Paget's disease of the breast

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Paget's disease of the breast
Synonyms	Paget's disease of the nipple
Pronounce	N/A
Specialty	N/A
Symptoms	Eczema-like changes to the nipple, itching, redness, discharge
Complications	Breast cancer
Onset	Typically over 50 years old
Duration	Chronic
Types	N/A
Causes	Unknown, associated with ductal carcinoma in situ
Risks	Age, family history, genetic mutations
Diagnosis	Biopsy, mammography, ultrasound
Differential diagnosis	Eczema, psoriasis, dermatitis
Prevention	N/A
Treatment	Surgery, radiation therapy, chemotherapy
Medication	Topical corticosteroids for symptom relief
Prognosis	Depends on stage of associated breast cancer
Frequency	Rare, 1-4% of all breast cancers
Deaths	N/A

Extramammary Paget disease - high magnification

Paget's Disease of the Breast, also known as Paget's Disease of the Nipple, is a rare type of cancer that typically affects the skin of the nipple and, often, the darker circle of skin around it, known as the areola. It is named after Sir James Paget, who first described the condition in 1874. Although it is associated with breast cancer in the majority of cases, Paget's disease of the breast itself is not a cancer but a syndrome that indicates the presence of breast cancer somewhere within the breast tissue.

Symptoms

The symptoms of Paget's disease of the breast are distinct and primarily affect the nipple and areola. Common symptoms include:

• Redness and flakiness of the nipple skin
• Itching or tingling sensation
• Yellow or bloody discharge from the nipple
• The appearance of a lump in the breast
• Changes in the shape or texture of the nipple and areola

Causes

The exact cause of Paget's disease of the breast is not fully understood. However, it is believed to result from the migration of cancer cells from a tumor within the breast to the nipple and surrounding areas. These cancer cells are most often from a ductal carcinoma in situ (DCIS) or an invasive breast cancer.

Diagnosis

Diagnosis of Paget's disease involves a combination of clinical examination, imaging tests, and biopsy. Imaging tests may include a mammogram and an ultrasound to look for underlying breast tumors. A biopsy, where a small sample of tissue is removed from the affected area, is crucial for confirming the diagnosis. The biopsy helps distinguish Paget's disease from other skin conditions like eczema or psoriasis, which can present with similar symptoms.

Treatment

Treatment for Paget's disease of the breast is tailored to the individual and depends on the extent of the disease and whether there is an associated breast cancer. Treatment options may include:

• Surgery to remove the affected tissue, which may range from removing the nipple and areola to a mastectomy, depending on the presence and extent of underlying breast cancer.
• Radiation therapy, often used after surgery to eliminate any remaining cancer cells.
• Chemotherapy and hormone therapy, which may be recommended if there is invasive breast cancer.

Prognosis

The prognosis for Paget's disease of the breast largely depends on the presence and extent of any underlying breast cancer. Early detection and treatment of both Paget's disease and any associated breast cancer are crucial for a favorable outcome.

Prevention

There are no specific measures to prevent Paget's disease of the breast. However, regular breast examinations and mammograms can help detect changes in the breast early, allowing for timely diagnosis and treatment.

Epidemiology

Paget's disease of the breast accounts for less than 5% of all breast cancer cases. It most commonly affects individuals over the age of 50, but it can occur at any age. Women are more frequently affected than men.

See Also

• Breast Cancer
• Mammogram
• Ultrasound
• Ductal Carcinoma In Situ (DCIS)
• Invasive Breast Cancer