Source: Jpn J Clin Hematol  |  Posted 5 years ago

By Ed Susman

MIAMI BEACH, FL -- March 13, 2006 -- Doctors have produced the first set of guidelines dealing with the unusual situation of Paget's disease breast cancer, which is frequently discovered as a carcinoma in situ of the nipple.

The guideline suggests treatment procedures following first clinical suspicion of Paget's disease based upon whether the diagnosis turns out to be Paget's disease without underlying cancer, Paget's disease with ductal carcinoma in situ or Paget's disease with invasive cancer.

Benjamin Anderson, MD, Director, Breast Health Center, University of Washington at Fred Hutchinson Cancer Research Center, Seattle, Washington, United States, presented the guideline here on March 10[^]th[] at the 11[^]th[] annual conference of the National Comprehensive Cancer Network (NCCN).

The NCCN is a consortium of 19 hospitals in the United States that has been developing guidelines for treatment of cancers since 1996. The NCCN guidelines are often used by hundreds of hospitals outside the network and internationally.

Dr. Anderson said that the diagnostic workup for Paget's disease includes mammography and ultrasound, and the use of magnetic resonance imaging may be considered as well. The guidelines suggest a nipple biopsy is required to complete the diagnosis.

"While surgery causes loss of the nipple, many women still prefer breast conservation surgery because the retention of the breast mound allows for use of regular dress," he said. He demonstrated results of surgery, illustrating the post surgical appearance. However, the guidelines consider the need for mastectomy after consultation with the patient.

If the cancer is found to be invasive, the guidelines call for axillary dissection to complete cancer staging. If the woman opts for a lumpectomy procedure, post-surgery radiation therapy is recommended.

If the cancer is determined to be an invasive form, Dr. Anderson said that the guidelines recommend systemic therapy.

[Presentation title: Update: Breast Cancer Guidelines]