Paget's disease of the breast is a type of cancer that manifests on and underneath the nipples. It is one of the rarest varieties of breast cancer, and it almost never occurs alone. Rather, Paget's disease is usually accompanied by a more common type of underlying cancer deeper within the breast. Tumors can cause chronic pain, fatigue, and eczema-like symptoms around the nipples. Non-surgical treatment options are limited, and most cases require mastectomy to ensure the cancer does not spread to lymph nodes and other parts of the body.
A woman of any post-pubescent age can suffer from this condition, but the majority of patients are over the age of 50. Very rarely, the cancer may develop in older men. Doctors are unsure what causes Paget's disease, but it is believed that both genetic and environmental factors play important roles. Exposure to high levels of radiation, as can occur during treatment for other cancers, may trigger Paget's disease of the breast. Obesity, high levels of estrogen hormones, and familial history of breast cancer also put women at an increased risk.
Paget's disease of the breast is a relatively quick-growing cancer, but physical symptoms may not be apparent for several months after a tumor starts to develop. The first signs of cancer can include tenderness, redness, and dryness around the nipple. The skin starts to flake and itch, and the nipple can flatten or appear inverted. Occasionally, a hard lump can be felt behind the nipple. Paget's disease is usually isolated to one breast, but it is possible to have symptoms in both breasts at a time or later develop the cancer on the other side.
A woman who notices changes to her breast should visit a doctor as soon as possible to receive a proper diagnosis. A specialist can perform a physical examination to evaluate the nipple's appearance and check for lumps. Mammograms are performed to look for underlying tumors deeper in the breast. If Paget's disease is suspected, the doctor can scrape a small sample of tissue from the nipple for laboratory analysis.
Once a diagnosis is confirmed, specialists can begin considering different treatment options. Surgery is usually necessary to remove part or all of the affected breast. If there is no underlying cancer, just the nipple and milk ducts can be excised. In most cases, however, the entire breast needs to be removed. If Paget's disease of the breast spreads to the lymph nodes in the armpits, they are taken out as well.
When cancer is detected and treated early, most women experience full recoveries following surgery. Padded bras and custom orthotics can be used to return symmetry to the chest. If tumors develop elsewhere the body after treatment, long-term chemotherapy or radiation may be needed to reduce the risk of fatal complications.