Have you ever noticed a small change, an itch, or something that looks like a rash on your nipple? It could be a normal skin condition, but if you have a little doubt in your mind, it's important to pay attention to it. Because, rarely, these symptoms can be the first sign of breast cancer. That's one of those rare, but very important conditions that we're going to talk about today.
What is Paget's Disease of the Breast?
Simply put, Paget's Disease of the Breast is a very rare type of cancer that develops in the skin of your nipple . Sometimes it can also affect the darker skin around the nipple, called the areola .
Consider, this can sometimes be limited to the nipple, as an early stage of breast cancer (stage 0 breast cancer) , called `ductal carcinoma in situ` (DCIS) . Or, it can be accompanied by a more serious `invasive breast cancer` that spreads to the milk ducts in the same breast. This is also called mammary Paget's disease .
This is because the skin on the nipple looks like `eczema` , so many people initially think it's just a normal rash. Symptoms can include itching, peeling skin, redness, sometimes a sore appearance, and a discharge from the nipple . But remember, not everyone who has these symptoms has Paget's disease. However, if you have this condition, these could be the first signs of underlying breast cancer .
Who can develop this?
Paget's disease of the breast mostly affects women . However, very rarely, men have been reported to develop it. The average age of diagnosis is around 57 years . However, it has been found in people much younger and older than that. Paget's disease accounts for less than 4% of all breast cancers. So, as you can imagine, this is a relatively rare condition.
How quickly/severely does this disease spread?
It really depends on whether you have ductal carcinoma underneath, and if so, what stage it is in. For example, if you have cancer only in your milk ducts and it hasn't spread to the surrounding breast tissue, we call it ductal carcinoma in situ (DCIS) . This is considered stage 0. This type of cancer is usually treated with surgery to remove the lump(s) and the nipple , followed by radiation therapy.
However, if this `ductal carcinoma` spreads beyond the milk ducts, it is called `infiltrating ductal carcinoma`.Or `invasive ductal carcinoma` . This cancer gets worse in stages . In the early stages, it can be treated by removing the affected breast tissue and the `axillary lymph nodes` in the armpit. However, when this `invasive breast cancer` spreads beyond the breast, that is, in the later stages , it becomes more aggressive and difficult to treat.
What are the symptoms?
These symptoms usually occur on your nipple and/or the dark skin around it (areola) . Most often, only one breast is affected, but very rarely, both can be affected. At first, these symptoms may seem to come and go, but they can get worse over time. Symptoms may include:
- Itching of the nipple , which can later lead to inflammation .
- Dry skin, peeling of the skin (on or around the nipple).
- A skin rash may appear. It may be red, raised, crusty, sore, or bleeding .
- Inflammation and pain .
- Like eczema getting wet, a crust forms and a liquid oozes out .
- Blood or pus-like fluid coming out of the nipple .
- Flat or inverted nipple .
- A palpable breast lump under the skin.
Important: Don't panic if you have one or two of these symptoms. However, if they persist or worsen, you should definitely seek medical advice.
What are the reasons? Why does this happen?
In fact, scientists still don't know exactly what causes cancer . But new research is constantly being done to find out. What we do know is that some of the cells in our bodies undergo abnormal changes , leading to uncontrolled division and replication . Current research suggests that these cellular changes may start in our DNA (genetic code) . But we don't know exactly why these changes happen, or when.
Scientists have found that there are often certain "risk factors" that contribute to the development of cancer. They believe that these factors may play a role in the development of the disease. For example, if you are exposed to environmental toxins , or if you smoke or drink alcohol frequently, you are more likely to develop the disease. However, surprisingly, 85% of breast cancers occur in people who have no known risk factors .
How is this disease accurately diagnosed?
When you see a doctor, he or she may first try to treat your condition with the same treatment as eczema . If that doesn't work, or if he or she suspects Paget's Disease of the Breast, he or she may need to take a sample of breast tissue and examine it under a microscope. Paget cells are easily identified this way. He or she will likely do a punch biopsy . This involves removing a small, round piece of tissue using a circular cutting tool (like a hole punch).
After you are diagnosed with Paget's Disease of the Breast, your doctor will want to find out if you have ductal carcinoma in situ and, if so, how far it has spread . To do this, he or she will first examine your breast tissue with imaging tests . For example , a mammogram or breast ultrasound may be done. If a suspicious area is found, he or she may recommend a needle biopsy to take a sample of breast tissue.
How is it treated?
Treatments include surgery and sometimes additional cancer therapies .
Surgery
Any cancer in your breast needs to be removed surgically. However, how much tissue is removed depends on your condition. If you only have Paget's Disease of the Breast, and there are no other lumps, you may have minimal, breast-conserving surgery . This means that your surgeon will try to remove only the affected tissue. He or she will remove your nipple, the dark skin around it (areola), and a small amount of normal tissue around it .
Depending on how far the cancer has spread, your surgeon may recommend a mastectomy (surgery to remove the entire breast) . If you prefer, you can also have breast reconstruction surgery afterwards.
Adjuvant Therapy
After surgery, you will likely be given additional, complementary treatments to prevent the cancer from coming back. These `adjuvant therapies` may include:
- Radiation therapy: High-energy rays are used to destroy cancer cells.
- Chemotherapy: Drugs are used to kill cancer cells or stop them from growing.
- `Hormone therapy`:Hormones help some breast cancers grow. This treatment blocks those hormones.
- Immunotherapy: Helps your own immune system fight cancer.
Can this disease be completely cured?
The chances of survival from breast cancer depend on the stage of the cancer when it is diagnosed . If you have Paget's disease of the nipple, which is only in the breast, or ductal carcinoma in situ (stage 0) , which has not spread beyond the milk ducts, your prognosis is very good . Most people who are diagnosed and treated early in these conditions make a full recovery . However, once breast cancer has spread, it becomes increasingly difficult to beat.
That's why it's so important to pay attention to even the slightest change and seek medical advice.
When should I see a doctor?
If you notice any changes in your breasts, whether they are changes in the skin or changes under the skin, always see a doctor. Most of the time it may not be cancer, but it's always best to get checked . If you have symptoms like eczema on or around the nipple or areola, and you've tried to treat it yourself and it doesn't help , definitely make an appointment to see a doctor for further testing.
How do you take care of yourself if you have this disease?
The best thing you can do for yourself is to start treatment as soon as possible . But, you also need support . At the very least , find someone you trust to talk to, go to your appointments, or help with household chores.
Bring a list of questions to ask the doctor, and be prepared to write down what is said, or ask someone to write it down for you. You can both review it later.
It's also important to stay mentally strong during times like this. Do things that bring you comfort, talk to family and friends, and seek counseling if necessary.
Is there a connection between Paget's disease of the breast and other 'Paget' diseases'?
This is a question that many people ask. Sir James Paget, an English surgeon in the late 19th century, made a number of medical discoveries. There are several diseases named after him, but not all of them are related to each other .
For example, `Paget's disease of the bone` is a non-cancerous bone disease. It is not related to Paget's disease of the breast.
But,There is another rare cancer called `extramammary Paget's disease` (EMPD), which is somewhat similar in nature.
Paget's disease of the breast is characterized by the presence of distinctive cancer cells in the skin of the nipple that can be seen under a microscope. They are called Paget cells because Paget first described them. Extramammary Paget's disease (EMPD) also has these Paget cells. It also has a similar rash, but it is not on the nipple, but on the genitals . Although these two diseases are similar, they are separate diseases . They do not occur together.
Take-Home Message
Okay, so here are some of the most important things we've talked about today to help you remember:
- Paget's Disease of the Breast is an early stage cancer of the milk ducts in the nipple . Sometimes, it can be accompanied by more advanced breast cancer.
- You may notice changes in your nipple, such as a crusty lump, peeling skin, oozing fluid, or a sore that doesn't heal .
- The sooner you recognize and treat this, the better your recovery outcome.
- Most people recover completely , but it may require surgery to remove it .
- If you notice any unusual changes in your breasts, especially your nipples, it's best to seek medical advice without wasting time .
We hope you have been informed by this information. Stay healthy!
👩🏽⚕️ Additional questions (FAQs)
💬 Is Paget's disease of the breast a skin rash?
From the outside, this looks like eczema or a rash on the nipple and the black ring around it. The skin becomes red, itchy, and starts to peel off until it bleeds. But the scariest thing is that, as a rule, 99% of breast cancer is hidden inside this external rash.
💬 Is this definitely cancer?
Yes! This is an extremely rare type of breast cancer. Although the disease looks like a skin disease, it develops in the milk ducts inside the breast (Ductal carcinoma). The cancer cells that form there grow up the milk ducts and become visible on the surface of the skin of the nipple.
💬 Will it heal at first if I apply a cream to it?
This is the biggest mistake women make! If you apply a cream (steroids) to your nipple when it itches, the itching will decrease a little in the first few days. Then you think it's okay. But the cancer is growing inside. Therefore, if a sore on the nipple has been there for more than 2 weeks, you should immediately have a biopsy.
` Breast cancer, Paget's disease, nipple symptoms, breast health, women's health, cancer detection, cancer treatment
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