|
INFLAMMATORY BREAST CANCER
|
|
ALTERNATE NAMES
|
Inflammatory Breast Carcinoma; IBC |
|
DESCRIPTION
|
Inflammatory Breast Cancer
(IBC) is a type of breast cancer in which the breast looks red and swollen and feels warm.
The skin of the breast may also show the pitted appearance called peau d ‘orange (like
the skin of an orange). The redness and warmth occur because the cancer cells block
the lymph vessels in the skin. IBC accounts for 1 to 5% of all breast cancer cases
in the United States. It tends to be diagnosed in younger women compared to non-IBC
breast cancer. It occurs more frequently and at a younger age in the African American
population than in the White population. Like other types of breast cancer, IBC can
occur in men, but usually at an older age than in women.
|
|
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
|
Diagnostic testing:
-
•
Imaging and staging tests including a diagnostic mammogram and an ultrasound of the
breast and regional lymph nodes;
-
•
PET scan, CT, or bone scan to determine extent of metastases; and
-
•
A biopsy is obtained and generally shows pathologic dermal lymphatic invasion.
Physical findings: Individuals with this impairment may present with:
-
•
A rapid onset of erythema (redness), edema (swelling), and a peau d‘orange appearance
(ridged or pitted skin);
-
•
There also may be a heaviness with increase in breast size, abnormal breast warmth,
with or without a lump that can be felt; and
-
•
Swollen lymph nodes may be present under the arm or above the collarbone, but this
may also be present in infection or injury.
ICD-9: 174.9
ICD-10:
C50.91
|
|
PROGRESSION
|
IBC is more likely to have metastasized (spread to other areas of the body) at the
time of diagnosis than non-IBC cases. As a result of this and the general aggressive
nature of the disease, the 5-year survival rate for patients with IBC is between 25
and 50%, which is significantly lower than the survival rate for patients with non-IBC
breast cancer.
|
|
TREATMENT
|
Treatment for IBC consists of chemotherapy, targeted therapy, surgery, radiation therapy,
and hormonal therapy. Individuals may also receive supportive care to help manage
the side effects of the cancer and its treatment. Chemotherapy is generally the first
treatment for individuals with IBC; and when given prior to surgery, is called neoadjuvant
therapy. The use of this neoadjuvant treatment has dramatically improved response
rate, although long-term overall survival is still worse as compared with other forms
of breast cancer. After chemotherapy, individuals may undergo surgery and radiation
therapy to the chest wall. Both radiation and surgery are local treatments that affect
only cells in the tumor and the immediately surrounding area. After initial systemic
and local treatment, patients with IBC may receive additional systemic treatments
to reduce the risk of recurrence.
|
| SUGGESTED
PROGRAMMATIC ASSESSMENT* |
Suggested MER for
Evaluation:
-
•
Clinical documentation of the characteristic changes of the skin as described above
and a pathology report with a diagnosis of malignancy;
-
•
Clinical history and examination that describes the diagnostic features of the impairment;
-
-
-
•
Results of imaging tests (e.g. Diagnostic mammogram, PET scan, CT scan, or bone scans).
|
| Suggested Listings for
Evaluation: |
| DETERMINATION |
LISTING
|
REMARKS |
| Meets |
13.10 A |
Inflammatory Breast Cancer currently meets the criterion in 13.10 A. |
| Equals |
|
|
| * Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
|