TN 20 (12-18)

DI 23022.200 Inflammatory Breast Cancer

COMPASSIONATE ALLOWANCE INFORMATION

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 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. The 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. 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

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.

  • Pathology reports.

  • Operative reports.

  • 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.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022200
DI 23022.200 - Inflammatory Breast Cancer - 12/13/2018
Batch run: 12/13/2018
Rev:12/13/2018