How it Develops There are two theories about how Paget's disease may develop. The first is that cancerous cells may be able to break off or separate from underlying ductal tumors and migrate to the surface of the breast, where they can then infect the nipple and areola. Because 97% of all Paget's disease sufferers will eventually be diagnosed with one or another type of ductal breast cancer, this theory obviously makes sense. The fact that a small subclass of Paget's victims do not have any other kind of breast cancer contradicts this idea, however, and this has led to speculation that at least in some cases tissue cells in the nipple may spontaneously mutate into cancer cells, just as they do with any other kind of breast cancer tumors.
These two possibilities are not mutually exclusive, and it is possible that each may be valid in some cases.
Diagnosis and Treatment
The only sure way to detect Paget's disease of the nipple is to take tissue samples from the area for a biopsy. If a woman tests positive for cancer, the next step will be a diagnostic mammogram combined with a clinical examination to see if another type of breast cancer is present in the underlying tissue – and as already mentioned, in most cases such a cancer will be found.
Only if invasive ductal breast cancer is diagnosed and has begun the process of metastasis (spreading) will it be necessary to perform a full mastectomy on a woman suffering from Paget's disease. If the carcinoma inside the breast is of the non-invasive variety, then a lumpectomy to remove the nipple, areola, and the deeper breast cancer tumor will be sufficient, and as is usually the case this treatment will be combined with radiation therapy designed to kill any remaining cancer cells in the breast. Naturally, if invasive breast cancer is found to have spread beyond the breast to other areas of the body, additional treatment for cancer such as chemotherapy may be required.
Raising Awareness
Because women do not usually recognize Paget's disease for what it is, many delay seeking medical attention, and the result is that any underlying invasive cancer that might be present will have more time to metastasize and migrate beyond the milk ducts of the breast. For this reason, promoting greater awareness about Paget's disease is critically important. Whenever a woman is experiencing any of the symptoms associated with this type of cancer, she should make an appointment to see a doctor as soon as possible. The fact that this is not happening frequently enough now shows that medical professionals still have a lot of work to do to spread the word about Paget's disease of the nipple.
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