In the 19th century, the British surgeon Sir James Paget described several clinical conditions. Two of them still bear his name today – and are often confused: Paget’s disease of bone and Paget’s disease of the nipple. Medically, the two have nothing to do with each other.
Paget’s disease of bone (osteitis deformans)
In Paget’s disease of bone, the natural process of bone remodelling is disrupted. First, the bone-resorbing cells (osteoclasts) break down excessive amounts of bone; new bone is then formed in a disorganised way. Although the new bone is thicker, it is less stable – it can become deformed and break more easily.
- Who is affected? Mainly people over 50, men somewhat more often than women. The disease occurs more frequently in some families.
- Where? Frequently the pelvis, spine, thigh, lower leg and skull – often only one or a few bones.
- Symptoms: many people affected have no symptoms; the disease is then discovered incidentally on an X-ray or through raised alkaline phosphatase in the blood. Possible symptoms include bone pain, local warmth, deformities (e.g. bowing of the lower leg), fractures, osteoarthritis of adjacent joints and – if the skull is affected – hearing loss.
- Cause: not fully understood. Genetic factors play a role; environmental factors are also being discussed.
- Treatment: in the case of symptoms or active disease in at-risk areas, bisphosphonates are used to slow the overactive bone resorption. This is supplemented by pain management, physiotherapy and, if complications arise, surgery where necessary.
Paget’s disease of the breast (Paget’s disease of the nipple)
Paget’s disease of the breast is a rare form of breast cancer that appears on the skin of the nipple and areola. It accounts for only a small proportion of all breast cancers and affects almost exclusively women, very rarely men.
- Typical signs: a usually one-sided, red, scaly or weeping change on the nipple, often with itching or burning. It can look like eczema. Later, crusts, bleeding or an inverted nipple may develop.
- Link with breast cancer: in most cases, a precancerous lesion (ductal carcinoma in situ) or invasive breast cancer is also found in the breast.
- Diagnosis: tissue sample (biopsy) of the skin change, as well as mammography, ultrasound and, if necessary, MRI of the breast.
- Treatment: depending on the findings, breast-conserving surgery with removal of the nipple and areola plus radiotherapy, or a mastectomy, supplemented by treatment of any underlying breast cancer. Later reconstruction of the nipple is possible.
Important in everyday life
A one-sided, “eczema-like” change on the nipple that does not heal after two to three weeks of treatment with skincare or corticosteroid cream should always be assessed by a doctor – ideally a gynaecologist or dermatologist. In Paget’s disease of bone, new bone pain, local warmth or deformities are a reason for an examination.
Note: This article is for general information only and does not replace medical advice.
