Is there a subset of patients with Paget's disease of the breast in whom you would omit radiation after a central lumpectomy?  

I would approach treatment following the same principle as low-risk DCIS. If there's no evidence of invasive or underlying DCIS, I would engage in discussions regarding the potential for radiotherapy or observation, with or without anti-estrogen therapy.

Breast Paget’s disease without underlying DCIS or invasive breast cancer is extremely rare, and I would remain suspicious of a pathological miss. If indeed negative, observation would be appropriate. However, our focus as a field should prioritize patients where radiotherapy is indicated. In ...

A central lumpectomy is almost always associated with a very large negative margin and observation. If this is the case for Paget's associated DCIS, then it is the most appropriate course.