Paget’s disease of the breast is a rare form of breast cancer that primarily affects the skin of the nipple and the surrounding darker area, known as the areola. It often begins with visible skin changes, such as redness, flaking, or crusting. This article explores its detectability through mammography.
Understanding Paget’s Disease of the Breast
Paget’s disease of the breast typically originates from cancer cells within the milk ducts of the breast and then spreads to the surface of the nipple and areola. These Paget cells infiltrate the epidermis, leading to the characteristic skin changes. Symptoms can include redness, flaking, scaling, crusting, or thickening of the nipple and areola. Individuals may also experience itching, burning sensations, pain, or nipple discharge that can be yellowish or bloody.
These skin changes often resemble benign conditions like eczema or dermatitis, which can lead to delays in diagnosis. Symptoms usually affect only one breast and may fluctuate in intensity initially before worsening. The presence of these persistent, unexplained nipple or areola changes warrants medical evaluation to ensure an accurate and timely diagnosis.
How Paget’s Disease Can Appear on a Mammogram
While Paget’s disease primarily manifests as skin changes, it is frequently associated with an underlying breast cancer within the breast tissue itself. In 80% to 90% of cases, Paget’s disease is linked to either ductal carcinoma in situ (DCIS) or invasive breast cancer. It is these underlying cancerous changes, rather than the superficial skin symptoms, that a mammogram may detect.
Mammographic findings that could indicate underlying cancer in the presence of Paget’s disease include the presence of suspicious microcalcifications, which are tiny calcium deposits, or a distinct mass or lump. Other potential signs observed on a mammogram might be skin thickening in the nipple-areolar region, nipple retraction, or an asymmetric density in the breast tissue. When such findings are present, they signal the need for further diagnostic investigation to determine the nature and extent of the underlying disease.
When Mammography May Not Detect Paget’s Disease
Mammography has limitations in detecting Paget’s disease directly, as the skin changes are typically not visible on these X-ray images. If there is no underlying mass, calcifications, or other significant changes within the breast tissue, the mammogram may appear normal or inconclusive. Studies indicate mammographic findings may be negative in up to 50% of individuals with Paget’s disease.
A normal mammogram does not rule out Paget’s disease, particularly if characteristic skin symptoms are present. The superficial nature of the disease or its confinement to the ducts without forming a palpable mass or calcifications can lead to diagnostic delays. This highlights why a comprehensive approach to diagnosis is important when symptoms persist, even with an unremarkable mammogram.
Additional Diagnostic Tools for Paget’s Disease
When Paget’s disease is suspected, especially if mammography findings are normal or unclear, several other diagnostic methods are employed. A thorough clinical examination by a healthcare professional involves visual inspection of the nipple and areola, and palpation of the breast for any lumps or thickening. The definitive diagnosis of Paget’s disease relies on a skin biopsy, typically a punch biopsy, where a small tissue sample is taken from the nipple or areola for microscopic examination to identify Paget cells.
Additional imaging techniques are frequently used to assess the extent of any underlying breast cancer. Breast ultrasound can be performed to evaluate a palpable lump or an area of concern, and it may reveal features such as hypoechoic areas, masses, or dilated ducts. Breast magnetic resonance imaging (MRI) is also utilized, especially for staging purposes if invasive cancer is suspected, as it can detect additional areas of cancer not visible on mammograms or ultrasounds. These various tools work together with clinical findings to provide a comprehensive diagnosis and guide treatment planning.