A. Hanna1, D. Goto2, S. Kesmodel1, K. Tkaczuk1, S. Feigenberg1, D. Mullins2, N. Hanna1, E. Bellavance1 1University Of Maryland,School Of Medicine,Baltimore, MD, USA 2University Of Maryland,School Of Pharmacy,Baltimore, MD, USA
Introduction: Paget disease (PD) of the breast represents a minority (~2%) of breast malignancies. Patients typically present with eczematous changes of the nipple due to intraepidermal spread of tumor cells. While the traditional treatment of PD is total mastectomy, recent small studies have supported treatment with breast conservation (BC) followed by adjuvant radiation. In this study, we aim to identify the current presenting and management patterns of patients being treated with PD compared to non-PD breast cancer.
Methods: The National Cancer Data Base was used to identify stage 0 – III unilateral breast intraductal or lobular carcinoma female patients 18 – 90 years old who underwent surgery from 2010 to 2012. Patients with PD were compared to patients without PD across demographic disease, and treatment variables. All statistical analyses were two-sided t-tests for continuous variables and chi-squared tests for discrete variables.
Results: Of 502,833 female patients in the database who had surgery in 2010 or later, 2708 PD patients and 284167 non-PD patients met inclusion criteria. PD was associated with underlying ductal carcinoma in situ in 24% and invasive cancer in 76% (78% intraductal and 22% lobular) of cases. Paget disease patients were younger, more likely to be African American, less educated and with lower income, possess government insurance plans (Medicare or Medicaid) and have more comorbidities than non-PD patients (all P < 0.0001). Breast cancer patients presenting with PD were more likely to present at a higher stage, undergo chemotherapy, and start treatment later than non-PD patients (all P < 0.0001). Breast cancers associated with PD were more likely to have lymphovascular invasion and test ER-, PR-, and Her2+. Only 23% of PD patients underwent BC compared with 58% of non-PD patients (p < 0.0001).
Conclusions: There are significant differences in the clinical presentation and local and systemic management of Paget disease of the breast and non-Paget disease in the United States, including disparities based on socioeconomic factors. Despite data supporting the use of breast conservation in the treatment of patients with Paget disease, a minority of these patients are actually treated with breast conserving surgery. Further studies are required to fully understand the extent to which differences in socioeconomic factors and clinical presentation affect the treatment and outcomes of Paget disease patients.