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Clinico-pathologic and mammographic characteristics of inflammatory and non-inflammatory breast cancer at six centers in North Africa

  • Epidemiology
  • Published:
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Abstract

Purpose

We describe the clinico-pathologic and mammographic characteristics of inflammatory breast cancer (IBC) and non-IBC cases enrolled in a case–control study. Because IBC is a clinico-pathologic entity with rapid appearance of erythema and other signs, its diagnosis is based on clinical observation and thus, by necessity, subjective. Therefore, we evaluate our cases by photographic review by outside expert clinicians and by degree of adherence to the two most recent definitions of IBC: the international expert panel consensus statement and American Joint Committee on Cancer (AJCC) 8th edition (we used the slightly less restrictive 7th edition definition for our study).

Methods

We enrolled 267 IBC and 274 age- and geographically matched non-IBC cases at 6 sites in Egypt, Tunisia, and Morocco in a case–control study of IBC conducted between 2009 and 2015. We collected clinico-pathologic and mammographic data and standardized medical photographs of the breast.

Results

We identified many differences between IBC and non-IBC cases: 54.5% versus 68.8% were estrogen receptor-positive, 39.9% versus 14.8% human epidermal growth factor receptor 2-positive, 91% versus 4% exhibited erythema, 63% versus 97% had a mass, and 57% versus 10% had mammographic evidence of skin thickening. Seventy-six percent of IBC cases adhered to the expert panel consensus statement and 36% to the AJCC definition; 86 percent were confirmed as IBC by either photographic review or adherence to the consensus statement.

Conclusions

We successfully identified distinct groups of IBC and non-IBC cases. The reliability of IBC diagnosis would benefit from expert review of standardized medical photographs and associated clinical information.

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Acknowledgements

We are very grateful to the women who participated in this study. We also thank the following individuals for their important contributions to the study, including identifying, enrolling, and interviewing study subjects, study management, data keying, logistical support, and translation: Tanta Cancer Center/Gharbiah Cancer Society: Dr. Salwas Samir, Dr. Eman Sobhy, Dr. Mohammed El Kholy, Mr. Khalid Dabboos, Ms. Hanaa Elmenshawy; NCI Cairo: Dr. Gamal Amira, Dr. Ahmed El Bastawisy, Dr. Heba Mohamed El Leethy, Dr. Usama Farouk El Nagar, Dr. Maha Yehia, Ms. Walaa Emara, Ms. Magda Hassan, Ms. Hanan Mabrouk; Institute Salah Azaiz: Dr. Karima Mrad, Dr. Dalenda Hentati, Dr. Houda Belfekih, Dr. Nesrine Chraiet, Dr. Amira Daldoul, Dr. Mouna Ayadi, Dr. Bassem Alani, Ms. Leila Fadhlaoui, Ms. Neila Ben Hassen; Ibn Rochd Oncology Center: Prof. Nadia Benchakroun, Dr. Hoda Eddakaoui, Dr. Myriam Hatime, Dr. Soufya Majdoul, Dr. Fadwa Qachach, Dr. Basma Billal, Dr. Hajar Kouss, Dr. Noureddine Matar, Dr. Iman Meziane, Dr. Sara Belkheiri, Dr. Karima Bendahhou, Dr. Majdouline Khounigere, Dr. Ibrahim Khalil Ahmadaye; University Hospital Center Mohammed VI: Dr. Mariam Affane, Dr. Sana Zabroug, Dr. Mouna Darfaoui, Mr. Hicham Jabraoui; IMS (data management and keying): Ms. Leslie Carroll, Mr. Bob Banks, Ms. Bette Griffith, Dr. Carol Giffen, Mr. Michael Spriggs; NCI-USA (logistical support): Mr. David Check, Ms. Prisca N. Fall; Westat (translation): Ms. Susan Crystal-Mansour, Ms. Jerelyn Bouic. The National Institutes of Health National Library of Medicine Interaction Tool used in this work was developed by the Communications Engineering Branch of the National Library of Medicine (Mr. Rodney Long and Mr. Leif Neve). We would also like to thank the CEESP students who assisted in different parts of the study during their CEESP projects.

Funding

The National Cancer Institute Intramural Research Program (CS), the Breast Cancer Research Foundation (SDM), the Metavivor Foundation (SDM), The Cancer Epidemiology Education in Special Populations (CEESP) Program—Grant R25 CA112383 (ASS).

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Correspondence to Catherine Schairer.

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Conflict of interest

Sandra Swain reports receiving honoraria from Novartis, personal fees from Cardinal Health, Daiichi-Sankyo, Eli Lilly & Co., Genentech/Roche, Genomic Health, Inivata, Peiris Pharmaceuticals, Tocagen; research support from Genentech; travel and accommodations from Caris Centers of Excellence, Daiichi-Sankyo, Eli Lilly & Co., Genentech/Roche, NanoString Technologies; and remuneration from AstraZeneca for participation on OlympiA IDMC. The other authors declare they have no conflicts of interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committees.

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Schairer, C., Hablas, A., Eldein, I.A.S. et al. Clinico-pathologic and mammographic characteristics of inflammatory and non-inflammatory breast cancer at six centers in North Africa. Breast Cancer Res Treat 176, 407–417 (2019). https://doi.org/10.1007/s10549-019-05237-5

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