Young Age, Triple-Negative Disease May Increase Brain Metastases Risk in Inflammatory Breast Cancer

These results, which showed that a patient with inflammatory breast cancer may have an increased risk for brain metastases if certain factors are present, may alert patients and doctors to consider routine brain scans while they undergo treatment for their disease.

Results from a recent study of patients with inflammatory breast cancer determined that several factors may increase the risk for brain metastases including a young age at the time of diagnosis, triple-negative breast cancer and visceral metastases (occurring in the soft internal organs).

Study author Dr. Laura E.G. Warren, assistant professor of radiation oncology at Brigham and Women’s Hospital in Boston, told CURE® that these risk factors — particularly regarding triple-negative disease — have also been seen in patients with noninflammatory breast cancer.

“Unfortunately, triple-negative breast cancer remains the most challenging breast cancer … to treat and we have the most work to do,” Warren said in an interview. “But the prognosis is the worst of the tumor subtypes within breast cancer. I think part of it is just the natural history of triple-negative breast cancer, it’s more aggressive.”

She added that aggressive disease is also common in younger patients.

“Their cancer is just biologically more aggressive,” Warren said. “I think in some ways, what we saw (in this study) is all of our risk factors were consistent with what generally is a more aggressive breast cancer to begin with. So (these findings) weren’t surprising because frankly, they’re also risk factors for distant disease in general, not just in the brain.”

Inflammatory Breast Cancer

Inflammatory breast cancer is a specific type of breast cancer that affects the lymph vessels and causes the skin of the breast to become red, swollen and enlarged, with many patients developing thick pitted skin, according to the American Cancer Society. Since the symptoms of this cancer may also be explained by infections or other inflammatory issues, patients are not often immediately diagnosed. By the time a patient displays these symptoms, the cancer has already spread to the lymph nodes, and many patients are therefore diagnosed when their disease has become distantly metastatic.

Though inflammatory breast cancer is rare and only affects up to 5% of breast cancer cases, it is often severe and therefore a difficult diagnosis.

In this current study, researchers performed a review of 531 patients diagnosed with inflammatory breast cancer between 1997 and 2019. Of these patients, 372 had stage 3 disease and 159 had stage 4 de novo disease (diagnosed once the cancer has spread to other parts of the body).

Researchers found that 23% of patients in the review developed brain metastases. A slightly larger percentage (30%) already had metastatic disease at the time their inflammatory breast cancer was diagnosed, though this includes patients whose metastases were not in the central nervous system.

During a median follow-up of 5.6 years, the incidence of brain metastases in patients with stage 3 disease was 5% at one year, 9% at two years and 18% at five years. These rates were 17%, 30% and 42%, respectively, in patients with stage 4 disease after a median follow-up of 1.8 years.

Impact of Study Findings

Warren discussed the possibility of adding brain imaging to the care plans of patients with breast cancer due to the high associated risk.

“I tried to put myself in in the patient's seat,” Warren said. “Nobody wants to be told that they're at a high risk of developing cancer to their brain. I think that's a scary thought for all of us. I want to offer some optimism there too. I do think knowing these data is helpful. Knowing these data to me means we can share with patients, ‘Let us know, if you're having any symptoms, come in early, we will find out, we will get a brain MRI, we will know.’”

Of note, 70% of patients in the study had symptoms when receiving a diagnosis of brain metastases.

“One could imagine there's a whole slew of people who have brain metastases potentially that are asymptomatic and they're not getting imaged,” Warren said. She also hopes that these data, although sobering, offer patients some hope especially after receiving a diagnosis.

“Just because the cancer has spread to the brain doesn't mean that there aren't options. There are lots of options,” she concluded. “We just first need to know that that's happened. Then we have a number of options that we can explore to treat you.”

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