title: Inflammatory breast cancer: a proposed conceptual shift in the UICC-AJCC TNM staging system.
abstract: In the absence of histological criteria that distinguish between inflammatory and non-inflammatory breast cancer, diagnosis of inflammatory breast cancer relies entirely on the existence of clinical criteria as outlined by the TNM classification. This classification restricts patients presenting with clinical criteria characteristic of inflammatory breast cancer to subcategory T4d, which immediately relegates all patients with non-metastatic inflammatory breast cancer to stage 3, regardless of tumour size or nodal spread. Patients who present with metastatic disease are consigned to stage 4, and the TNM classification does not distinguish patients on the basis of the presence of inflammatory criteria. Evidence by our group and others suggests that patients with inflammatory breast cancer have significantly reduced overall survival among those who present with distant metastasis at diagnosis (stage 4). In light of these results, this Personal View addresses whether the current TNM staging classification accurately represents a distinction between patients with inflammatory and those with non-inflammatory breast cancer.
authors.affiliation: Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Medical Oncology, The National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Tamer M
authors.initials: TM
authors.lastname: Fouad
authors.affiliation: Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Angelica M Gutierrez
authors.initials: AMG
authors.lastname: Barrera
authors.affiliation: Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Reuben
authors.affiliation: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lucci
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Woodward
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stauder
authors.affiliation: Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Bora
authors.initials: B
authors.lastname: Lim
authors.affiliation: Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: DeSnyder
authors.affiliation: Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Banu
authors.initials: B
authors.lastname: Arun
authors.affiliation: Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Babiera
authors.initials: B
authors.lastname: Gildy
authors.affiliation: Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Vicente
authors.initials: V
authors.lastname: Valero
authors.affiliation: Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
authors.affiliation: Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: nueno@mdanderson.org.
authors.forename: Naoto T
authors.initials: NT
authors.lastname: Ueno
mesh_terms: D005260:Female; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000145:classification / Q000473:pathology*; D009367:Neoplasm Staging / Q000592:standards*