Redirecting the Radar:
Sisters Raise Awareness of Hard-to-Detect Inflammatory Breast Cancer
By: Mary Jo Layton (The Record, New Jersey)
Melissa Bruchman and her sisters are well-versed in breast cancer detection:
monthly self-exams, regular visits to the gynecologist, and annual mammograms to spot
tumors.
Yet none of the precautions helped Bruchman, who nearly died from a rare and
extremely aggressive type of breast cancer known as Inflammatory Breast Cancer (IBC).
The disease, one of the deadliest types of cancer, often develops without the
forming of a tumor, making it nearly impossible to detect in routine diagnostic tests.
The symptoms are a red rash on the breast that can be hot tot the touch, painful or
swollen breasts, or even a bruise.
Too often, the cancer is misdiagnosed as a breast infection. Doctors mistakenly
prescribe antibiotics while the cancer thrives, undetected for weeks or months. In fact,
women with this cancer are typically diagnosed when they are in Stage 3, just a step
away from the most fatal phase when the disease has spread to other organs and is
considered incurable.
This type of cancer amounts for up to 5% of the 215,000 cases of breast cancer
diagnosed each year in the United States. It occurs when cancer cells block the lymph
vessels in the skin of the breast, causing the breast to become red, swollen, and warm.
“It invades the lymphatic system and the bloodstream much quicker,” said Dr.
Stanley Waintraub, Chief of Breast Cancer Services at Hackensack University Medical
Center. “It’s like poison in the air system in a building. When you invade the lymphatic
system of a person, you have a transport network for the cancer all over your body.”
After her sister Melissa’s hellish battle with the disease, Barbara Bogart launched
a crusade to help other women get diagnosed and treated much more quickly. Last
month, the Ridgewood, New Jersey resident organized a dinner for 40 Bergen County
physicians and specialists to increase awareness of the disease.
Dr. Michael F. Wesson of Valley Hospital in Ridgewood attended and applauded
the efforts to inform doctors, especially primary care physicians, that breast cancer may
present with a variety of symptoms rather than just a lump.
“It’s so rare, you don’t look for this type of cancer,” said Wesson, Co-Director of
Valley’s Department of Radiation Oncology. Women, too, are often unaware that a
potential rash or change in skin – in some cases that resembles the dimpled look and tint
of an orange- could be an aggressive cancer.
Bogart has handed out pamphlets at her local Rite-Aid and in nails salons and
plans on speaking at a symposium on breast cancer at George Washington University in
Washington, D.C., this month with her sister at her side.
“Melissa was in so much pain for so many months,” said Bogart, a mother of two
and daughter-in-law of the late film legend. “It was so frustrating not knowing what we
were dealing with.”
Bruchman’s terrible journey began in the summer of 2002, when her breasts
became swollen and tender. She bought new bras, only to outgrow them quickly –
despite losing 12 pounds in preparation for her daughter’s wedding. She would change
bras five times a day and still couldn’t get comfortable.
Bruchman, who lives in Cold Spring Harbor, New York, chalked up the changes
in her body to impending menopause. After all, she was in her late 40s. She never
suspected cancer.
In early November 2002, she noticed a red rash the size of a quarter on top of her
right breast. Her yearly mammogram and ultrasound were done around that time and
showed no abnormalities.
Her physician prescribed antibiotics to clear up what was a suspected case of
mastis – a breast infection. The doctor mentioned the possibility of IBC, so Bruchman
went to a breast surgeon in January.
“She basically said to me, ‘Why are you here?’ ” Bruchman said. “ ‘You have a
negative sonogram and a negative mammogram. You’re fine.’ “
Several more weeks of antibiotics yielded no change in her breasts. Bruchman
consulted another specialist.
It’s a familiar story to many advocates, who insist doctors are often reluctant to
suspect breast cancer if a mass is not detected.
“You have to be your own doctor and absolutely insist on a biopsy,” said Marilyn
Kirschenbaum, Vice President of IBC Research Foundation, a Washington advocacy
group. Kirschenbaum became an advocate after her daughter, Karen, developed IBC at
age 39. Her daughter is a seven-year survivor of the disease.
“Fortunately, we’ve been brainwashed about the lump,” said Kirschenbaum.
“Unfortunately, we don’t realize that there could be other symptoms. It’s time to move
on and start educating more women that there’s more than one type of breast cancer.”
For Bruchman, it wasn’t until February 2003 that a biopsy of a suspicious area in
her breast was done and the breast surgeon confirmed she had cancer. Even then,
specialists were unaware that she had IBC, which requires intensive chemotherapy long
before surgery.
Bruchman underwent a lumpectomy. But in the days following surgery, she
developed a fever, severe pain, and a rash that stretched from her chest around her back.
“I was plum-colored, and the drumbeat of pain was unbearable,” she said.
Bruchman’s condition worsened at home, where she was on intravenous
antibiotics that didn’t seem to help.
“I really thought a couple of times a week that I was dying,” she said.
Her sister tracked down yet another specialist who finally zeroed in on the
disease. A skin biopsy confirmed that Bruchman had IBC, a diagnosis that launched an
aggressive treatment: intensive chemotherapy, then in October, modified radical
mastectomy followed by intensive radiation.
Bruchman endured daily doses of radiation to her chest wall and clavicle area for
about a month. In February, a follow-up mammogram revealed trouble spots in her left
breast.
“At that point, we just decided to do a simple mastectomy,” she said. Last month,
she had another round of breast surgery. And her prognosis is great, she said.
In March she became a grandmother, and she looks forward to sharing in young
Amelie’s life.
“I’m so lucky to see every day and not be sick,” she said.
The sisters want to ensure other women will be able to say the same thing.
Symptoms
Not all cases of breast cancer are detected when a lump is discovered by a woman or
revealed in a mammogram. In cases of Inflammatory Breast Cancer, a tumor is rarely
found. Here are the symptoms women should look for to recognize this rare but
extremely aggressive cancer:
 A rash or redness on the breast that may be warm to the touch.
 Swollen, painful, or itchy breasts.
 A change in skin texture that can resemble the peel of an orange.
For more information:
Cancer.org
MayoClinic.org
IbcResearch.org
IbcSupport.org