Local Breast Cancer Recurrence after Mastectomy and Breast-Conserving Surgery for Paget's Disease: A Meta-Analysis

Paget's disease (PD) of the breast is a rare presentation of breast malignancy. Mastectomy has been considered the standard of care, but several studies have shown that breast-conserving surgery (BCS) with radiotherapy is an alternative option. According to the literature, the total recurrence rate is as high as 20-40%. In an effort to enable a rational therapy decision, we compiled and analyzed the available data on PD.

Pubmed, Web of Knowledge, and China Journal Net were searched for studies concerning treatment for PD between 1990 and 2013. A meta-analysis was performed to compare the effect of different treatments.

7 studies with a total of 685 patients were included. The cumulative local recurrence rate was 7.6%, 5.6% among women undergoing mastectomy and 13.2% among those treated with BCS. Compared to the BCS group, mastectomy showed significant differences in terms of local recurrence (odds ratio = 0.38, 95% confidence interval 0.21-0.69; p = 0.001).

Since not all currently available diagnostic and therapeutic options (magnetic resonance imaging, radiotherapy, tamoxifen) were systematically used in the studies included in this meta-analysis, it may be presumptuous to suggest that mastectomy is the right choice for all patients with PD in a modern interdisciplinary setting. Rather we can conclude that all efforts should be undertaken to assure local control since BCS is not equivalent to mastectomy in the treatment of PD.