Paget's disease of the breast: what it is, symptoms and treatment

Paget's disease of the breast, or DPM, is a rare type of breast disorder that is usually related to other types of breast cancer. This disease is rare to appear in women before the age of 40, being more frequently diagnosed between the ages of 50 and 60. Although rare, Paget's disease of the breast can also arise in men.

The diagnosis of Paget's disease of the breast is made by the mastologist through diagnostic tests and evaluation of symptoms, such as pain in the nipple, irritation and local desquamation and pain and itching in the nipple.

Symptoms of Paget's disease of the breast

Symptoms of Paget's disease usually occur in only one breast and are more frequent in women over 50, the main ones being:

  • Local irritation;
  • Pain in the nipple;
  • Desquamation of the region;
  • Changing the shape of the nipple;
  • Pain and itching in the nipple;
  • Burning sensation in the place;
  • Hardening of the areola;
  • Darkening of the site, in rarer cases.

In more advanced cases of Paget's disease, there may be involvement of the skin around the areola, in addition to retraction, inversion and ulceration of the nipple, so it is important that treatment be started as soon as possible.

The most suitable doctor to diagnose and guide the treatment of Paget's disease of the breast is the mastologist, however the identification and treatment of the disease can also be recommended by the dermatologist and gynecologist. It is important that the diagnosis is made as soon as possible, as this way it is possible to treat correctly, with good results.

How the diagnosis is made

The diagnosis of Paget's disease of the breast is made by the doctor through the evaluation of the symptoms and characteristics of the woman's breast, in addition to imaging tests, such as breast ultrasound and magnetic resonance imaging, for example. In addition, mammography is indicated in order to also check for the presence of lumps or microcalcifications in the breast that may be indicative of invasive carcinoma.

In addition to imaging tests, the doctor usually requests a biopsy of the nipple, in order to verify the characteristics of the cells, in addition to immunohistochemical examination, which corresponds to a type of laboratory examination in which the presence or absence of antigens is verified. that can characterize the disease, such as AE1, AE3, CEA and EMA that are positive in Paget's disease of the breast.

Differential diagnosis

The differential diagnosis of Paget's disease of the breast is made mainly of psoriasis, basal cell carcinoma and eczema for example, being differentiated from the latter by the fact of being unilateral and with less intense itching. Differential diagnosis can also be made taking into account the response to therapy, since in Paget's disease, topical treatment can relieve symptoms but has no definitive effects, with recurrence.

In addition, Paget's disease of the breast, when pigmented, must be differentiated from melanoma, and this occurs mainly through the histopathological exam, which is done to evaluate the breast cells, and immunohistochemistry, in which it is the presence of HMB-45, MelanA and S100 antigens in the melanoma and absence of the antigens AE1, AE3, CEA and EMA, which are normally present in Paget's disease of the breast.

Treatment for Paget's disease of the breast

The treatment indicated by the doctor for Paget's disease of the breast is usually mastectomy followed by sessions of chemotherapy or radiation therapy, as this disease is often related to invasive carcinoma. In less extensive cases, surgical removal of the injured region may be indicated, preserving the rest of the breast. Early diagnosis is important to prevent not only disease progression, but also surgical treatment.

In some cases, the doctor may choose to carry out the treatment even without confirmation of the diagnosis, indicating the use of topical medications. The problem related to this type of conduct is that these drugs can relieve symptoms, however they do not prevent the disease from progressing.