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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Second opinion always a good idea

Peter H. Gott, M.D.

DEAR DR. GOTT: I enjoyed your article several months ago regarding Paget’s disease of the breast. I thought your readers might be interested in my experience, which happened in 1999.

I noticed my left nipple was quite red when compared to the right one. I observed this daily for about two weeks before deciding it was something that perhaps should be evaluated. A surgeon did a biopsy for me, and the diagnosis was Paget’s disease of the breast. He told me that he was not familiar with this, wanted to do some research on it, and would get back to me.

I decided to do a little research, too, and called the National Cancer Institute at (800) 4-CANCER. The material sent to me stated it was an indication of cancer and was very often in both breasts. I then heard from the biopsy surgeon, who stated he felt he could do a limited excision. I explained that my daughter insisted I get a second opinion and would get back to him.

A surgeon I selected was very familiar with Paget’s, and he told me that I should have a double mastectomy, because the cancer could possibly be in both breasts; however, all my nodes were negative. This happened 10 years ago, and I have had no cancer since then. I am now a firm believer in second opinions, as well as in early evaluation.

DEAR READER: Congratulations to you for doing research and getting a second opinion. In all likelihood, it saved your life.

Paget’s is a rare form of breast cancer that begins in the ducts and extends to the skin of the nipple and areola. While the name is the same, it isn’t at all related to Paget’s disease of the bone.

Symptoms can include redness, discharge, a flattened or inverted nipple, changes in one breast only, scaly skin on the nipple, itching and burning.

There is routine testing that often precedes a diagnosis. The first step is commonly a mammogram, followed by an ultrasound, MRI, possible needle biopsy and ultimately surgery in most cases. Two common procedures from which to choose are a lumpectomy, in which only the diseased portion of the breast is removed, or a simple mastectomy, that removes the entire breast but not the lymph nodes.

Annual mammograms are extremely important. Follow-up with a trained specialist can be a matter of life and death. Beyond that, the American Cancer Society is a tremendous resource, both for answering questions and for providing support. You certainly received appropriate guidance and are an inspiration to others.

For other readers who would like additional information, I recommend my Health Report “An Informed Approach to Surgery.” Simply send a self-addressed stamped No. 10 envelope and a check or money order for $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Readers may write to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.