Paget’s Disease of the Breast – A Breast Cancer Story

It is now October (yikes – how did that happen?!?) meaning pumpkins, mums, football and multi-colored piles of leaves on the ground. It also means pink ribbons galore – from the bakery to your favorite makeup and more – pink ribbons are all around.

The statistics on breast cancer are sobering – 1 in 8 women will be diagnosed with breast cancer during her lifetime, and estimates say over 230,000 women and 2300 men will face a new diagnosis of breast cancer this year. It’s easy to be overwhelmed or feel numb when faced with numbers like these and easy to feel pink overload this month. To help keep the focus on the disease and the breast cancer survivor, I’d like to share a story of one such special lady with you.

Ms M. asked to meet with me one day to talk. Ms. M. was diagnosed with Paget’s disease of the breast, and at the time of her diagnosis, the cancer had already spread to the lymph nodes under her arm.  Her reason for wanting to meet with me? She wanted to share her story with others, hoping that her story could spare others some of her pain.

Paget’s disease of the breast is a rare form of breast cancer – about 1-4 % of breast cancers. Paget’s disease is a cancer involving the nipple and adjacent tissue. Tumors are usually present within the breast tissue as well, although may be difficult to find on mammography alone. Many times the underlying cancers are non-invasive, also called ductal carcinoma in situ.

The changes in the nipple range from the dramatic to the subtle. One of the reasons Ms M.’s cancer was not found earlier was the innocent look of the change. She described it as a smooth red bump on her nipple, about the size of a pencil eraser. Bumps on the nipple are common- but this one was new, larger than any others, and did not go away.

So what can Paget’s disease of the nipple look like and what changes should prompt a doctor’s evaluation?

• The nipple may be red, itchy and/ or scaly.
• Sometimes the changes may mimic a skin disorder like eczema.
• Flaky, thickened skin may be seen at or next to the nipple.
• The nipple may flatten or invert (pucker in).
• Nipple leakage or discharge may be seen as can oozing from the skin.
• Bumps that are new and persist, even if smooth like Ms. M’s can also be a sign of Paget’s disease.

What should you do?

• First, know yourself.  Know the normal look of your nipple and seek evaluation if your nipple changes.
• Any of the above signs or symptoms that persist should prompt a doctor’s visit.
• Mammography and possibly breast ultrasound will likely be the first steps in evaluation if you are over 30.
• Many times these tests will be negative and no abnormalities will be seen.
• If the changes do not improve or worsen, biopsy of the nipple and adjacent skin are the next step. Even if innocent looking, a bump that is new and hangs around needs to be biopsied- seek a second opinion if needed to get action. Because the cancer is rare and the changes so variable, diagnosis can be hard.

So Ms. M., here’s to you! Your mindful and courageous attitude, your desire to spread the word and in so doing help others is an inspiration. This October, we salute you and stand with you.  

We will fight the fight until a cure is found.  

Image credit: Autumn’s Flower free creative commons, by D Sharon Pruitt (Pink Sherbet Photography) via Flickr; Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0).

Originally published 10/1/15 on mammographykc.com.