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Modern Trends in the Surgical Management of Paget’s Disease

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

We examined the incidence and modern national trends in the management of Paget’s disease (PD), including the use of breast-conserving surgery (BCS), mastectomy, axillary surgery, and receipt of radiotherapy.

Methods

Using surveillance, epidemiology and end results (SEER) data, we identified 2631 patients diagnosed with PD during 2000–2011. Of these patients, 185 (7 %) had PD of the nipple only, 953 (36.2 %) had PD with ductal carcinoma in situ (PD-DCIS), and 1493 (56.7 %) had PD with invasive ductal carcinoma (PD-IDC). Trends in age-adjusted incidence, primary surgery, sentinel lymph node biopsy (SLNB), and axillary lymph node dissection were examined. Multivariable logistic regression was used to evaluate factors associated with receipt of BCS and radiotherapy.

Results

A decrease in the age-adjusted incidence of PD occurred from 2000 to 2011 (−4.3 % per year, p < 0.05). The overall rates of mastectomy in the PD only, PD-DCIS, and PD-IDC groups were 47, 69, and 88.9 %, respectively. Only in the PD-IDC group did the proportion of patients undergoing BCS increase significantly, from 8.5 % in 2000 to 15.7 % in 2011 (p = 0.01). Of those who underwent axillary surgery, the proportion of patients undergoing SLNB increased from 2000 to 2011. In adjusted analyses, Paget’s subgroup, older age, central tumor location, low/intermediate grade, tumor size <2.0 cm, SEER region, and year of diagnosis after 2006 were significantly associated with receipt of BCS.

Conclusions

The incidence of Paget’s disease has decreased over time while modern trends in local therapy suggest that BCS, SLNB, and adjuvant radiotherapy remain underutilized.

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Acknowledgment

The authors thank Ellen McCarthy, PhD, MPH, Harvard Medical School, for her guidance and expertise with SEER database programming. S.W. thanks the Cedars Cancer Institute Henry R. Shibata Fellowship, Montreal, QC, Canada

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Authors and Affiliations

  1. Harvard School of Public Health, Boston, MA, USA

    Stephanie M. Wong MD & Emily Stamell MD

  2. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

    Stephanie M. Wong MD

  3. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Rachel A. Freedman MD, Emily Stamell MD & Stephen D. Desantis BS

  4. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

    Jane E. Brock MBBS, PhD

  5. Department of Surgery, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA

    Yasuaki Sagara MD, Stephen D. Desantis BS & Mehra Golshan MD

Authors
  1. Stephanie M. Wong MD
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  2. Rachel A. Freedman MD
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  3. Emily Stamell MD
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  4. Yasuaki Sagara MD
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  5. Jane E. Brock MBBS, PhD
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  6. Stephen D. Desantis BS
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  7. Mehra Golshan MD
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Corresponding author

Correspondence to Mehra Golshan MD.

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Wong, S.M., Freedman, R.A., Stamell, E. et al. Modern Trends in the Surgical Management of Paget’s Disease. Ann Surg Oncol 22, 3308–3316 (2015). https://doi.org/10.1245/s10434-015-4664-3

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  • DOI: https://doi.org/10.1245/s10434-015-4664-3

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