Synopsis
Recognise inflammatory breast cancer within apparent mastitis, trigger urgent imaging and representative biopsy when inflammation is atypical or non-resolving, and avoid diagnostic delay from repeated empirical antibiotics.
- Inflammatory breast cancer is a clinical pattern of rapid erythema, oedema and enlargement caused by dermal lymphatic tumour involvement, often without a discrete palpable mass.
- Mastitis is more likely during lactation with pain, fever and milk-stasis triggers, but age or breastfeeding status alone cannot exclude cancer.
- Features of concern include peau d’orange, diffuse skin thickening, rapid progression, nipple change, abnormal nodes, absent pus and failure to respond to appropriate antibiotics and drainage.
Key red flags
Diffuse peau d’orange, rapid breast enlargement, nipple retraction or abnormal nodes without a drainable collection requires urgent suspected-cancer assessment.
Investigation priorities
Identify mass, distortion, calcification, skin thickening and disease distribution.
Management branches
A non-lactating 58-year-old has diffuse erythema and swelling without an abscess and no improvement after a suitable antibiotic course.
- Reassess the entire breast and nodes, documenting area of skin involvement, peau d’orange, nipple change, temperature and systemic state.
- Use the suspected-cancer route under NG12 rather than prescribing a second empirical course without a new infective finding.