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This section gives information about a condition called Paget’s disease of
the breast. It should ideally be read with CancerBACUP’s general information on
cancer of the breast.
* What is Paget's disease of the breast?
* Signs and symptoms
* Diagnosis
* Treatment
* What further treatments may be used?
* Research trials
* Your feelings
* References
What is Paget's disease of the breast?
Paget’s disease of the breast is an eczema-like change in the skin of the
nipple, and 90% of women who have it have an underlying breast cancer. The
underlying breast cancer may be an invasive breast cancer or ductal carcinoma in
situ (DCIS). In DCIS the cancer cells are completely contained within the cells
lining the milk ducts.
Around half of the women who have Paget’s disease will have a breast lump that
can be felt at the time it is diagnosed.
Paget’s disease occurs in about 1–2% of all women with breast cancer. Usually,
it first appears as a scaly red rash affecting the nipple and sometimes the dark
area of skin surrounding the nipple (the areola). The rash always affects the
nipple first and may then affect the areola. It does not go away and may become
sore. The area may bleed slightly.
Paget’s disease usually occurs in women in their fifties, but it can occur at a
later age. It can affect men but this is extremely rare.
The cause is unknown, but certain women seem to be at a higher risk of
developing any type of breast cancer and this is discussed further in our
general information on cancer of the breast.
Signs and symptoms
The first symptom is usually an eczema-like rash, as described above. The skin
of the nipple and areola may be red and inflamed and there may be crusting,
bleeding and ulceration. Some women have an itching or burning sensation. Fluid
may leak from the abnormal area of cells. The nipple may turn inwards (be
inverted) and there may be a discharge. There may or may not be a lump in the
breast.
Diagnosis
Paget’s disease can be confused with other skin conditions such as eczema,
dermatitis or psoriasis, as they can look very similar. This can make Paget’s
disease difficult to diagnose. Paget’s disease usually affects the nipple first
and then the surrounding tissue.
Other skin conditions usually affect the areola (the dark area of skin around
the nipple) first, and then spread into the nipple.
Several tests may be carried out to diagnose Paget’s disease of the breast. They
may include the following:
Mammogram (breast x-ray) Mammograms may be used to look for changes in the
affected breast and to check the other breast.
Ultrasound A gel is spread on the breast and a small device, which emits sound
waves is rubbed over the area. The echoes are converted into a picture of the
breast tissue by a computer. This test is painless and takes just a few minutes.
Biopsy This is the main test for cancer cells below the skin surface. A small
piece of skin and underlying breast tissue is taken and sent to the laboratory
to be examined under a microscope. The biopsy is usually done using a local
anaesthetic, which numbs the area. The biopsy may be taken at the same time as
an ultrasound so that it is certain that the biopsy is taken from the abnormal
area.
Imprint or scrape cytology Cells from the affected area are scraped or pressed
on to a slide and examined under a microscope.
Treatment
The treatment will depend on whether or not the cancer cells have spread to
surrounding breast tissue and how much of the breast is affected.
Surgery
Surgery is the main treatment for Paget’s disease. Removal of the breast
(mastectomy) may be recommended, especially if the cancer is affecting a wide
area (is extensive) or is at a distance from the nipple. Surgery aimed at
keeping as much of the breast tissue as possible (known as breast-conserving
therapy) may be recommended if the cancer is found to be close to the nipple and
only affecting a small area of underlying tissue. This involves the removal of
the nipple, areola and an area of underlying tissue and some normal tissue
around it.
What further treatments may be used?
For some people, no further treatment will be needed after surgery. Others will
need radiotherapy, hormonal therapy or chemotherapy. These may be used
separately or together.
Radiotherapy
Radiotherapy treats cancer by using high-energy rays that destroy the cancer
cells. Radiotherapy to the remaining breast tissue is usually recommended after
breast-conserving surgery.
Hormonal therapy
Hormonal therapies are commonly used for treating breast cancer. They reduce the
production of hormones within the body, or prevent the hormones from stimulating
the cancer cells to grow. Tamoxifen is a commonly used hormonal treatment.
Chemotherapy
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. It is not
used to treat DCIS, but may be given if the cancer is invasive.
Research trials
Research into treatments for Paget’s disease of the breast is ongoing. Cancer
doctors use clinical trials to assess new treatments. Before any trial is
allowed to take place, an ethics committee must have approved it and agreed that
the trial is in the interest of patients.
You may be asked to take part in a clinical trial. Your doctor must discuss the
treatment with you so that you have a full understanding of the trial and what
it means to take part. You may decide not to take part or withdraw from a trial
at any stage. You will then receive the best standard treatment available.
CancerBACUP has further information that explains how clinical trials are set up
and answers common questions that people have about them.
Your feelings
You may have many different emotions including anger, resentment, guilt, anxiety
and fear. These are all normal reactions and are part of the process many people
go through in trying to come to terms with their illness.
Source :
http://www.cancerbacup.org.uk/Cancertype/Breast/Typesofbreastcancer/Pagetsdisease