What is Paget's disease of the breast?
The symptoms can resemble those of a skin condition, and this sometimes delays diagnosis, increasing the risk of a life-threatening condition.
Paget's disease indicates a 90 percent chance of an underlying breast cancer.
Symptoms of Paget's disease vary depending on the stage of development. They usually only occur in one breast.
The main symptoms include:
- flaky or scaly skin on the nipple that does not heal over time
- straw-colored or bloody nipple discharge
- flattened or inverted nipples
The earliest symptom of Paget's disease is often an eczema-like rash, usually affecting only one nipple. The skin of the nipple and the dark skin around it (areola) may become red, itchy, and inflamed. Some women have an itching or burning sensation.
Other symptoms may include:
- fluid discharge from the abnormal area of cells
- a lump in the breast
- redness, oozing, and crusting
- a sore that does not heal
The symptoms usually affect the nipple first, then spread to the areola, and finally the breast. Symptoms often disappear temporarily, which may falsely lead an individual to believe that the condition has resolved.
On average, a woman may experience signs and symptoms for 6 to 8 months before a diagnosis is made.
Paget's disease or eczema?
Paget's disease is difficult to diagnose due to its resemblance to dermatitis and eczema. The latter, unlike Paget's disease, usually affects the areola first and then the nipple.
The following images show Paget's disease of the breast and eczema. The content may be graphic.
More rarely, Paget's disease can affect men.
Paget's disease moves from the nipple and out to the areola.
Paget's disease is sometimes mistaken for eczema.
Most women do not visit the doctor because they mistake the condition for contact dermatitis or eczema. Women who feel a lump or notice skin irritation that does not heal for over a month are advised to seek the opinion of a specialist.
A person may also experience crusty, oozing, or hardened skin resembling eczema on the nipple, areola, or both. The skin changes may fluctuate early on, making it appear as if the skin is healing on its own.
Some patients complain of burning sensations in the nipples or breasts. These symptoms usually occur in more advanced stages, when serious destruction of the skin often prompts them to visit a doctor.
Lumps or masses in the breast may occur in up to 50 percent of people. In more advanced stages the disease may cause tingling, increased sensitivity, and pain.
The exact cause of Paget's disease of the breast is unknown. However, there are two theories. The leading theory is that there is already a cancer of the breast, and some of these cells migrate through the milk ducts to the surface of the nipple.
Another theory is that the skin cells of the nipple spontaneously transform into cancer cells. In a few cases of Paget's disease, there is no underlying breast cancer, or if a tumor is present, it is unrelated to the disease in the nipple.
The risk factors are similar to those for other types of breast cancer. They include:
- age, as the risk increases with age
- a previous personal history of breast cancer or breast abnormalities
- having a relative with breast cancer
- having denser breast tissue
- overweight or obesity
- hormone replacement therapy (HRT)
- excessive alcohol consumption
One of the most common methods of diagnosing Paget's disease of the breast is a mammogram.
A doctor will examine any unusual areas of the breast, especially the skin on and around the nipples and feel for any lumps or areas of thickening. A mammogram and a biopsy can confirm the diagnosis.
Treatment will depend on the findings and the characteristics of the underlying breast cancer.
Surgery is the most common treatment.
If invasive cancer or ductal carcinoma in situ (DCIS) is diagnosed, a modified radical mastectomy may be recommended. In this operation, a surgeon removes the breast, the lining over the chest muscles, and some of the lymph nodes under the arm.
If the underlying breast cancer is not invasive, the surgeon may perform a simple mastectomy to remove only the breast and the lining over the chest muscles.
If the disease is confined to the nipple and the surrounding area, the person may undergo breast-conserving surgery or lumpectomy followed by radiation therapy.
During breast-conserving surgery, a surgeon removes the nipple, areola, and the entire portion of the breast believed to contain the cancerous cells. In most cases, radiation therapy is also used to help prevent the cancer from returning.