I had BC a few years ago and now my daughter aged 32 has just been to BC Clinic after emergency referal. She is currently breast feeding her 5 month old baby. Consultant said that itchy, weeping lesion on nipple and areolar which she has had for 2 months is not an infection and they needs to rule out Pagets disease, however the consultant said will not be able to biopsy area until my daughter has stopped breast feeding for 4 months. She didnt do any U/S, or other investigation. I dont understand why they cant take skin scrape to rule out eczema and do a punch biopsy of skin area to check for Pagets as this would not initailly be a deep biopsy of breast and i cant see how taking sample from this area would impact on milk ducts etc. I am thinking should she be referred to dermatologist who would do skin biopsy? Or is there any other way other than sitting on it for another 4 months. If she has Pagets surely it is better to diagnose this early for a better treatment outcome.
Hi suez
Thanks for posting.
It’s understandable you’d like to know more about the best way of assessing your daughters’ symptoms without having to wait longer than necessary, particularly as you’ve had a diagnosis of breast cancer yourself.
Assessing breast symptoms whilst a woman is pregnant or breast feeding is possible, but sometimes needs to be undertaken in a slightly different way.
It’s not possible for us to say why the consultant has said your daughter should wait 4 months before a biopsy can be done or why imaging such an ultrasound scan hasn’t been arranged.
Performing a skin scrape or punch biopsy of the nipple is a common way of looking at cells within the skin to determine if they are associated with Pagets disease.
It’s possible to carry either of these tests out, but as they can cause complications such as a fistula (a connection between a milk duct and the skin) in some individuals, it’s important for the risks and benefits of doing this to be discussed in detail first.
Where a nipple biopsy is performed, it will usually be necessary to advise the woman to refrain from breast feeding from that breast for a period of time afterwards, until healing has taken place and a definite diagnosis has been made.
An ultrasound can sometimes be useful but may need to be done immediately after breast feeding so the breast tissue can be seen more clearly.
It sounds as though it would be useful for your daughter to speak to her GP about her experience at the breast clinic. She could ask if a second opinion can be requested to see if another clinician may approach assessing her symptoms differently. This may include being seen by a dermatologist.
You or your daughter could call our helpline if you would like to talk this through or have any further questions. The helpline team have time to listen to your concerns, talk things through and signpost you to more support and information. Your call will be confidential, and the number is free from UK landlines and all mobile networks. The number is 0808 800 6000, (Relay UK -prefix 18001).
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Best wishes
Catherine
Breast Care Nurse
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