Original Scientific ArticlesPaget’s disease of the breast: a 33-year experience
Section snippets
Methods
The medical records of all patients diagnosed or treated at RPCI for PD between January 1963 and June 1996 were reviewed. Collected data included: age at diagnosis, race, menopausal status, family history, symptoms, physical examination findings, mammographic findings, surgical therapy, pathologic findings/diagnosis, lymph node involvement, surgical therapy, adjuvant therapy, recurrence of cancer, and date of last followup. Persons having one or more first degree relatives with breast cancer
Results
In the 33-year period reviewed, 2 men and 78 women with a histologic diagnosis of PD were seen or treated at RPCI. The median followup for all patients was 61 months (range 2–288 months). The median age at diagnosis was 57 years (range 23–85 years). At the time of diagnosis 76% of the women were postmenopausal. Ten patients (13%) had a first-degree relative with breast cancer.
Patient characteristics and clinical findings are summarized in Table 1. Of the 80 patients with a histologic diagnosis
Discussion
At RPCI, 80 patients with PD were treated over a 33-year period and 82% were found to have a related breast cancer. Sixty four percent of patients presented with nipple ulceration and 31% complained of nipple discharge. Thirty of 68 patients (group 1) were found to have a clinically apparent breast lesion. A cancer was identified in 93% of these patients (75% invasive, 25% DCIS). Fifty-seven percent of the patients in this group had pathologic axillary nodes and their median tumor size was 4.2
Conclusions
This retrospective review of patients with Paget’s disease of the breast treated at a single institution over 33 years reinforces the well described natural history of the disease. It also suggests that an underlying breast cancer is found in most, but not all, patients with PD and identifies differences between PD and DCIS. These differences suggest that treatment of PD, especially in patients with no associated breast mass, cannot simply reflect the treatment of DCIS. The treatment of
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