Paget’s Disease Of The Breast, What Is It?

Dr. Harness explains defines Paget’s disease of the breast and explains why it is commonly misdiagnosed as Eczema. Learn more about Paget’s disease in this video.

Jay K. Harness, MD: In 1874, Sir James Paget described Paget’s disease of the breast. Now, what is Paget’s disease of the breast? Why is it such a rare form of breast cancer? How would I, as a patient, potentially recognize Paget’s? Is Paget’s often misdiagnosed for eczema, as an example, of the nipple areolar area?

We are trying to keep the definitions non-medical here and pretty straightforward and pretty simple if I can. Paget’s disease of the breast makes up only about one to little over four percent of all breast cancers.

When you look at the nipple, or the nipple and the areola, to the eye it does look like eczema, and what’s happening is that cancer cells are coming up and getting into and growing into the surface – the epithelium, if you will, covering the nipple, giving that kind of scaling effect, that kind of heartbreak, if you will, of eczema.

Quite frankly, through the years, I have lost track of the number of patients I have seen with Paget’s disease of the breast whose primary care physicians initially treated them with topical steroids thinking that this was eczema of the breast.

Could it be? Yeah, it’s part of the differential, but far more important, if you have changes like that of either the nipple and/or the areola, the very first thing that needs to be done is your breast needs to be seen and evaluated by a breast surgeon. You need imaging studies including mammograms and ultrasound and possibly even MRI.

Making the diagnosis is pretty simple. You can do a little punch biopsy like dermatologists do, of the skin of the nipple, and there’s certain Pagetoid cells that make it straight forward for the pathologist to make the diagnosis.

Now typically, there’s an underlying cancer, underneath the nipple areolar complex. It can be downstream, if you will, and the cancers come up the ductal system into the nipple and so we often see Pagets associated with either in situ breast cancer or invasive breast cancer.

There are times, but not a lot, where we can actually find the source underneath the nipple areolar complex and particularly now with breast MRI, we should almost always be able to find the source.

Well what about the treatment? The treatment of Paget’s is basically like an in situ cancer, if that’s what it’s associated with, down deeper in the breast. Unfortunately, the nipple and areola typically need to be removed as well as obviously treating the underlying cancer.

So, there are lots of variations to Paget’s disease of the breast and I don’t want to try and get into all those variations now. Pagets is an unusual form of breast cancer. It is treated in a very straightforward way by multidisciplinary centers. You need the appropriate imaging studies to figure out what’s going on underneath the nipple area.

And the bottom line for our viewers is that if you or you know someone that has what you believe looks like eczema of either to the nipple areolar area, you need an evaluation right away.

Dr. Jay K. Harness is a board certified surgeon currently treating patients at St. Joesph Hospital in Orange, CA. Dr. Harness specializes in complete breast health, breast cancer surgery, oncoplastic reconstruction, genetic screening, management of breast health issues, risk assessment and counseling. Dr. Harness is the medical director for Breast Cancer Answers.com, and guides this first ever social media show’s information by drawing on his former leadership experience as the President of the American Society of Breast Surgeons and Breast Surgery International. Dr. Harness graduated from the University of Michigan, Ann Arbor in 1969 and spent time early on in his career at the University of Michigan Medical Center.

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