High Proportion of Inflammatory Breast Cancer in the Population‐Based Cancer Registry of Gharbiah, Egypt

To the Editor: Inflammatory breast cancer (IBC), the most lethal form of breast cancer, constitutes 1-2% of all breast cancers in the United States (1). Breast cancer com­ prises 352% of women's cancers in the Gharbiah can­ cer registry (GCR) of Egypt (2). Hospital-based studies from the National Cancer Institute of Cairo University (NCI-Cairo) in Egypt suggested that IBC accounts for 10% of breast cancers (3). However, these estimates lacked confirmation from population- based studies. To remedy this deficit, we performed this study to evaluate the frequency and features of IBC in GCR. Our initial review of GCR data between 1999 and 2003 showed that IBC did not exist despite the clini­ cal experience with frequent cases of IBC at the GCR and the 10% relative frequency of the disease at NCI- Cairo. A multi-disciplinary group of physicians in Egypt and the United States, who were experienced in the diagnosis and management of IBC, collaboratively developed an 84-item checklist of symptoms, signs, and clinical characteristic suggestive of IBC to facili­ tate and standardize abstraction of information from medical records. IBC cases were identified using the simplified clinical definition of Merajver and Sabel (4) that used erythema, edema, and peau d'orange as the three main clinical features of IBC. Subsequently, cases were grouped as follows: most-likely IBC exhib­ ited all three features, possible IBC cases had any two of the three symptoms or had peau d'orange only, and non-IBC cases had edema only, erythema only, or had none of these three clinical features. IBC status was based on clinical criteria for IBC diagnosis (erythema, edema, and peau d'orange). The checklist was applied to all cases that had at least one of the three defining features of IBC and missing data was denoted.