Paget’s disease of the breast

Overview

Paget’s disease of the breast is a particularly uncommon type of breast cancer that affects the black circle of skin (areola) around the nipple and begins on the nipple. It is important to note that Paget’s disease of the breast is unrelated to the metabolic bone illness, Paget’s disease of the bone.

This type of breast cancer usually develops after the age of 50 and is commonly associated with ductal breast cancer in situ (meaning in its original location) or, less frequently, invasive breast cancer. It is rare for Paget’s disease of the breast to only affect the nipple.

Initially, Paget’s disease of the breast may be mistaken for a common rash since it can look similar to eczema on the nipple. Symptoms may include nipple discharge, red or raised plaques on the skin, scaling, and itching. However, it is important to note that most individuals with these symptoms do not have Paget’s disease. Nevertheless, if you do have these symptoms, they might be the first obvious indications of underlying breast cancer.

Symptoms

The symptoms of Paget’s disease of the breast typically impact the nipple and the skin around it, known as the areola. These symptoms can be similar to those of a benign skin condition such as dermatitis, which can make it challenging to identify Paget’s disease.

Paget’s disease of the breast could manifest as any of the following:

• Itchiness
• Reddish discoloration
• An ache or tingling sensation
• Thickening of the breast skin
• Skin that is flaky or scaly on your nipple
• A nipple that has been flattened or turned inward
• Breast bulge under the skin that can be felt.
• Bloody, pus-like or straw-colored nipple discharge
• Eczema-like skin that is crusty, seeping, or hardened on the areola, nipple, or both

Usually, signs and symptoms of this condition are only present in one breast, starting in the nipple and potentially spreading to other parts of the breast. Skin changes may appear and disappear early on or improve with topical treatment, leading to the illusion of healing. Typically, signs and symptoms persist for several months before a diagnosis is confirmed.

It is important to monitor any changes in your breasts. If you detect a lump or experience persistent itching or skin irritation for over a month, schedule an appointment with your doctor. Additionally, if treatment for a breast injury does not resolve the issue, schedule a follow-up appointment with your doctor.

Causes

The exact cause of Paget’s disease of the breast remains unknown. However, it is understood that cancer involves abnormal changes in specific cells that result in uncontrolled division and replication. The current understanding is that these changes may originate in the DNA or genetic code of cells. Nonetheless, the reasons for these changes occurring at specific times remain unknown.

Risk factors

The risk factors that increase your chances of developing Paget’s disease of the breast are similar to those that raise your risk of developing other types of breast cancer.

Some factors that increase your risk of developing breast cancer are as follows:

• Aging. Risk increases with age
• Early menstruation. Your risk of developing breast cancer rises if you start menstruating before age 12.
• Late menopause. Breast cancer is more likely to strike women who started menopause later in life.
• Late primary pregnancy. Your risk of breast cancer may increase if you have your first child after turning 30.
• Never experience pregnancy. Your risk of developing breast cancer may be higher if you have never been pregnant.
• Genetically inheriting genes that poses risk for having cancer. It is possible for parents to pass on some DNA mutations that enhance the risk of breast cancer to their offspring. The BRCA1 and BRCA2 gene mutations are the most well-known ones. These genes can significantly increase your risk of developing breast cancer and other malignancies, but they do not guarantee that you will develop one.
• Postmenopausal hormone therapy. Breast cancer risk may increase with hormone therapy drugs that combine estrogen and progesterone to treat menopause symptoms and indications. When you quit using these drugs, the danger goes down.
• History of breast problem. You are more likely to develop breast cancer if a breast biopsy revealed Lobular Carcinoma in Situ (LCIS) or atypical hyperplasia of the breast.
• Breast cancer in the past. You run a higher risk of getting breast cancer in the other breast if you’ve already had it in the first.
• Breast cancer history in the family. Your risk of developing breast cancer is enhanced if a parent, sibling, or child, particularly one who was diagnosed at a young age, had the disease. Nevertheless, the majority of breast cancer patients do not have a family history of the condition.
• Being exposed to radiation. Your risk of developing breast cancer is higher if you had chest radiation treatments as a kid or young adult.
• Being overweight. Your risk of developing breast cancer rises if you are obese.
• Alcohol consumption. Alcohol consumption raises the possibility of breast cancer.