What is Paget’s Disease
Paget’s disease is a rare type of breast cancer (representing only 1% of cases of this type of neoplasm) that occurs in the skin of the nipple and areola, usually affecting only one breast.
In 80% to 90% of cases, it is associated with ductal carcinoma in situ (DCIS), a cancer with very low risk of spread. Less frequently, it may be associated with invasive carcinoma, which requires more careful treatment.
Symptoms of Paget’s disease
When the disease manifests, the skin of the nipple and areola typically appears scaly and red. There may be blood or yellowish discharge from the nipple, along with a burning sensation and itching. In some cases, the nipple may appear flattened or inverted. Its main symptoms are:
- Redness and irritation of the nipple and/or areola;
- Crusting and scaling of the nipple area;
- Bleeding from the skin of the nipple and/or areola;
- Yellowish fluid or blood coming from the nipple;
- Burning and/or itching of the nipple and/or areola.
Diagnosis of Paget’s disease
Many times, the doctor treats the symptoms of Paget’s disease as eczema and only later, upon not observing satisfactory improvement, requests a biopsy. This mistake occurs because most eruptions on the nipples are just a mild skin infection or a reaction to some irritant, an allergy.
In the biopsy, a small sample of the affected skin is taken for analysis in the laboratory. After the diagnosis of Paget’s disease, further tests are needed to look for an underlying breast cancer. One or more of the following imaging tests may be done to check for other changes in the breast:
- Diagnostic mammography;
- Breast ultrasound;
- Magnetic resonance imaging (MRI)
Treatment for Paget’s disease of the breast
Paget’s disease can be treated with surgical removal of the entire breast (mastectomy) or part of it, often followed by radiation therapy.
If the conservative surgery option is chosen, the entire area of the nipple and areola also needs to be removed—and can be later surgically reconstructed.
If invasive cancer is found, lymph nodes under the arm will also be removed and examined for cancerous areas.
If no lump is felt in the breast tissue and biopsy results show that the cancer has not spread, the outlook is excellent. However, in some cases where invasive carcinoma is found, chemotherapy may be necessary to increase the chances of curing the disease.
Prevention of Paget’s disease of the breast.
There is no defined strategy for preventing Paget’s disease of the breast, other than important factors for maintaining overall health and reducing the risk of complications in general: controlling weight, not smoking, avoiding excessive alcohol consumption, and using contraceptive and hormone replacement treatments cautiously.
