mastitis, especially if there is no obvious cause (such as the first appearance of menstruation in young women, puberty in adolescent boys, prostate cancer in older men having treatment, or in nursing mothers) a biopsy is an appropriate precaution.
In Atlanta, a new regime was described which has been found to control inflammatory breast cancer in women who have already been treated with standard therapies without effect.
Dr Charles E Geyer showed that a combination of the drugs lapatinib and capecitabine doubled the patient’s survival time. Lapatinib is produced by GlaxoSmithKline and capecitabine by Roche.