Paget’s Disease Of The Breast – 7 Weird Symptoms & Treatments

Paget's disease of the breast

A type of cancer called Paget’s disease of the breast can occur as or resemble eczema, with skin changes involving the nipple. The disease is a rare disease that represents 1% to 4.3% of all breast cancers and was first described by Sir James Paget in 1874.

What does Paget’s disease of the breast look like?

In other words, Paget’s disease of the breast refers to changes in the breasts that indicate cancer cells have formed in or around the nipples. Redness on or around the nipple shows changes are happening under the skin.

Paget’s disease usually occurs in other areas of the breast, with another type of cancer, usually ductal carcinoma in situ (CDIS) or invasive breast cancer. Paget’s disease is very common in women, but it also can affect men. It usually occurs after 50 years. The average age at diagnosis is 62 for women and 69 for men, but it can really show anytime. 1% and 4% of breast cancer cases have Paget’s disease.

Symptoms of Paget’s disease may resemble a skin condition, such as eczema or psoriasis. This sometimes delays diagnosis and increases the risk of life-threatening illness. The disease itself is harmless and superficially limited and is sometimes dismissed. Although it actually shows hidden breast cancer.

Paget’s disease of the nipple

Paget's disease of the breast

This could also mean Paget’s disease of the breast. Paget’s nipple disease is a very rare breast cancer form where cancer cells accumulate in or around the nipple. Cancer usually affects the nipple ducts (small milk-transport tubes) and then spreads to the nipple’s surface and the areola (dark skin around the nipple). Nipples and areolas are usually scaly, red, itchy, and painful.

A recent study by the National Cancer Institute shows that Paget’s disease of the breast accounts for nothing less than 5% of all breast cancer cases in the USA is very important to be aware of the symptoms since it is known that more than 70% of people who have Paget’s disease also have cancer somewhere else in their breast, either DCIS or invasive carcinoma. Unusual occurrence and nipple or areola changes are often the early sign of breast cancer.

Doctors aren’t fully sure how Paget’s disease develops. It is possible that the cancer cells grow in the breast milk ducts and then reach the surface of the nipple. This seems to explain why many people with Paget’s disease have a second area of cancer within the breast.

A second theory is that breast cells become cancerous. This theory explains a small number of people who have

  1. Have Paget’s disease only at the nipple or
  2. second breast cancer that seems to be completely independent of Paget’s disease.

Paget’s nipple disease is prevalent in women, but just like other forms of breast cancer, it can also affect men. The disease often develops after the age of 50. The National Cancer Institute makes us understand that the average age of diagnosis is 62 for women and 69 for men.

Paget’s disease symptoms

Symptoms of Paget’s disease depend on the stage of development. They usually occur only in one breast. The main symptoms are:

  • Itching, tingling or burning in the area close to the nipple and areola.
  • Redness or pigmentation.
  • Peeling, thickening or scaling of the areola does not heal over time.
  • Nipple discharge that may be yellow or contain blood.
  • Flattened or inverted nipples
  • A brittle lesion with irregular edges.
  • in some cases, ulcers.

These usually affect only one nipple. About half of all people with Paget’s breast disease have a breast lump behind their nipple. 90% of these cases have invasive breast cancer.

Paget’s disease causes the nipple and surrounding skin to become red, painful, scaly or flaky. At first, these symptoms tend to come and go.

Over time, the symptoms of breast Paget’s disease often worsen and may include:

  • Itching, tingling and/or burning sensation.
  • Pain and tenderness or sensitivity.
  • Scaling formation and skin thickening.
  • Yellow or bloody discharge from the nipple

Since Paget’s nipple disease is rare, doctors often confuse it with eczema (severe skin rash and inflammation), infection or injury, or other skin conditions. For many people, it may take several months to get the correct diagnosis.

If you are experiencing any or one of the symptoms mentioned above and it continues despite treatment, have it examined by a breast specialist. In most cases, Paget’s breast disease affects one and not both breasts.

Diagnosing Paget’s disease usually involves the following steps:

Physical examination of the breast

Paget's disease of the breast

With special attention to the areola or area around the nipple. The doctor may feel a lump or mass in the breast.

A mammogram

to check the breast area and look for signs of cancer in other areas of the breast.

Ultrasound and/or MRI of the breast

Go for an MRI to take additional breast’s additional photos and search for other cancer areas.

Nipple and areola biopsy

A breast surgeon may perform minor surgery to get rid of a small piece of tissue from the areola and the nipple and study it under a microscope. If there are unusual discharges from the breast, the doctor may also take a sample for examination.

Difference between Paget’s disease and eczema

Doctors often find it difficult to diagnose Paget’s disease due to its similarity to dermatitis and eczema. Unlike Paget’s disease, dermatitis and eczema usually affect the areola and then the nipple.

A person should not consult a doctor, because they are confused with contact dermatitis or eczema. Anyone who notices a lump or skin irritation that does not heal within a month should seek advice from a specialist.

A person may also have crisp, filtered, or hardened skin that looks like eczema in the nipple, areola, or both. Skin changes can fluctuate early and make the skin look healing. Burning can occur as the disease progresses.

At this point, severe skin destruction often leads people to consult a doctor.

Causes Of Paget’s Disease Of The Breast

Paget's disease of the breast

Doctors do not know the exact cause of Paget’s breast disease. One theory states that a person already has breast cancer and some cancer cells migrate from the milk ducts to the surface of the nipple.

Another possible explanation is that the nipple’s skin cell spontaneously turns into cancer cells. In some Paget’s disease cases, there is no underlying breast cancer, or if tumors are present, it is not linked to disease in the nipple.

Risk factors of Paget’s disease

Risk factors are similar to other types of breast cancer.

These include:

  • Age because the risk increases over time
  • The previous occurrence of breast cancer or breast abnormalities
  • You have a relative with breast cancer having denser breast tissue
  • Overweight or obesity
  • Hormone replacement therapy (HRT) ]
  • Excessive alcohol consumption

The rate of spread of breast cancer depends solely on whether it is invasive or not. Learn more here

Treatment for Paget’s disease of the breast

An examination of the unusual areas of the breast, especially the skin around the nipple, is carried out by a doctor, to for lumps or thickened areas.

A doctor may recommend one of the following to confirm the diagnosis.

Also, Unlike mastectomy, if you need breast-sparing surgery, you also need to undergo breast radiation therapy to treat Paget’s disease. Studies have detected that postoperative radiation therapy reduces the risk of cancer coming back. If you have mastectomy and radiation therapy, you may also want to think about breast reconstruction.

There are many opinions in the medical community during reconstruction for people receiving radiation therapy. Talk to your doctor if you are doing breast reconstruction before or after radiation.

Treatment depends on the results. If there is breast cancer, the doctor will prescribe a treatment based on the characteristics and stage of the disease.

Breast Paget’s Disease surgery

If the changes affected a large area of the breast, surgery may be the only option needed for such a person. The type of surgery required for Paget’s disease of the breast depends on how far the underlying breast cancer has progressed. In addition to removing the breast and areola, the surgeon will also need to remove any cancer within the breast.

Surgery types

Invasive cancer or ductal carcinoma in situ (DCIS)

In these cases, a modified radical mastectomy can be recommended by a doctor. A surgeon removes the breast and crosses the pectoral muscles and some lymph nodes under the arm.

Although mastectomy is the traditional treatment for breast Paget’s disease, in some cases, it is a more limited surgical option. This surgery is sometimes called “breast-sparing surgery” and is designed to remove cancer while keeping the breast tissue healthy.

The type of mastectomy depends on how far cancer has progressed:

  • Total or simple mastectomy: breast removal without removing the axillary (underarm) lymph nodes. However, a sentinel node biopsy should be performed to examine nodules that are very close to the tumor for signs of cancer spread.
  • Modified radical mastectomy: Surgery to remove the breast and some lymph nodes under the arm.

Non-invasive breast cancer

The doctor may determine to remove only the breast and some lining of the breast muscles if the underlying breast cancer is not invasive, by performing a simple mastectomy.

Breast reconstruction can restore the appearance of the breast after the surgery.

If there is cancer, but only affects the nipple and surrounding area, the doctor may recommend surgery and then radiation therapy to protect the breast or lumpectomy. This type of surgery removes the nipple, areola, and any part of the breast that contains cancer cells. For this reason, most people receive radiation therapy to prevent cancer from coming back.

Breast-conserving surgery

This usually means a lumpectomy to remove the breast and areola and also remove underlying cancer. The aim is to remove cancer and a small border of healthy tissue to ensure that cancer does not remain.

Research suggests that anyone with Paget’s disease should have a sentinel lymph node biopsy, although there is no cancer beyond the nipple. Some studies have shown that, although cancer appears to be limited to the areola and the nipple, it is possible to have cancer of the lymph nodes. It is imperative to know if your lymph nodes are carcinogenic to get proper treatment.

Hormone therapy targeted therapy and chemotherapy.

Depending on the cancer type, the doctor may recommend drug therapy with medication or with hormones that affect how a particular gene works.

These treatments can reduce the risk of cancer spreading. Chemotherapy can help prevent the coming back of cancer, especially if:

  • The tumor was large.
  • The cells had spread to the lymph nodes.
  • Cells are aggressive

Once treatment is complete, it is important to attend all follow-up appointments and continue to look for changes.