From the Guidelines
The treatment for Paget's disease of the breast should involve surgical removal of the tumor, with breast-conserving surgery being a viable option for localized disease, followed by radiation therapy, as this approach has been shown to achieve satisfactory local control and reduce the risk of recurrence 1. When considering treatment options, it's essential to evaluate the extent of the disease and the presence of any underlying breast cancer.
- For localized Paget's disease without an associated tumor, breast-conserving surgery, including removal of the nipple-areola complex, may be sufficient, followed by radiation therapy to the whole breast.
- In cases where an associated breast tumor is present, mastectomy may be recommended, especially if the disease is more extensive.
- Radiation therapy is typically given after breast-conserving surgery to reduce the risk of recurrence, and a radiation boost may be considered to the site of the resected nipple-areola complex and any associated resected cancer site.
- For patients with invasive breast cancer associated with Paget's disease, additional treatments, such as chemotherapy, hormone therapy, or targeted therapy, may be necessary, depending on the tumor characteristics and patient preferences. The goal of treatment is to achieve local control, reduce the risk of recurrence, and improve overall survival, while also considering the patient's quality of life and preferences 1. Key considerations in treatment planning include:
- The extent of disease and presence of underlying breast cancer
- Tumor characteristics, such as hormone receptor status and HER2 status
- Patient preferences and quality of life considerations
- The need for additional treatments, such as chemotherapy, hormone therapy, or targeted therapy, in cases of invasive breast cancer.
From the Research
Treatment Options for Paget's Disease of the Breast
The treatment for Paget's disease of the breast typically involves a combination of surgery, radiation therapy, and possibly systemic therapy. The goal of treatment is to remove the cancerous cells and prevent the disease from spreading.
- Surgery: The primary treatment for Paget's disease is surgery, which may involve breast-conserving surgery (BCS) or mastectomy 2, 3, 4, 5. BCS is often preferred for patients with early-stage disease, while mastectomy may be necessary for those with more advanced disease or underlying invasive cancer.
- Radiation Therapy: Radiation therapy is often used in conjunction with BCS to eliminate any remaining cancer cells and reduce the risk of recurrence 3, 5.
- Systemic Therapy: Systemic therapy, such as chemotherapy or hormone therapy, may be recommended for patients with underlying invasive cancer or those at high risk of recurrence 3, 5.
Factors Influencing Treatment Choices
The choice of treatment for Paget's disease depends on several factors, including:
- Tumor size and location: The size and location of the tumor can affect the choice of surgery and the need for radiation therapy 2, 4.
- Presence of underlying invasive cancer: Patients with underlying invasive cancer may require more aggressive treatment, including mastectomy and systemic therapy 3, 5.
- Patient preferences: Patient preferences and lifestyle factors can also influence treatment choices, such as the decision to undergo BCS or mastectomy 5.
Outcomes and Prognosis
The outcomes and prognosis for patients with Paget's disease of the breast are generally favorable, with high survival rates and low recurrence rates when treated appropriately 2, 4, 5. However, the disease can be associated with underlying invasive cancer, which can affect prognosis and treatment outcomes 3, 5.