Inflammatory breast cancer gets a closer look in North Africa and the Middle East

The Breast Cancer Research Foundation's Sofia Merajver, MD, PhD, of the University of Michigan Comprehensive Cancer Center in Ann Arbor, is a pioneer of U.S. and international research on inflammatory breast cancer, with ongoing studies in Egypt, Tunisia and now Morocco.

Inflammatory breast cancer is aggressive and challenging to treat because it is often not diagnosed until it reaches a late stage. The disease begins in the breast duct tissue, but it does not stay there long, spreading quickly to lymphatic vessels in the skin and surrounding tissue causing the breast to become swollen, red and hot.

Luckily, the incidence of inflammatory breast cancer in the United States is very low, hovering at 1-2 percent of all breast cancers. In other parts of the world, such as Northern Africa and the Middle East, the picture is much worse. There, 15 percent of all breast cancer cases are inflammatory, posing a serious public health problem. The very existence of these studies has improved the level of detection and primary treatment of inflammatory breast cancer in these three countries by partnering international researchers with local doctors and clinics for a more systematic response to the disease. In addition, the teams are starting new programs to educate the community and raise awareness of the importance of early detection of the disease.

Merajver's primary interests are in determining how inflammatory breast cancer cells move and invade other tissues and understanding why the disease is more common in certain areas such as the Nile Valley and Northern Africa. To this end, she and her colleagues are looking at the "genetic signature" of inflammatory breast cancer in populations where there is a higher incidence of it. In a new publication, Merajver and her colleagues confirm that women in the Nile Delta (lower Egypt) have a form of the disease that is very aggressive, but so far appears to have a similar genetic signature to the U.S. cases. This study provides answers, but also new questions. Why are women in North Africa more susceptible to inflammatory breast cancer; what are the reproductive and environmental factors that favor this type of cancer? To find answers and accelerate progress, Merajver and her colleagues are studying environmental factors, reproductive history and viruses as possible complicating culprits in the occurrence and determinants of the prognosis of inflammatory breast cancer throughout the world.

This year's BCRF funding has allowed the Michigan-based oncologist and researcher to establish the first dedicated inflammatory breast cancer clinic in Ann Arbor (only the second such clinic in the whole country). Since October 2007 the patient traffic has doubled, both in terms of those seeking primary diagnosis and second opinions. "This disease has a disproportionate burden of morbidity and mortality; these patients warrant special and extremely prompt attention," says Merajver. "The clinic is helping us help more women with the disease and track the specifics of a greater number of cases so we can better understand it, too. Soon we hope to have a definitive molecular signature of this disease and better drugs based on signaling pathways that are activated in inflammatory breast cancer. We need to stop its enormous capacity to spread."