Paget's disease of the breast: there is a role for breast-conserving therapy.
BACKGROUND
The optimal surgical management of Paget's disease of the breast remains to be defined. Mastectomy has been the standard of care, but several institutions have recently advocated breast-conserving surgery, particularly for patients with minimal disease. In an effort to develop rational treatment guidelines, we examined our institutional experience with Paget's disease of the breast.


METHODS
Patients with Paget's disease of the breast who had surgical therapy at our institution between 1949 and 1993 were reviewed. In addition to patient and tumor characteristics, charts were reviewed for treatment modalities, locoregional recurrence patterns, and survival. Subgroups were compared for differences in survival in both univariate and multivariate analyses.


RESULTS
A total of 104 patients met the study criteria. The most common presenting symptoms were nipple discharge and eczematous changes of the nipple/areola complex. Ninety-seven patients (93.2%) had an underlying invasive or noninvasive cancer associated with Paget's disease. Ninety-two patients (88.5%) underwent mastectomy, and 12 (11.5%) had a breast-conserving procedure. On univariate analysis, patients with age <60 years at diagnosis, stage II disease, positive lymph nodes, invasive disease, or a palpable mass had significantly lower 10-year disease-specific and recurrence-free survival. There were four locoregional recurrences (three after mastectomy and one after breast conservation). There were no significant differences in overall, disease-specific, or recurrence-free survival according to the type of surgery.


CONCLUSIONS
Paget's disease of the breast is almost always associated with an underlying breast cancer. Breast-conserving approaches result in local control and survival rates similar to those achieved with mastectomy.
Kawase
Kazumi
K
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, Texas 77030, USA.
Dimaio
Dominick J
DJ
Tucker
Susan L
SL
Buchholz
Thomas A
TA
Ross
Merrick I
MI
Feig
Barry W
BW
Kuerer
Henry M
HM
Meric-Bernstam
Funda
F
Babiera
Gildy
G
Ames
Frederick C
FC
Singletary
S Eva
SE
Hunt
Kelly K
KK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000401:mortality; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010144:Paget's Disease, Mammary / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis