Nipple cancer
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Nipple Cancer: Insights from Recent Research
Prevalence and Detection of Nipple Involvement in Breast Cancer
High Incidence of Nipple Involvement
Nipple involvement in breast cancer is more common than previously recognized. Studies have shown that a significant percentage of mastectomy specimens reveal malignant changes in the nipple. For instance, one study found that 58% of nipples in mastectomy specimens had tumor involvement, with most cases being non-invasive ductal or lobular types. Another study reported a 30.2% incidence of carcinomatous involvement of the nipple, highlighting the importance of thorough examination techniques.
Challenges in Detection
Detecting nipple cancer can be challenging. Imaging studies, such as mammography, often fail to reveal cancers originating in the nipple. In a study of 24 patients with nipple-invasive primary carcinomas, mammography did not detect the cancer in most cases. This underscores the need for careful clinical and histological examination, especially in patients opting for nipple-sparing mastectomy.
Clinical and Pathological Features
Types of Nipple Cancer
Nipple cancer can present in various forms, including ductal carcinoma in situ (DCIS), invasive carcinoma, and Paget's disease. DCIS involving the nipple skin, often associated with Paget's disease, was found in 42% of cases in one study, with a significant portion showing HER2 positivity. Invasive carcinomas, both ductal and lobular types, were also observed, with some cases presenting as subtle nipple thickening or skin changes.
Factors Influencing Nipple Involvement
Several factors influence the likelihood of nipple involvement in breast cancer. Tumor-nipple distance, tumor grade, lymph node metastasis, and HER2 positivity are significant predictors. A study of 316 mastectomy specimens found that HER2 amplification, larger tumor size, and closer tumor-nipple distance were associated with higher rates of nipple involvement. Additionally, multifocal and multicentric tumors showed a higher incidence of nipple involvement.
Nipple-Sparing Mastectomy: Safety and Efficacy
Oncologic Safety
The safety of nipple-sparing mastectomy (NSM) remains a topic of debate. However, recent studies suggest that NSM can be a safe option for selected patients. The overall rate of occult nipple malignancy was found to be 11.5%, with specific tumor characteristics influencing this rate. Retroareolar sampling is recommended to ensure the absence of malignancy in the nipple-areolar complex .
Recurrence and Complications
The recurrence rates following NSM are comparable to those of breast-conserving surgery followed by radiotherapy. A comprehensive review found that the local recurrence rate for NSM was 0.9%, with skin flap recurrence at 4.2%. Complication rates, including nipple necrosis, were also evaluated, with full- and partial-thickness necrosis rates at 2.9% and 6.3%, respectively.
Conclusion
Nipple cancer is a significant concern in breast cancer patients, with a notable incidence of nipple involvement. Detection can be challenging, necessitating thorough clinical and histological evaluations. Nipple-sparing mastectomy, while controversial, appears to be a viable option for carefully selected patients, with recurrence rates and complications comparable to other surgical options. Patients should be informed of the risks and the importance of monitoring for any changes in the nipple area.
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