Paget's disease of the breast

Paget's disease of the breast – also referred to as Paget’s disease of the nipple – is a rare cancer that affects the skin of your nipple and the areola. Your areola is the darker circle of skin around your nipple. This condition is often mistaken for less serious skin issues like eczema or dermatitis.

Paget’s disease of the breast typically signals that there might be underlying breast cancer, either in the ducts of the breast (ductal carcinoma in situ) or invasive breast cancer.

There’s also a form of Paget’s disease that affects your bones.These conditions are not related and just share a name.

Symptoms of Paget's disease of the breast

Recognizing the symptoms of Paget's disease of the breast is key to seeking timely treatment.

The common signs you should be aware of:

• Nipple and areola changes: You might notice redness, flakiness or crustiness of the skin on your nipple and areola. These changes can look like eczema but don't improve with typical treatments for skin conditions.
• Nipple discharge: There can be a yellowish or bloody discharge from your nipple.
• Itching or tingling: A persistent itching or tingling sensation in your nipple and areola area is another possible sign.
• Nipple inversion: Your nipple might become flattened or turned inward.
• Lump or thickening: Sometimes, there can be a palpable lump in your breast, indicating an underlying mass.

If you notice any of these symptoms, schedule an appointment with your doctor as soon as possible.

How fast does Paget's disease of the breast develop?

How fast Paget's disease of the breast occurs varies per person. In some cases, it can develop slowly over several months or even years. For others, it may progress more rapidly, particularly if there's an underlying invasive breast cancer.

The initial skin changes might seem minor and easily overlooked, which is why many people don't seek medical advice until the condition has advanced. Regular breast self-exams and being aware of any changes in your breast skin and nipple can help in catching the disease early.

Risk factors of Paget's disease of the breast

Understanding potential risk factors can help you be more vigilant of your health. While Paget's disease of the breast is rare, several factors might increase your risk:

• Age: Most cases are diagnosed in women over the age of 50.
• History of breast cancer: A personal or family history of breast cancer can elevate your risk.
• Genetic factors: Certain genetic mutations, such as BRCA1 or BRCA2, can increase your risk.
• Radiation exposure: Previous radiation treatment to your chest can also be a risk factor.
• Hormonal factors: Long-term hormone replacement therapy after menopause has been linked to a higher risk of breast cancer.

Even if you have one or more of these risk factors, it doesn’t mean you will develop Paget's disease of the breast.

Diagnosing Paget's disease of the breast

Diagnosing Paget's disease of the breast involves several steps, starting with a thorough examination by your doctor.

Here’s what you can expect during the diagnostic process:

• Clinical breast exam: Your doctor will physically examine your breasts, checking for lumps, skin changes and any discharge from the nipples.
• Mammogram: This imaging test is used to look for abnormalities in your breast tissue. Sometimes, a mammogram might not show Paget’s disease clearly, especially if it’s confined to the nipple.
• Ultrasound: An ultrasound can provide more detailed images of the breast tissue and help identify any underlying lumps or masses.
• Biopsy: A definitive diagnosis is often made through a biopsy, where a small sample of skin or tissue from the nipple and areola is taken and examined under a microscope.

Paget's disease of the breast treatment

Treating Paget's disease of the breast typically involves addressing both the disease in the nipple area and any underlying breast cancer. The most common treatment for Paget’s disease of the breast is surgery.

Treatment options may include:

• Surgery: Options include a mastectomy, where the entire breast is removed, or breast-conserving surgery, such as a lumpectomy, which removes the affected tissue while leaving the rest of the breast intact.
• Radiation therapy: Often used after surgery, radiation therapy helps destroy any remaining cancer cells and reduce the risk of recurrence.
• Chemotherapy: In cases where invasive breast cancer is found, chemotherapy might be necessary to treat cancer throughout the body.
• Hormone therapy: If the cancer is hormone receptor-positive, meaning the cells bind to the hormones estrogen or progesterone, hormone therapy can help reduce the risk of cancer returning by blocking hormones that fuel cancer growth.
• Targeted therapy: For certain types of breast cancer, drugs that target specific characteristics of cancer cells can be effective.

Your care team at Aurora Health Care will use a collaborative approach to provide the best treatment possible. Supportive care services such as counseling, nutrition therapy, palliative care and physical therapy may also be offered to help you manage the physical and emotional challenges of cancer treatment.