Paget Disease of the Breast - Treatment

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How is Paget disease of the breast treated?

For many years, mastectomy, with or without the removal of lymph nodes under the arm on the same side of chest (known as axillary lymph node dissection), was regarded as the standard surgery for Paget disease of the breast. This type of surgery was done because patients with Paget disease of the breast were almost always found to have one or more tumors inside the same breast. Even if only one tumor was present, that tumor could be located several centimeters away from the nipple and areola and would not be removed by surgery on the nipple and areola alone.

Studies have shown, however, that breast-conserving surgery that includes removal of the nipple and areola, followed by whole-breast radiation therapy, is a safe option for people with Paget disease of the breast who do not have a palpable lump in their breast and whose mammograms do not reveal a tumor.

People with Paget disease of the breast who have a breast tumor and are having a mastectomy should be offered sentinel lymph node biopsy to see whether the cancer has spread to the axillary lymph nodes. If cancer cells are found in the sentinel lymph node(s), more extensive axillary lymph node surgery may be needed. Depending on the stage and other features of the underlying breast tumor (for example, the presence or absence of lymph node involvement, estrogen and progesterone receptors in the tumor cells, and HER2 protein overexpression in the tumor cells), adjuvant therapy, consisting of chemotherapy and/or hormonal therapy, may also be recommended.

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Comment from: Edie, 55-64 Female (Patient) Published: December 16

My right nipple became scaly and was sometimes was slightly sticky. One day I noticed the nipple was inverted. Nothing made it reverse so I had a diagnostic mammogram. I had googled my symptoms and Paget's disease of the nipple came up. I wasn't surprised when the radiologist confirmed it. I had a lumpectomy but wasn't satisfied with having to do radiation, so had mastectomy and reconstruction instead. I am pleased with my decision. This was over 2 years ago.

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