Three years ago, Indonesian housewife Dian (not her real name) felt a lump in her right breast. She was 37 years old then, married with three children.

She knew about breast cancer but dismissed that possibility because throughout her life, she had rarely been ill, even with the flu.

Three months after she felt that lump, her breast began to redden and swell.

When Dian decided to fly to Singapore to seek treatment from Associate Professor Hong Ga Sze, head and senior consultant at KK Women's and Children's Hospital's KK Breast Centre, she was not sure of what to expect even though her family doctor in Indonesia had told her she had breast cancer.

'I couldn't really believe what was happening to me because I had not heard about breast cancer making the skin of the breast so red and raw,' she said.

Dr Hong diagnosed her condition as Inflammatory Breast Cancer (IBC), a rare and aggressive form of breast cancer.

He said IBC tends to strike younger women more so than non-IBC.

IBC accounts for 1 to 3 per cent of breast cancer cases in the United States. Dr Lee Soo Chin, senior consultant at the National University Hospital's (NUH) department of haematology-oncology, said NUH treats five to 10 new IBC patients annually.

Dian underwent chemotherapy followed by a mastectomy. She has been seeing Dr Hong every six months for regular check-ups because IBC has a high recurrence rate.

Unlike Dian, most women suffering from IBC rarely develop the tell-tale sign of a lump, making it difficult to identify.

'Due to similar symptoms, it is not uncommon for IBC to be misdiagnosed as mastitis, a fairly common breast infection,' said Dr Lee.

Madam Lim Snow Jade, 53, developed IBC four years ago. When Madam Lim, who is an active church volunteer and the wife of a pastor, first experienced itchy red skin around her left nipple, she thought little of it.

She said: 'There was no pain and I didn't feel sick, so I thought it was just a minor rash.'

According to Dr Wong Seng Weng, consultant medical oncologist at The Cancer Centre, IBC rapidly infiltrates the skin of the breast and clogs up the blood and lymphatic channels. This causes the breast to become congested, leading to pain, swelling, redness, warmth and thickening of the skin.

Madam Lim, who has three children and an adopted daughter, sought medical advice when the 'minor rash' on her breast did not disappear after five months.

She had chemotherapy for about three months at NUH before undergoing a mastectomy, followed by more chemotherapy and radiotherapy.

She never felt nauseous during chemotherapy.

'Sometimes, I even went shopping after my chemo sessions,' she said.

Madam Lim thinks public awareness of IBC is important. Had she been aware of the symptoms of IBC, she would definitely have sought medical treatment earlier.

She said: 'I never felt any lumps in my breast so I didn't think I had developed breast cancer.'

She is aware that IBC often has a high recurrence rate, but she maintains an upbeat outlook.

She said: 'Cancer is not the end of the world. Worrying doesn't help at all. I try to keep a positive attitude, pray for my blessings and enjoy life.'

This article was first published in Mind Your Body, The Straits Times on Oct 2, 2008.