It’s crucial to understand that Paget’s disease of the nipple is often associated with breast cancer. Therefore, any changes you observe in your breast tissue or skin warrant immediate attention from your General Practitioner (GP). Prompt medical consultation is essential if you notice any alterations affecting your nipple or breast.
Specifically, you should consult your GP if you experience changes such as:
- Skin changes on your nipple or areola (the darker skin surrounding the nipple)
- Any new lumps in your breast
Paget’s disease of the nipple shares similar symptoms with eczema, another skin condition known to cause red, itchy, and dry skin. Because of this similarity, it is vital to seek a professional diagnosis from your GP rather than self-diagnosing eczema. Paget’s disease is a form of breast cancer, and early diagnosis significantly improves the chances of successful treatment and a positive outcome.
Initial Examination and Medical History for Paget Disease Diagnosis
Your GP will conduct a thorough examination of both breasts, even if symptoms are present in only one. To aid in the diagnostic process for Paget disease, they will also gather important information by asking about:
- Your specific symptoms and how long you have experienced them.
- Your personal history of breast cancer or any family history of the disease.
- Your age and menopausal status (whether you have gone through menopause).
- Any medications you are currently taking, including hormone replacement therapy (HRT), used for menopause symptom management, or oral contraceptives.
- Your alcohol consumption habits.
- Your weight and any recent weight fluctuations.
If your GP suspects the possibility of breast cancer, they will expedite a referral to a specialist breast clinic for comprehensive diagnostic testing to confirm or rule out Paget disease and associated breast cancers.
Diagnostic Procedures at a Breast Clinic for Paget Disease
Upon referral to a breast clinic, you will undergo a series of tests designed to determine if breast cancer is present and, if so, to identify the specific type of breast cancer. To accurately document the condition of your breasts and monitor any changes, the clinic staff may take photographs of your breasts.
The diagnostic tests you may undergo at the clinic include:
- Clinical Breast Examination: A physical examination of your breasts to detect lumps or any other abnormalities.
- Mammogram: This is an X-ray imaging technique used to examine the breast tissue.
- Ultrasound Scan: Often the initial imaging method for younger women, pregnant individuals, and those who are breastfeeding.
- Skin Biopsy: Crucial if Paget’s disease is suspected. This involves taking a small skin sample from the nipple and/or areola for microscopic examination.
The Role of Mammography in Paget Disease Diagnosis
A mammogram is a straightforward procedure utilizing low-dose X-rays to create detailed images of the internal breast structure. Mammograms are effective in identifying early tissue changes, sometimes before a lump becomes palpable.
However, it’s important to note that mammogram effectiveness can be reduced in younger women due to denser breast tissue, making it harder to interpret the images. For women under 35, a breast ultrasound might be recommended as an alternative initial diagnostic tool. Despite this, if Paget’s disease of the nipple is a concern, mammography becomes a vital part of the pre-surgical assessment and diagnosis process.
During a mammogram, a radiographer will position one breast at a time on a flat X-ray plate. A second plate will compress the breast from above, flattening it to ensure a clear image. An X-ray is then taken, providing a detailed view of the breast’s internal structures. This process is repeated for the other breast. While a mammogram might cause slight discomfort or be briefly painful, the procedure is quick, usually taking only a few minutes. The resulting images are then carefully reviewed by two specialists, known as film readers, image readers, or radiologists, to identify any signs of cancer.
Ultrasound Imaging for Breast Evaluation in Paget Disease
For individuals under 35, a breast ultrasound may be preferred over a mammogram due to the limitations of mammography in dense breast tissue. Ultrasound is also valuable in determining whether a breast lump is solid or fluid-filled. Furthermore, it is a safe imaging option for pregnant or lactating individuals.
Breast ultrasound employs high-frequency sound waves to generate images of the breast’s interior. A handheld device called a transducer is placed on the breast, emitting sound waves and capturing the returning echoes to create a visual representation on a monitor. This allows for the detection of lumps and other abnormalities.
Skin Biopsy: Confirming Paget Disease Diagnosis
A skin biopsy is frequently employed to definitively confirm a diagnosis of Paget’s disease of the nipple. This procedure involves extracting a small tissue sample from the nipple or surrounding areola. The sample is then meticulously examined under a microscope and tested in a laboratory to identify the presence of cancerous cells, thus confirming or excluding Paget disease as the diagnosis.
Further Diagnostic Tests Following Paget Disease Diagnosis
If breast cancer is confirmed following the initial tests for Paget disease, additional investigations may be necessary to determine the cancer’s characteristics and guide treatment decisions. These further tests help to understand the type and extent of breast cancer, ensuring the most effective treatment plan is developed.
