Inflammatory Breast Cancer in Tunisia from 2005 to 2010: Epidemiologic and Anatomoclinical Transitions from Published Data

  • Mejri, N. (Department of Medical Oncology, University Hospital A Mami) ;
  • Boussen, H. (Department of Medical Oncology, University Hospital A Mami) ;
  • Labidi, S. (Department of Medical Oncology, University Hospital A Mami) ;
  • Bouzaiene, H. (Department of Radiotherapy, Institute Salah Azaiez) ;
  • Afrit, M. (Department of Medical Oncology, University Hospital A Mami) ;
  • Benna, F. (Department of Radiotherapy, Institute Salah Azaiez) ;
  • Rahal, K. (Department of Surgical Oncology, Institute Salah Azaiez)
  • Published : 2015.03.04


Aim: To report epidemiologic and anatomoclinical transitions of inflammatory breast cancer (IBC) in Tunisia. Materials and Methods: Data including clinico-pathological data for 208 cases of T4d or PEV 3 non-metastatic breast cancer diagnosed between 2005 and 2010 were collected from patient records. Chi2 and Z tests were used to compare variables with two Tunisian historical series and a series about Arab-American patients. Results: Thirty three percent of our patients had their first child before 23 years of age and 56% had their menarche before 12 years, 75% never receiving oral contraception. Obesity was observed in 42% of women and IBC occurred during pregnancy in 13% of cases. Tumor grade was II-III in 90% of cases, HR was negative in 52%, HER2 was over expressed in 31% and invasion of more than 3 axillary nodes occurred in 18% of patients. We observed a pCR rate of 19% after neoadjuvant treatment (anthracyline-taxane used in 79%, trastuzumab in 27% ). Compared to historical Tunisian series (since 1996), IBC epidemiology remained stable in terms of median age, menopausal status and obesity. However we observed a significant decrease in median clinical tumor size and number of positive axillary lymph nodes. Comparison to IBC in Arab-Americans showed a significant difference in terms of median age, menopausal status, positivity of hormonal receptors and educational level. Conclusions: Our assessment of epidemiologic transition showed a reduction of clinco-pathological stage of IBC, keeping the same characteristics as compared to Tunisian historical series over a period of 14 years. Features seem to be different in Arab-American patients, probably related to migration, "occidentalization" of life style and improvement in socio-economic level.


  1. Amiri-Kordestani L, Kamangar F, Zujewski JA (2013). Inflammatory breast cancer: yet another risk of the obesity epidemic? J Natl Cancer Inst, 105, 1340-2.
  2. Boussen H, Bouzaiene H, Ben Hassouna, et al (2010). Inflammatory breast cancer in Tunisia. Cancer, 116 (S11), 2730-35.
  3. Chang S, Buzdar AU, Hursting SD (1998). Inflammatory breast carcinoma incidence and survival. Cancer, 82, 2366-72.<2366::AID-CNCR10>3.0.CO;2-N
  4. Chouchane L, Boussen H, Sastry KS (2013). Breast cancer in Arab populations: molecular characteristics and disease management implications. Lancet Oncology, 14, 417-424.
  5. Corbex M, Bouzbid S, Boffetta P (2014). Features of breast cancer in developing countries, examples from North-Africa. Eur J Cancer, 50, 1808-18.
  6. Dawood S, Lei X, Dent R (2014). Survival of women with inflammatory breast cancer: a large population-based study. Ann Oncol, 25, 1143-51.
  7. Gogia A1, Raina V, Deo SV, et al (2014) Inflammatory breast cancer: a sinqory breast cancer in women, 1992–2009, United States. Ann Surg Oncol, 21, 1267-270
  8. Hance KW, Anderson WF, Devesa SS, et al (2005). Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst, 97, 966-75.
  9. Hirko KA, Soliman AS, Banerjee M, et al (2013). Characterizing inflammatory breast cancer among Arab Americans in the California, Detroit and New Jersey Surveillance, Epidemiology and End Results (SEER) registries (1988-2008). SpringerPlus, 2, 1-8.
  10. Labidi SI, Mrad K, Mezlini A, et al (2008). Inflammatory breast cancer in Tunisia in the era of multimodality therapy. Ann Oncol, 19, 473-80.
  11. Lè MG, Arriagada R, Contesso G, et al (2005). Dermal lymphatic emboli in inflammatory and noninflammatory breast cancer: a French-Tunisian joint study in 337 patients. Clin Breast Cancer, 6, 439-45
  12. Levine PH, Veneroso C (2008). The epidemiology of inflammatory breast cancer. Seminars in oncology, 35, 11-16
  13. Mourali N, Muenz LR, Tabbane F, et al (1980). Epidemiologic features of rapidly progressing breast cancer in Tunisia. Cancer, 46, 2741-6.<2741::AID-CNCR2820461234>3.0.CO;2-W
  14. Natori A, Hayashi N, Soejima K, et al (2013). A comparison of epidemiology, biology, and prognosis of inflammatory breast cancer in Japanese and US populations. Clin Breast Cancer, 13, 460-4.
  15. Rehman S, Reddy CA, Tendulkar RD (2012). Modern outcomes of inflammatory breast cancer. Int J Radiat Oncol Biol Phys, 84, 619-24.
  16. Robert SA, Strombom I, Trentham-Dietz A, et al (2014). Socioeconomic risk factors for breast cancer: distinguishing individual- and community-level effects. Epidemiology, 15, 442-50.
  17. Robertson FM, Bondy M, Yang W, et al (2010). Inflammatory breast cancer: the disease, the biology, the treatment. CA: A Cancer J Clin, 60, 351-75.
  18. Schairer C, Li Y, Frawley P, et al (2013). Risk factors for inflammatory breast cancer and other invasive breast cancers. J Natl Cancer Inst, 105, 1373-84.
  19. Schlichting J, Solima AS, Schairer C, et al (2012). Association of inflammatory and noninflammatory breast cancer with socioeconomic characteristics in the Surveillance, Epidemiology, and End Results Database, 2000-2007. Cancer Epidemiology Biomarkers & Prevention, 21, 155-65.
  20. Schlichting JA, Soliman AS, Schairer C, et al (2012). Inflammatory and non-inflammatory breast cancer survival by socioeconomic position in the Surveillance, Epidemiology, and End Results database, 1990-2008. Breast Cancer Res Treat 134, 1257-68.
  21. Schinkel JK, Zahm S H, Jatoi I, et al (2014). Racial/ethnic differences in breast cancer survival by inflammatory status and hormonal receptor status: an analysis of the surveillance, epidemiology, and end results data. Cancer Causes Control, 1-10.
  22. Shahbaz M, Lean HH (2012). Does financial development increase energy consumption? The role of industrialization and urbanization in Tunisia. Energy Policy, 40, 473-9.
  23. Veneroso C, Siegel R, Levine PH (2008). Early age at first childbirth associated with advanced tumor grade in breast cancer. Cancer Detect Prev, 32, 215-223

Cited by

  1. Clonal Evolutionary Analysis during HER2 Blockade in HER2-Positive Inflammatory Breast Cancer: A Phase II Open-Label Clinical Trial of Afatinib +/- Vinorelbine vol.13, pp.12, 2016,
  2. Biological features of inflammatory breast cancer in North Africa: burden and research priorities vol.7, pp.2, 2018,
  3. Outcome of inflammatory breast cancer in Moroccan patients: clinical, molecular and pathological characteristics of 219 cases from the National Oncology Institute (INO) vol.18, pp.1, 2018,