Paget’s disease is a rare type of breast cancer (it represents only 1% of the 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 carcinoma in situ (DCIS), a cancer with a very low risk of dissemination. Less frequently, it can be associated with invasive carcinoma, whose treatment requires more care.
Symptoms of Paget’s disease
When the disease manifests itself, the skin of the nipple and areola usually appears scaly and red. There may be blood or yellow fluid coming out of the nipple, as well as a burning sensation and itching. In some cases, the nipple appears flat 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;
- Yellow fluid or blood coming out of the nipple
- Burning and/or itching in 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, when he does not see a satisfactory improvement, he asks for a biopsy. This mistake occurs because most of the 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 laboratory analysis. After Paget’s disease is diagnosed, further tests are needed to look for 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.
Paget’s disease can be treated by surgical removal of the entire breast (mastectomy) or part of it, often followed by applications of radiation therapy. If conservative surgery is chosen, the entire nipple and areola area also needs to be removed – and can later be surgically reconstructed.
If invasive cancer is found, the lymph nodes under the arm will also be removed and examined to see if there are any foci of cancer there.
If no lumps are felt in the breast tissue and the biopsy results show that the cancer has not spread, the outlook is excellent. However, in some cases where foci of invasive carcinoma are found, the use of chemotherapy may be necessary to increase the chances of curing the disease.
There is no set strategy on how to prevent Paget’s disease, other than the important factors to keep your health up to date and reduce the risk of complications in general: controlling your weight, not smoking, avoiding excessive alcoholic beverages, using contraceptives and hormone replacement type treatments with caution.