Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.200 Inflammatory Breast Cancer
COMPASSIONATE ALLOWANCE INFORMATION
INFLAMMATORY BREAST CANCER
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 percent 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. Symptoms of IBC may include redness, swelling, and warmth in the breast, often without a distinct lump in the breast. Symptoms include heaviness, burning, aching, increase in breast size, tenderness, or a nipple that is inverted (facing inward). These symptoms usually develop quickly-over a period of weeks or months. Swollen lymph nodes may also be present under the arm, above the collarbone, or in both places. However, it is important to note that these symptoms may also be signs of other conditions such as infection, injury, or other types of cancer.
Inflammatory Breast Carcinoma, IBC, Locally Advanced Breast Cancer
DIAGNOSTIC TESTING AND CODING
Diagnosis of IBC is based primarily on the results of a doctor's clinical examination. Biopsy, mammogram, and breast ultrasound are used to confirm the diagnosis.
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 (anticancer drugs) 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 (cancer coming back).
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 percent, which is significantly lower than the survival rate for patients with non-IBC breast cancer.
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.
Suggested Listings for Evaluation:
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Inflammatory Breast Cancer currently meets Listing 13.10A