Paget's disease of the breast

Description

Paget's (PAJ-its) disease of the breast is a rare form of breast cancer. Paget's disease of the breast starts on the nipple and extends to the dark circle of skin (areola) around the nipple. Paget's disease of the breast is not associated with Paget's disease of bone, a metabolic bone disease.

Paget's disease of the breast occurs most often after the age of 50 years old. Most people with this diagnosis also have underlying ductal breast cancer, either in situ — meaning in its original place — or, less commonly, invasive breast cancer. Only on rare occasions is Paget's disease of the breast is confined to the nipple.

Symptoms

Paget's disease of the breast affects your nipple and usually the skin (areola) around it. It is easy to confuse the signs and symptoms of Paget's disease of the breast to the irritation of the skin (dermatitis) or other non-cancerous (benign) skin condition.

Possible signs and symptoms of Paget's disease of the breast include:

  • Scaly or flaky skin in the nipple
  • Crispy, oozing, or hardening of the skin that resembles eczema of the nipple, the areola, or in both
  • Itching
  • Redness
  • A sensation of tingling or burning sensation
  • Straw-colored or bloody nipple
  • A flattened or turned in (inverted) nipple
  • A lump in the breast
  • The thickening of the skin of the breast

Signs and symptoms usually occur in one breast only. The disease generally begins in the nipple and may extend to the areola, and other areas of the breast.

The skin changes may come and go early or respond to topical treatment, making it appear as if your skin heals. On average, the signs and symptoms for several months before the diagnosis is made.

When to see a doctor

Be aware of any changes in your breasts. If you feel a lump in the breast, or if you experience itching or irritation of the skin that persists for more than a month, make an appointment with your doctor.

If you are being treated for an injury to the skin on the breast, and the condition does not go away with treatment, make a follow-up appointment with your doctor.

Causes

Doctors do not know what causes Paget's disease of the breast. The most widespread theory is that the disease results from an underlying cancer of the breast ductal. The cancer cells from the original tumor, then travel through the milk ducts to the nipple and the surrounding skin. Another theory is that the disease can develop independently in the nipple.

Risk factors

The risk factors that affect your chance of developing Paget's disease of the breast are the same factors that affect the risk of developing any other type of breast cancer.

Some of the factors that make you more susceptible to breast cancer include:

  • The increase of the age. Your risk of breast cancer increases with age.
  • A personal history of breast conditions. If you have had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.
  • A personal history of breast cancer. If you have had cancer in one breast, you have a higher risk of developing cancer in the other breast.
  • A family history of breast cancer. If your father, mother, brother or son was diagnosed with breast cancer, especially at a young age, your risk of breast cancer is higher. Even so, the majority of people diagnosed with breast cancer have no family history of the disease.
  • Inherited genes that increase the risk of cancer. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known of the mutations of the genes known as BRCA1 and BRCA2. These genes can increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.
  • The exposure to radiation. If you have received radiation treatments to your chest as a child or a young adult, your risk of breast cancer is higher.
  • Obesity. Being obese increases the risk of breast cancer.
  • In the beginning of your period at a younger age. In the beginning of your menstrual period before age 12 increases your risk of breast cancer.
  • Beginning menopause at an older age. If you began menopause at an older age, are more likely to develop breast cancer.
  • Having your first child at an older age. If you give birth to your first child after 30 years of age, you may have an increased risk of breast cancer.
  • Having never been pregnant. If you have never been pregnant, the risk of breast cancer may be higher.
  • Postmenopausal hormone therapy. Hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause may increase the risk of breast cancer. The risk decreases after you stop taking these medicines.
  • The consumption of alcohol. Drinking alcohol increases the risk of breast cancer.

Prevention

The breast cancer risk reduction for people with an average risk of

Make changes in your everyday life can help reduce your risk of breast cancer. Try:

  • Ask your doctor about breast cancer screening.Talk to your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms. Talk with your doctor about the benefits and risks of the test. Together, you can decide what breast cancer screening strategies are appropriate for you.
  • Become familiar with your breasts through breast self-exam for breast awareness.You can choose to become familiar with their breasts once in a while, the inspection of their breasts during a breast self-exam for breast awareness. If there is a new change, lumps or other unusual signs in your breast, talk to your doctor immediately. Breast awareness can't prevent breast cancer, but it can help to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.
  • Drink alcohol only in moderation, if at all. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink per day for women and up to two drinks per day for men.
  • Exercise most days of the week. Try to do at least 30 minutes of exercise most days of the week. If you haven't been active lately, ask your doctor whether it's ok and start slowly.
  • Limit postmenopausal hormone therapy.The combination of hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy. You can experience bothersome signs and symptoms during the menopause and, for you, the increased risk of breast cancer may be acceptable in order to relieve menopause signs and symptoms. To reduce the risk of breast cancer, the use of the lowest dose of hormone therapy possible for the least amount of time.
  • Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, talk to your doctor about healthy strategies to achieve this. Reduce the number of calories you eat each day and gradually increase the amount of exercise.
  • Choose a healthy diet. Eating a Mediterranean diet supplemented with extra virgin olive oil and nuts can reduce the risk of breast cancer. The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts. The people who follow the Mediterranean diet choose healthy fats, such as olive oil, over butter and fish instead of red meat.

Ask your doctor about breast cancer screening. Talk to your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms.

Talk with your doctor about the benefits and risks of the test. Together, you can decide what breast cancer screening strategies are appropriate for you.

Become familiar with your breasts through breast self-exam for breast awareness. You can choose to become familiar with their breasts once in a while, the inspection of their breasts during a breast self-exam for breast awareness. If there is a new change, lumps or other unusual signs in your breast, talk to your doctor immediately.

Breast awareness can't prevent breast cancer, but it can help to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.

Limit postmenopausal hormone therapy. The combination of hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy.

You can experience bothersome signs and symptoms during the menopause and, for you, the increased risk of breast cancer may be acceptable in order to relieve menopause signs and symptoms.

To reduce the risk of breast cancer, the use of the lowest dose of hormone therapy possible for the least amount of time.

The breast cancer risk reduction for people with a high risk

If your doctor has determined that you have a higher risk of breast cancer, you can discuss options to reduce the risk, such as:

  • Preventive medications (chemoprevention).Estrogen-blocking drugs to reduce the risk of breast cancer if you have a high risk of the disease. These medications carry the risk of side effects, so doctors reserve these drugs for those who have a very high risk of breast cancer. Discuss the risks and benefits with your doctor.
  • Preventive surgery. If you have a very high risk of breast cancer, you may choose to have their healthy breasts surgically removed (prophylactic mastectomy). You can also choose to have their healthy ovaries (prophylactic oophorectomy) to reduce the risk of breast cancer and ovarian cancer.

Preventive medications (chemoprevention). Estrogen-blocking drugs to reduce the risk of breast cancer if you have a high risk of the disease.

These medications carry the risk of side effects, so doctors reserve these drugs for those who have a very high risk of breast cancer. Discuss the risks and benefits with your doctor.

Paget's disease of the breast

Diagnosis

Tests and procedures used to diagnose Paget's disease of the breast include:

  • The breast exam. Your doctor will check both of your breasts and the lymph nodes in the armpit, feeling for lumps or other abnormalities.
  • Mammogram. A mammogram is an x-ray of the breast. Mammograms are commonly used for the detection of breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate the abnormality.
  • Ultrasound of the breast. The ultrasound uses sound waves to produce images of structures deep in the body. The ultrasound can be used to determine if a new breast lump is a solid mass or a fluid-filled cyst.
  • Breast magnetic resonance imaging (MRI). A Magnetic resonance image (MRI) of the machine uses a magnet and radio waves to create pictures of the inside of your chest. Before a breast mri , you will receive an injection of dye.
  • Removing a sample of breast cells for testing (biopsy). During a biopsy, the doctor removes a sample of suspect tissue. The biopsy samples are sent to a laboratory for analysis to determine if the cells are cancerous. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options.

Other tests and procedures may be used, depending on your situation.

Treatment

If you have Paget's disease of the breast, it is likely that you need surgery. The type of surgery depends on the condition of the skin around her nipple and how advanced the underlying cancer is.

Surgical options include:

  • The removal of the entire breast (mastectomy). A mastectomy is an operation to remove all of the breast tissue. Most of the mastectomy procedures to remove all of the breast tissue — the lobules, ducts, fatty tissue and skin, including the nipple and areola (total or simple mastectomy).
  • Extraction of the breast cancer (lumpectomy). During a lumpectomy, which may be referred to as the breast-conserving surgery or wide local excision, the surgeon removes the cancer and a small margin of surrounding healthy tissue. If you and your doctor choose this option, you will also receive radiation therapy after.
  • The removal of a limited number of lymph nodes (sentinel node biopsy).To determine if the cancer has spread to the lymph nodes, your surgeon will discuss with you the role of the removal of the lymph nodes that are the first to receive the lymph drainage of your cancer. If no cancer is found in lymph nodes, the chance of finding cancer in any of the rest of the lymph nodes is small and there are no other nodes need to be removed.
  • The removal of several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel lymph nodes, the surgeon will discuss with you the role of extraction in the lymph nodes of the armpit.
  • The removal of both breasts. Some people with cancer in one breast, you can choose your other (healthy) breast removed (contralateral prophylactic mastectomy) if you have an increased risk of cancer in the other breast, due to a genetic predisposition or strong family history.

The removal of a limited number of lymph nodes (sentinel node biopsy). To determine if the cancer has spread to the lymph nodes, your surgeon will discuss with you the role of the removal of the lymph nodes that are the first to receive the lymph drainage of your cancer.

If no cancer is found in lymph nodes, the chance of finding cancer in any of the rest of the lymph nodes is small and there are no other nodes need to be removed.

You may choose to have breast reconstruction after surgery. Discuss your choices and preferences of your surgeon.

Consider the possibility of a referral to a plastic surgeon before your surgery. Your options may include reconstruction with a breast implant or reconstruction using your own tissue. These operations can be performed at the time of the mastectomy or at a later date.

Adjuvant therapy

After the operation, your doctor may recommend additional treatment (adjuvant therapy) with anti-cancer drugs (chemotherapy), radiation therapy, or hormone therapy to prevent a recurrence of breast cancer.

Your specific treatment will depend on the extent of the cancer and if the cancer positive for certain characteristics, such as having estrogen or progesterone receptors.

Coping and support

A breast cancer diagnosis can be overwhelming. And just when you are trying to deal with the shock and fears about their future, you will be asked to make important decisions about your treatment.

All the world is a personal way of coping with a cancer diagnosis. Until you find what works for you, it might help:

  • Learn what you need to know about your breast cancer.If you want to know more about the breast cancer, ask your doctor for more details — the type, stage, and hormone receptor status. Ask for good sources of up-to-date information about your treatment options. To know more about cancer and your options can help you feel more confident when making treatment decisions. Even so, some people may not want to know the details of your cancer. If this is how you feel, let your doctor know that too.
  • Talk with other survivors of breast cancer.You may find that it is helpful and encouraging to talk to other people with breast cancer. In contact with the American Cancer Society to find out about support groups in your area. Organizations that can connect with other cancer survivors online or by telephone, including After the Diagnosis of Breast Cancer and cancer care.
  • Find someone to talk to. Find a friend or family member who is a good listener, or to speak with a member of the clergy or a counselor. Ask your doctor for a referral to a counselor or other professional who works with cancer survivors.
  • Keep your friends and family cercanos.Su family and friends can provide a crucial support network for you during your cancer treatment. As you start to tell people about your diagnosis of breast cancer, the more likely it is to get a lot of offers of help. Think about the future, about things that you might want to help, if it is to talk with someone if you feel low or get help to prepare the meals.
  • Take care of yourself. Make your wellness a priority in the treatment of cancer. Get enough sleep so that you wake up feeling rested, choose a diet full of fruits and vegetables, make time to do gentle exercise on the days you feel up to it, and find time for the things you enjoy, such as reading or listening to music.

Learn what you need to know about your breast cancer. If you want to know more about the breast cancer, ask your doctor for more details — the type, stage, and hormone receptor status. Ask for good sources of up-to-date information about your treatment options.

To know more about cancer and your options can help you feel more confident when making treatment decisions. Even so, some people may not want to know the details of your cancer. If this is how you feel, let your doctor know that too.

Talk with other survivors of breast cancer. You may find that it is helpful and encouraging to talk to other people with breast cancer. In contact with the American Cancer Society to find out about support groups in your area.

Organizations that can connect with other cancer survivors online or by telephone, including After the Diagnosis of Breast Cancer and cancer care.

Keep your friends and family nearby. Your family and friends can provide a crucial support network for you during your cancer treatment.

As you start to tell people about your diagnosis of breast cancer, the more likely it is to get a lot of offers of help. Think about the future, about things that you might want to help, if it is to talk with someone if you feel low or get help to prepare the meals.

Preparing for your appointment

If you suspect that you have Paget's disease of the breast, your first appointment may be with your family doctor. Or, when you call to make an appointment, you may be referred directly to a doctor who specializes in the treatment of breast conditions.

What you can do

To prepare for your appointment:

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you are experiencing. Include even those that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information. Include any major stresses or recent life changes.
  • Make a list of all the medications. Also include vitamins or supplements you are taking.
  • Consider the possibility of a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of their time together. Some basic questions to ask include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What kinds of tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • You should see a specialist? What will that cost, and will my insurance cover it?
  • Are there brochures or other printed material that I can take with me? What sites do you recommend?
  • What is going to determine whether I should plan for a follow-up visit?

What to expect from your doctor

Your doctor may ask you questions about:

  • The nature of the skin, changes in the nipple
  • If you also experience nipple discharge, bleeding, burning, or itching
  • If you have any other breast, signs and symptoms, such as a breast lump or area of thickening
  • If you have any pain in the breasts
  • How much time you have experienced signs and symptoms

Your doctor may also ask you questions about your personal and family medical history and other potential risk factors for breast cancer.

Symptoms and treatment of Paget's disease of the breast