title: Paget's disease of the nipple as local recurrence after breast-conservation treatment for early-stage breast cancer.
abstract: Breast conservation treatment (BCT) for early-stage breast cancer is associated with survival rates comparable with mastectomy but has the risk of ipsilateral breast tumor recurrence, including Paget's disease of the nipple. A small number of cases of Paget's disease presenting as local recurrence following BCT for breast cancer have been previously reported. Between 1977 and 2002, 2181 women with early-stage breast cancer were treated with BCT at the Hospital of the University of Pennsylvania. In this cohort, there were 183 local treatment failures, 4 of which were cases of Paget's disease (2.2%), which are reported herein. These local recurrences developed 1.8, 3.8, 7.3, and 9.7 years after diagnosis of the patients' primary tumors. Three of the 4 primary cancers were invasive ductal carcinomas, with an associated intraductal component, and 1 was ductal carcinoma in situ. All 4 patients were successfully given salvage therapy consisting of mastectomy with or without tamoxifen, with follow-up times of 20.9, 10.6, 3.1, and 3.8 years. Paget's disease as local recurrence after BCT is uncommon and can be treated with salvage therapy if detected early.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA. plastaras@xrt.upenn.edu
authors.forename: John P
authors.initials: JP
authors.lastname: Plastaras
authors.forename: Eleanor E
authors.initials: EE
authors.lastname: Harris
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Solin
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D009558:Nipples / Q000473:pathology; D010144:Paget's Disease, Mammary / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects