Is there a change in the skin on your nipple? Could it be Paget's Disease of the Breast?

What do you think if you see a small rash or peeling skin on your nipple? Most of the time, you think it's just a normal skin condition, maybe something like eczema. True, it can be that way in most cases. However, very rarely, a small mark like this can be the first sign of breast cancer. That's one of those rare, but important types of cancer that we're going to talk about today.

Simply put, what is Paget's disease of the breast?

Paget's disease of the breast is a very rare type of cancer that occurs in the skin of your nipple, and sometimes in the dark skin around the nipple (areola). Sometimes it can be limited to the nipple. This is called stage 0 breast cancer, or ductal carcinoma in situ . But sometimes, along with this skin change, there can also be invasive breast cancer that has spread to the milk ducts inside the breast.

Because the symptoms are similar to eczema, many people initially mistake it for a common skin condition. Symptoms include itching, peeling, redness, and sometimes a discharge from the nipple. Remember, not everyone who has these symptoms has Paget's disease. However, if you have this condition, it could be the first sign of cancer developing inside the breast.

Who is most likely to get this disease?

Paget's disease of the breast is most common in women. However, it has been reported in men as well. The average age of diagnosis is usually around 57 years. However, it can occur in people much younger and older than that. It is so rare that it accounts for less than 4% of all breast cancers reported. So, even though it is a very rare condition, it is important to be aware of it.

How quickly does this disease spread? How severe can it be?

It really depends on whether or not you have other cancer inside your breast, and if so, what stage it is in.

• If the cancer is confined to the milk ducts: If your cancer is confined to the milk ducts and has not spread to the surrounding breast tissue, we call it "ductal carcinoma in situ" (DCIS) . This is considered stage 0 cancer. This type of cancer is treated by removing the cancer cells and the nipple with surgery, followed by radiation therapy. If the disease is detected at this stage, the chance of a complete cure is very high.

• If the cancer has spread outside the milk ducts: When the cancer in the milk ducts starts to spread into the surrounding breast tissue, it is called "invasive ductal carcinoma." This cancer develops in several stages. In the early stages, it can be treated by removing the affected breast tissue and the axillary lymph nodes. However, when the cancer starts to spread outside the breast, that is, in the later stages, the disease becomes more severe and difficult to treat.

What are the symptoms of Paget's disease?

These symptoms usually appear on your nipple and/or the dark skin around it (areola). Most often, these symptoms are only seen in one breast, but very rarely, they can occur in both breasts. Although these symptoms may seem to come and go at first, they tend to get worse over time.

What is the real reason for this?

The exact cause of cancer is still a mystery to scientists. But new research is constantly being conducted to uncover new facts. What we do know is that cancer occurs when some of the cells in our body become abnormal, dividing and growing uncontrollably. It is currently believed that these cellular changes may begin with changes in our genetic code, or DNA . But there is still no clear answer to why these changes occur.

Scientists have found that there are certain "risk factors" that increase the risk of developing cancer. For example, exposure to certain environmental toxins, smoking, and excessive alcohol consumption increase the risk of cancer. But surprisingly, 85% of breast cancers occur in people who have no major risk factors.

How to diagnose this disease? (Diagnosis)

When you go to see a doctor with symptoms like these, he may initially think it's just eczema. So he'll treat it. But when those treatments don't help, or when Paget's disease is suspected, he'll need to do some tests to accurately diagnose the disease.

The first and most important step is to take a small piece of tissue from the skin of the nipple and examine it under a microscope (biopsy). The most common method used for this is a "punch biopsy." This means that a small circular piece of skin is taken and examined with a small instrument, similar to a paper punch. This is the easiest way to identify cancer cells related to Paget's disease.

Once Paget's disease is confirmed, the next step is to find out if there is any other cancer in the breast and, if so, how far it has spread. To do this, your doctor will order imaging tests such as a mammogram or breast ultrasound . If these tests find any suspicious areas of cancer, they may recommend a "needle biopsy," which involves removing a small piece of tissue from the area with a needle.

What are the treatments?

Treatment includes surgery and sometimes additional cancer treatments (adjuvant therapies).

1. Breast cancer surgery

Any cancer in your breast will need to be removed surgically, but the amount of tissue removed will depend on your condition.

• Breast-conserving surgery: If you only have Paget's disease of the nipple and no other tumors, your surgeon will try to remove only the affected tissue. This involves removing your nipple, the skin around it (areola), and a small amount of healthy tissue around it.
• Mastectomy: If the cancer has spread to a large area, your surgeon may recommend removing the entire breast (mastectomy). After surgery, you can have breast reconstruction surgery if you wish.

2. Adjuvant therapy

After surgery, additional, complementary treatments are given to prevent the cancer from coming back. This is called adjuvant therapy.

• Radiation therapy: The use of high-energy rays to destroy any remaining cancer cells.
• Chemotherapy: Using drugs to kill cancer cells or stop their growth.
• Hormone therapy: Hormones play a role in the growth of some breast cancers. For such cancers, drugs that block the action of hormones are given.
• Immunotherapy: A treatment that stimulates your own body's immune system to fight cancer cells.

Can this be cured completely?

If you have only Paget's disease of the nipple, or DCIS (stage 0) that has not spread beyond the milk ducts, your chances of recovery are very high. Many people who are diagnosed and treated early in these conditions make a full recovery. It is only when breast cancer begins to spread that it becomes increasingly difficult to beat. Therefore, it is important to recognize the symptoms and see a doctor as soon as possible.

What time should I see a doctor?

In particular, if you have symptoms of eczema on or around your nipples, and they don't go away even after you treat them, be sure to see a doctor again for further testing. Don't ignore something minor.

How can I take care of myself if I have this disease?

The best way to take care of yourself is to start treatment as soon as possible. But you also need a lot of psychological support.

• Have someone to support you: talk to you, share your feelings, go to the doctor with you, and help with household chores with someone you trust (husband, family member, friend).
• Write down your questions: Before you go to see the doctor, write down all the questions you want to know on a piece of paper.
• Take notes: Take notes of what the doctor says. If you ask your companion to do the same, you can give the doctor your full attention. You can both review the information later.

Paget's Disease of the Breast, Breast Cancer, Nipple Rash, Ductal Carcinoma in Situ