Dear Dr. Gott: I am a retired surgeon who reads your column almost every day. I find it interesting and informative, and I commend you for the service you render to a large number of readers. However, a recent column of Feb. 21 contained information that may prove disastrous to some patients, and I would like to set the record straight. I am referring to the advice you gave to a patient who has a non-healing wound on the breast. One diagnosis paramount to consider is Paget’s disease of the breast, which would indicate an underlying carcinoma. In fact, for a surgeon, that would be the first consideration.
Dear reader: You are correct. I did not cover the possibility of Paget’s disease of the breast but recommended the patient engage the services of her physician for a culture of the wound. I directed my attention toward a likely infection, since she constantly irritated the breast.
For my readers’ interest, I will give a little background about the condition. It was named after Sir James Paget, a scientist who observed an association between changes in the appearance of the breast and underlying cancer. Paget’s disease is an uncommon form of breast cancer that involves less than 5 percent of all cases diagnosed. It occurs most frequently in those over 50, and unfortunately, such women are found to have underlying, infiltrating ductal breast cancer. It presents with redness, itching, burning, oozing or hardened skin that takes on an appearance of eczema. There may be flaking or scaling skin on the nipple, a lump, discharge, a flattened or inverted nipple and more. Changes occur in one breast only.
Risk factors include radiation exposure, a personal or family history of breast cancer, exposure to estrogen (such as hormone-replacement therapy) and advancing age.
Diagnosis is accomplished through biopsy during which a physician removes a small sample of tissue that is subsequently examined under a microscope to determine whether cancer cells are present. If surgery is required, a modified radical mastectomy for removal of the breast, the lining over the chest muscles and some lymph glands might be the recommendation of choice when a diagnosis of invasive cancer has been made. Another procedure might be simple mastectomy that removes the breast and lining over the chest muscles only. Radiation may be recommended to ward off recurrence.
Women should perform periodic breast exams. Modifications should be brought to their physicians’ or gynecologists’ attention for follow-up. General guidelines for testing are every two years for women under 50 and annually for those older, unless personal or family history dictates more frequent testing.
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