Paget Disease of the Breast

A rare form of breast cancer, Paget's disease of the breast starts on the nipple extending to the areola, or the dark circle of skin.

The cancer usually affects women 50 years and older and most patients have underlying ductal breast cancer, which can be in its original place or an invasive breast cancer.

Paget’s disease of the breast is rarely limited to the nipple.

The signs and symptoms of Paget’s disease of the breast are commonly mistaken for a skin irritation or other noncancerous skin condition. 

The signs and symptoms of this condition may include:

• Scaly or flaky skin on the nipple
• Eczema-like appearance on the nipple – crusting, hardened, oozing skin
• Redness and itching
• Tingling or burning feeling on the area
• Bloody discharge from the nipple
• Inverted nipple
• Thickened skin of the breast
• Lump in the breast

The symptoms usually affect only one breast and starts with the nipple and spreads to the areola and other parts of the breast. Symptoms may respond to topical medication, that is why it is commonly mistaken for a skin disease. The symptoms come and go and most women only seek medical intervention after a few months of recurring signs. 

It is important to see a doctor if you feel a lump on your breast or if the skin irritation come and go for a month or so. If you have been treating a skin injury around the area, but remain unresponsive to treatment, visit your doctor.

The cause of Paget’s disease of the breast is still not known. However, there is a theory that it is caused by an underlying ductal breast cancer.

Cancer cells that come from the original tumor travel to the nipple and surrounding skin through the milk ducts. In another theory, cancer develops in the nipple on its own.

Surgery is the main treatment method for Paget's disease of the breast.

You are likely to require a surgery if you are diagnosed with Paget’s disease of the breast. The kind of surgery, however, will depend on the skin condition and how advanced the cancer is. Options for surgery include:

Simple mastectomy. This procedure is recommended if there’s an underlying breast cancer, but the lymph nodes are not affected. It involves removal of the affected breast.

Lumpectomy. It is a breast-conserving surgery that removes only the diseased part of the breast. In treating Paget’s disease of the breast, the surgeon is likely to remove a wedge- or cone-shaped part of the breast that usually include the nipple and areola. With lumpectomy, the surgeon focuses on removing the cancer tissues, yet removing as little of the tissue as possible. The surgery requires follow-up radiation therapy, so if for some reason you can’t have radiation, the doctor might recommend another type of surgery. After treatment, you may opt to have a nipple reconstruction surgery.

 After the surgery, adjuvant therapy might be recommended. This is additional treatment that may involve hormonal therapy, radiation, or taking anti-cancer drugs (chemotherapy). The adjuvant treatment needed depends on the extent of cancer and if the tumors are positive for estrogen, progesterone receptors and other significant characteristics. 

There are several things that might help prevent the development of Paget’s disease of the breast. Eating a healthy diet, limiting alcohol consumption, not smoking, and getting enough physical activity are some of them. However, some things are just beyond your control, since age, genetics, and family history play a big part.

Some women who have high risk even do surgical and medical interventions, such as risk-reducing surgery like prophylactic mastectomy. However, the option is not best for everyone.

If you have a family history of breast cancer, discuss your personal risks with your doctor to help you weigh the options.

Lifestyle modifications are necessary in order to cope with Paget's disease of the breast.

It can be very overwhelming to know that you have breast cancer. It is also difficult for most women to cope with it.

However, it may help to:

• Research. Try to know everything about your condition. Look for up-to-date info for any treatment options. Getting more knowledge can make you feel more confident about your condition and the possible treatment options.
• Get the support you need. Finding other breast cancer survivors and patients and talking about their own experiences may help you cope with your condition. The American Cancer Society can help you locate organizations near your area. Your partner, a family member or a friend who is a good listener can also help you cope with the condition, as well as a counselor or a clergy officer.
• Maintain intimacy with your partner. You may think less attractive about yourself, especially once you had a surgery. Tell your partner about the fears and insecurities you feel.
• Take care of yourself. During cancer treatment, your wellness must be your number 1 priority. Get the sleep that you need, eat more fruits and vegetables, and do light exercises every now and then to help restore your energy and strength. Keep your mind and body relaxed by taking a time out and doing things that you enjoy – read, listen to music, take a short stroll.

Risk factors that affect the chance of paget's disease of the breast are:

• Age
• Personal medical history
• Family medical history
• Genetic predisposition
• Dense breast tissue
• Radiation exposure
• Excess weight
• Use of hormone replacement
• Race