One in eight American women will get breast cancer in their lifetime and as many as 20% of cases are missed by routine mammogram screening. The prevalence of this disease and the difficulty of diagnosis make breast cancer one of the leading health concerns for women. But it doesn’t have to be that way.
The Cell Death and Stress Sciences Laboratory at Duke University is making significant strides in the fight against cancer through cutting-edge research on inflammatory breast cancer (IBC). The lab is led by Dr. Gayathri Devi, a Duke University School of Medicine professor and Program Director of the Duke Consortium for Inflammatory Breast Cancer and the Awareness of Rare Cancer Initiative, a program supported by the Duke Cancer Institute. IBC accounts for 2-4% of all breast cancers yet leads to 8-10% of deaths, a disproportionately high rate that underscores the difficulties in diagnosing and treating this rare and aggressive form of breast cancer.
Above: Women’s Cancer Care center in Raleigh, NC (operated by the Duke Cancer Institute). Image courtesy of the Duke Cancer Institute.
Inflammatory breast cancer differs from more common types of breast cancers (such as ductal carcinoma) in several ways. In IBC, cancerous cells growing in breast tissue spread to nearby lymphatic vessels, causing the characteristic inflammation. Because of this unusual growth pattern, doctors diagnose IBC starting at Stage III—at which point the cancer has already spread to the skin. Another reason this unusual pathology is so sinister is that IBC does not form a tissue lump, making it difficult to detect with a mammogram and less noticeable to afflicted individuals. IBC is also more aggressive and spreads more quickly than other types of breast cancer. The five-year relative survival rate of IBC is 39%, meaning that women with IBC are 39% as likely to live for five years post-diagnosis as women in the general population.
Symptoms of IBC include rapid changes in the appearance of just one breast (such as thickness, heaviness, swelling, or abnormal warmth), development of a reddish-purple bruise-like color or an orange peel-like dimpling texture, tenderness and aches, flattened or inward-turned nipples, and enlarged lymph nodes. Women under 40 years old, Black women, and women with obesity are most likely to be diagnosed with IBC. IBC is diagnosed with physical exams and imaging techniques such as mammograms and ultrasound and must be confirmed with a biopsy sample. Treatment includes a combination of chemotherapy, surgery, radiation therapy, and hormone therapy.
Above: Symptoms of inflammatory breast cancer. Image courtesy of the Cleveland Clinic.
The Cell Death Lab works to combat IBC by studying its molecular mechanisms. In particular, researchers study how normal and cancerous cells signal stress-induced death—earning the lab its name—and how these differences relate to the body’s immune response to cancer. Through these efforts, researchers have identified a family of proteins called Inhibitors of Apoptosis Proteins (IAPs), which function to promote cancer cell survival. Understanding their role could help illuminate how and why cancerous IBC cells spread so quickly and aggressively. Current research also aims to find why the lymphatic immune system has difficulties targeting IBC’s cancerous cell clumps and researchers have pioneered innovative 3D-bioengineered models to better investigate these questions. Beyond molecular mechanisms, the lab also investigates the broader-scale causes of IBC, exploring how environmental factors and population health may impact IBC incidence.
The Cell Death Lab’s work isn’t just limited to the lab. The lab’s team—consisting of researchers, clinicians, population health scientists, and advanced practice providers—is invested in advancing awareness about this rare cancer, with outreach efforts such as the Duke Rare Cancer Trainee Coalition, a club led by two of the lab’s undergraduate researchers, Hillary Hsu (Trinity ’25) and Kate Reddy (Trinity ’25). The club’s goal is to “connect research on rare cancers with advocacy and community outreach,” Hsu said. “Rare diseases affect more people than even I had thought. It is really amazing to connect with students, faculty, and community members who share their research and personal experiences dealing with rare cancers.” The club has raised awareness about IBC symptoms and research through events like What's Best for Breasts?, an annual community health education event organized by Duke Health, and Rare Disease Day, an annual day for rare disease awareness. The Duke Rare Cancer Trainee Coalition is eager to gain support from anyone interested in advancing health outcomes and welcomes new members. Keep an eye out for future outreach events organized by the club, and stay tuned for more groundbreaking research from the Cell Death Lab as it continues to work on the front lines of inflammatory breast cancer research.
Above: Members of the Duke Rare Cancer Trainee Coalition tabling on the Bryan Center Plaza to spread awareness for Rare Disease Day (Feb. 28) 2025. Image courtesy of Hillary Hsu Trinity ’25.
