Is There a New Kind of Breast Cancer?: Paget’s Disease

By Tonia Bair

Many women have received an email warning that a “new form of breast cancer” starts as a rash on a woman’s breast, instead of showing up as a lump. According to the email, a young woman developed a rash, similar to that of young nursing mothers. The rash was treated with antibiotics, but did not clear up. Her doctor sent her for a mammogram, which showed a mass in her breast. The mass turned out to be cancer, a type called “Paget’s disease of the breast.”

This Internet story is actually based on truth. Although this type of breast cancer is not “new,” it is rare. According to information on the National Cancer Institute’s website (www.nci.nih.gov), Paget’s disease of the breast is a rare form of breast cancer that makes up 1 to 4 percent of all breast cancer cases. The NCI site reports that scientists are not sure how the disease occurs, but there are two theories. One theory is that cells from a tumor in the breast move through the milk ducts to the skin of the nipple; the other theory is that skin cells on the nipple spontaneously become cancerous.

The signs of Paget’s disease include scaling and crusting lesions on the skin of the nipple or areola, discharge, nipple inversion, flattening of the nipple or a lump. Paget’s disease of the breast is often confused with skin conditions like eczema. It usually affects women who are middle-aged, but can occur later. It can also very rarely affect men.

According to the NCI, most people with Paget’s disease have an underlying breast cancer as well. People who have Paget’s disease but who do not have a breast lump that can be felt usually have “ductal carcinoma in situ” (DCIS), where cancerous cells are in the milk duct linings but have not spread. People who have a lump usually have an invasive cancer.

Treatment of Paget’s disease depends on how far the cancer has advanced. If there is no underlying cancer, only radiation may be necessary. DCIS or a small tumor may only require a lumpectomy, which is the removal of the lump plus the surrounding tissue. A larger tumor may require a mastectomy.

A doctor may test for Paget’s disease of the breast by a biopsy, by scraping cells from the affected area and examining them under a microscope, or by mammogram. It is recommended that women see a health care provider if they notice any lumps, sores, discharge or rashes, or if a rash on the breast does not clear up after treatment.

It is important not to confuse Paget’s disease of the nipple with inflammatory breast cancer, another rare but serious breast condition that also produces external symptoms. For more information see What Women Need to Know about Inflammatory Breast Cancer.