The Connection Between Paget Disease and Breast Cancer

October 23, 2024 Fazi Jutt

Written by: Dr. Syeda Jannat Shayyan | Company: Jininews

Introduction

Paget’s disease of the breast is a rare condition that is often linked to breast cancer. Although it affects a small percentage of breast cancer patients, its significance cannot be understated. This article will explore the connection between Paget’s disease and breast cancer, helping readers understand the symptoms, diagnosis, and treatment options available. In addition, we will discuss the role of early detection and awareness in managing these conditions.

Breast cancer continues to be one of the most common cancers worldwide, and awareness of lesser-known forms, like Paget’s disease, is critical for timely diagnosis and treatment. If left untreated, Paget’s disease of the breast can lead to more serious health complications.

In this article, we will delve deep into how these two conditions are interlinked, focusing on various aspects of Paget’s disease and its connection to breast cancer.

What is Paget’s Disease of the Breast?

Paget’s disease of the breast, also known as Paget’s disease of the nipple, is a rare type of cancer that starts in the ducts of the breast and spreads to the skin of the nipple and areola. It was first described by Sir James Paget in 1874, who linked changes in the nipple with underlying breast cancer. This condition usually affects women, although in rare cases, it can also occur in men.

Symptoms of Paget’s Disease of the Breast
The symptoms of Paget’s disease of the breast can resemble those of other skin conditions, such as eczema or dermatitis. However, the persistent nature of these symptoms and their localization around the nipple and areola can be key indicators of Paget’s disease. Common symptoms include:

Itching, tingling, or redness in the nipple and/or areola
Flaky or crusty skin on the nipple
A flattened or inverted nipple
Yellowish or bloody discharge from the nipple
A lump in the breast (in some cases)

It’s important to note that these symptoms may appear mild at first, which can delay diagnosis. However, if symptoms persist, medical attention should be sought promptly.

Breast Cancer and Paget’s Disease: How Are They Connected?

Paget’s disease of the breast is closely related to underlying breast cancer. In fact, in about 90% of cases, people with Paget’s disease also have breast cancer, either in situ (confined to the milk ducts) or invasive (spreading to surrounding tissues). The connection between the two lies in the fact that Paget’s disease often indicates that cancer cells from the ducts have spread to the nipple and surrounding skin.

Ductal Carcinoma In Situ (DCIS) and Paget’s Disease

One of the most common breast cancers associated with Paget’s disease is Ductal Carcinoma In Situ (DCIS). DCIS is a non-invasive form of breast cancer, meaning the cancer cells are confined to the milk ducts and have not spread to other parts of the breast or body. DCIS can be detected through a mammogram and often presents no symptoms. However, in some cases, it manifests as Paget’s disease.

Invasive Ductal Carcinoma (IDC) and Paget’s Disease

Invasive Ductal Carcinoma (IDC) is another form of breast cancer that may coexist with Paget’s disease. IDC is more aggressive than DCIS, as the cancer cells break out of the milk ducts and invade nearby tissues. Paget’s disease can be a sign that the cancer is spreading or becoming more advanced, making early detection crucial.

Risk Factors for Developing Paget’s Disease and Breast Cancer

Several risk factors can increase the likelihood of developing both Paget’s disease and breast cancer. These include:

Age: Paget’s disease of the breast is most common in women over 50. Similarly, the risk of breast cancer increases with age.
Family History: A family history of breast cancer or other related cancers can increase the risk of developing both Paget’s disease and breast cancer.
Genetic Mutations: Inherited mutations in genes such as BRCA1 and BRCA2 increase the risk of breast cancer, and by extension, Paget’s disease.
Hormonal Factors: Prolonged exposure to estrogen, either through early menstruation or late menopause, may raise the risk of breast cancer, which can be associated with Paget’s disease.
Personal History of Breast Cancer: Women who have had breast cancer before are at a higher risk of developing Paget’s disease or a recurrence of breast cancer.

Diagnosis of Paget’s Disease and Breast Cancer

Diagnosing Paget’s disease involves a combination of clinical exams, imaging tests, and biopsy procedures. A healthcare professional will assess the symptoms and use the following methods to confirm the diagnosis:

Physical Examination: A doctor will examine the breast for any abnormalities, including changes in the skin, nipple, and areola. They will also check for any lumps or masses.
Mammogram: This imaging test is used to detect any underlying breast cancer, such as DCIS or IDC, which may be present alongside Paget’s disease.
Breast Ultrasound: Ultrasound may be used to examine the breast tissue and detect any lumps or abnormalities.
Biopsy: A biopsy involves taking a small sample of tissue from the nipple or affected area to examine it under a microscope. This is the definitive test for diagnosing Paget’s disease and determining if cancer cells are present.
Magnetic Resonance Imaging (MRI): In some cases, an MRI may be used to get a clearer picture of the breast tissue, especially if mammogram results are inconclusive.

Treatment Options for Paget’s Disease and Breast Cancer

Treatment for Paget’s disease of the breast often involves addressing both the local condition and any underlying breast cancer. The treatment plan depends on the stage and type of breast cancer, as well as the extent of Paget’s disease.

Surgery

Surgery is the most common treatment for Paget’s disease, and the type of surgery depends on the extent of the disease. Options include:

Mastectomy: In a mastectomy, the entire breast is removed, including the nipple and areola. This is often recommended when there is invasive breast cancer or if Paget’s disease affects a large portion of the breast.
Breast-Conserving Surgery (Lumpectomy): In a lumpectomy, only the affected part of the breast, including the nipple and areola, is removed, while the rest of the breast remains intact. This option may be suitable for smaller, localized cancers.

Radiation Therapy

Radiation therapy is often used after surgery to kill any remaining cancer cells and reduce the risk of recurrence. It is particularly common after breast-conserving surgery.

Chemotherapy

Chemotherapy may be recommended if there is invasive breast cancer or if the cancer is aggressive. Chemotherapy works by targeting and killing cancer cells throughout the body.

Hormone Therapy

If the breast cancer is hormone receptor-positive, hormone therapy may be prescribed to block the effects of estrogen and progesterone, which can fuel the growth of cancer cells.

Targeted Therapy

For certain types of breast cancer, such as HER2-positive cancers, targeted therapy may be used to specifically attack cancer cells with HER2 protein overexpression.

The Importance of Early Detection and Awareness

Early detection of Paget’s disease and any underlying breast cancer is crucial for successful treatment and outcomes. Regular breast self-exams, clinical exams, and mammograms can help detect changes early, improving the chances of recovery.

Women should be aware of any changes in their breasts, especially around the nipple and areola, as these could be signs of Paget’s disease. Any persistent symptoms, such as itching, crusting, or discharge, should be evaluated by a healthcare professional.

Living with Paget’s Disease and Breast Cancer

Living with Paget’s disease and breast cancer can be challenging, but with the right treatment and support, many women are able to manage their condition effectively. Support groups, counseling, and rehabilitation services can play an important role in helping patients cope with the emotional and physical aspects of their diagnosis.

Conclusion

Paget disease of the breast is a rare but serious condition that is often associated with underlying breast cancer. Early detection and treatment are key to managing both Paget’s disease and breast cancer effectively. If you notice any unusual changes in your breasts, especially around the nipple or areola, seek medical advice promptly. With advancements in medical technology and treatment options, many women diagnosed with Paget’s disease and breast cancer are able to lead full, healthy lives.