BBC’s Victoria Derbyshire on how an ‘inverted nipple’ indicated cancer – Paget’s disease

Queen's Jubilee: Victoria Derbyshire 'emotional' over Paddington

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The BBC broadcaster, who was diagnosed with breast cancer in 2015, has spoken about her cancer battle multiple times in the past, the most recent for documentary series The Waiting Room with Dr Sukh. Despite admitting that the diagnosis understandably came as a “huge blow”, the 53-year-old went on to say that overcoming the disease brought her “overwhelming joy and happiness to be alive”, also encouraging her to marry her long-term partner Mark Sandell and strip off on live TV for ITV’s The Real Full Monty.

“It was a huge blow to get that diagnosis, because you never think it’s going to happen to you even though now the figures are one in two people over a lifetime will get a cancer diagnosis,” Derbyshire admitted.

“It’s such a blow but I want people to know that with the NHS, they’re in really good hands, by that I mean, there is expertise, there is skill, there is compassion, and there is loveliness.

“That might sound odd, but that was my experience. In the most fearful time of your life, they’re going to make you feel less afraid because they really know.”

From thinking that she was “going to die” from the illness to now saying yes to nearly every opportunity that it has given to her, Derbyshire now aims to make others more aware of breast cancer, especially as she was so unaware of the signs and symptoms herself before her diagnosis.

She continued to say: “I think I realised when I had my diagnosis, the more you talk about it, the more information you get out to people and that’s a good thing because there will always be women who need to know about breast cancer.

“I didn’t know anything really about the symptoms of breast cancer until I was diagnosed myself. I’m almost ashamed to say that.

“I’ve interviewed a number of people over the years who’ve had breast cancer but because you never think it’s going to happen to you, you don’t necessarily take in the detail.

“So I found that by talking about it helped me, and also I felt the more that I talked about it, it also helped normalise cancer.

“I felt when I was diagnosed, there was still a stigma around cancer and people spoke about it in hushed tones, and I don’t feel they do anymore and I think that’s a really good thing.

“’I thought very early on I was going to die. Mark and I went to a little park and really cried and hugged. Saying I might die is such a weird thing to say aloud. We had no idea then if it was treatable. Once the tears were over, we went into practical mode, telling work, friends and family.”

Documenting every process of her illness through a video diary, Derbyshire endured six rounds of chemotherapy and 30 sessions of radiotherapy to finally being told in 2017 that there was no evidence of active cancer.

For the BBC journalist, one of the telling signs of her cancer was an “inverted nipple” on her breast that can indicate breast cancer.

It is important to note that people can be born with inverted nipples, where the nipples indent inwards, although on stimulation they will generally face outwards. This is completely normal and does not require assessment by a doctor.

However, as the Specialist Breast Cancer Surgery website states, nipple retraction or inversion that is new, occurring only in one breast, or where the nipple does not come out on stimulation “can be a concerning sign of breast cancer”. This should be discussed immediately with your doctor.

Other changes to the nipple that can indicate something is not quite right include:

  • Red nipples
  • Scaly or crusty skin
  • Thickened skin
  • Pain or burning sensation
  • Itchy nipples
  • Palpable lump
  • Nipple discharge.

In particular changes to the nipple can be a sign of a particular type of breast cancer known as Paget disease of the nipple or breast. This eczema-like condition causes changes to the skin of the nipple and the area of darker skin around the areola and can signify breast cancer in the tissue behind the area.

As a rare condition, about one to four percent of individuals with breast cancer have Paget’s disease of the nipple, but the NHS states that there are certain risk factors that may make individuals more likely to develop breast cancer.

These include:

  • Age – the risk of developing breast cancer increases with age
  • Having close relatives with breast cancer
  • Having had breast cancer before
  • Having had a type of benign (non-cancerous) breast disease before – certain types of benign breast disease may be associated with an increased risk of breast cancer, but this is only seen in a very small number of women
  • Being overweight – particularly if you’ve been through the menopause (you can use the body mass index healthy weight calculator to find out whether you’re overweight or obese)
  • Drinking a lot of alcohol – your risk can increase with the amount of alcohol you drink.

After noticing changes to the nipple or areola, GPs will be able to assess an individual and in most cases use a biopsy to confirm a suspected diagnosis of Paget’s disease of the nipple. As the disease is associated with breast cancer, the sooner it’s diagnosed, the better the outcome is likely to be.

Surgery is the main treatment for Paget’s disease of the nipple. Depending on whether the cancer has spread, surgery will either involve removing the whole breast (a mastectomy), or the nipple and areola with the breast tissue underneath them (a central excision). Individuals may also need further treatment including chemotherapy or radiotherapy to destroy cancerous cells.

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