Paget's Disease Can Be Successfully Treated with Breast-Conserving Therapy

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According to results presented at the 2003 San Antonio Breast Cancer Symposium, Paget's disease confined to the nipple or areola can be successfully treated with breast-conserving therapy followed by radiation.

Paget's disease of the breast accounts for only 1% to 4% of all breast cancers. Paget's disease of the breast often has symptoms including redness, scaling of the skin, itching, or burning in the area of the nipple or areola (darker-colored skin directly surrounding the nipple). The nipple may also change appearance, including a flattening against the breast, or a bloody discharge may occur. Approximately half of patients with Paget's disease of the breast also have a cancerous lump in the breast that can be felt. Historically, standard treatment for Paget's disease of the breast included a mastectomy, which is the surgical removal of the entire breast. However, researchers have increasingly been using breast-conserving therapy, in which only a portion of the breast is surgically removed, for the treatment of Paget's disease that does not appear to have spread from the area of the nipple instead of mastectomy. Medical literature on results from breast-conserving therapy in the treatment of these patients is scarce, and researchers are beginning to collect more information involving this issue so that physicians and patients can make the most appropriate treatment decisions based on sound data.

Researchers from the MD Anderson Cancer Center recently evaluated data comparing outcomes of patients with Paget's disease of the breast who were treated with mastectomy or breast-conserving therapy. This data included 109 patients who were diagnosed between 1949 and 1993 and the average follow-up was approximately 7 years. For patients who had no cancer outside the area of the nipple or areola found on scans or no lumps that could be felt, overall survival, cancer-free survival, and cancer recurrences occurring at or near the site of origin were equal between patients treated with mastectomy or breast-conserving therapy. Patients with more advanced breast cancer, such as those with cancer spread to lymph nodes, and those younger than 60 years of age, had worse overall survival than the rest of the group of patients, regardless of therapy. These findings are consistent with other types of breast cancer. The researchers concluded that breast-conserving therapy provides equal outcomes to mastectomy in patients with Paget's disease of the breast that is confined to the nipple or areola. 1

Results from a second clinical study evaluating breast-conserving therapy in Paget's disease of the breast were also presented at the meeting. Researchers from New York analyzed data involving 45 patients diagnosed between 1990 and 1997 with Paget's disease that had not spread and were treated with either a mastectomy or breast-conserving therapy. Approximately half of the patients underwent a mastectomy and half underwent breast-conserving therapy. The average time of follow-up was approximately 7 years. Overall survival, recurrence rates and time to recurrence were all similar between mastectomy and breast-conserving therapy patients. Cancer recurrences occurred in 17% of patients treated with breast-conserving therapy, and 14% of patients treated with a mastectomy. The average time to a cancer recurrence was approximately 2 years in both groups of patients. Overall survival was 85% for patients treated with breast-conserving therapy, and 78% for those treated with a mastectomy. The researchers concluded that breast-conserving therapy is an acceptable treatment option for patients with Paget's disease of the breast that is confined to the nipple or areola region. 2

References:

1. Kawase K, DiMaio D, Tucker S, et al. Paget's disease of the breast: a long-term follow-up study. Proceedings from the 26th annual San Antonio Breast Cancer Symposium. December 2003. Abstract #449.

2. Joseph K, Komenaka I, Ditkoff B, et al. Therapeutic options for Paget's disease: an update. Proceedings from the 26th annual San Antonio Breast Cancer Symposium. December 2003. Abstract #156.