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October is Breast Cancer Awareness month.

It doesn't mean you should let down your guard for the other eleven months. We have to treasure our health and guard it as if we were guarding against intruders in our home.

We guard it by seeking medical attention and advice for existing problems as well as practicing preventative care. Starting with a yearly mammography at age 40 or younger, if there is a history of breast cancer, is said to be preventative care. Also, doing monthly self-exams is a large part of preventive care.

However, there is a form of breast cancer that is not detectable on a mammography and does not start with a lump. You need to be aware of this type of cancer even if your mammography comes back benign year after year.

Paget's disease of the nipple is a form of breast cancer that is not detectable on a mammography.

In 1874, James Paget, an English surgeon, noted an association between the appearance of the nipple and underlying breast cancer. Symptoms of the disease of the nipple can include redness, mild scaling and flaking of the nipple skin.

There can also be discharge and bleeding and flattening of the nipple against the breast. In addition, there may be a rash on the areola, the darker area surrounding the nipple.

Improvement in the skin can occur spontaneously, lulling you into a false sense of healing, thus delaying an appointment with your health care professional.

However, the condition will occur again with other symptoms such as increased sensitivity, burning, itching and pain. You are concerned, however -- you just had a mammography and were told that everything is fine. You're confused and scared and dread the appointment you know you have to make with your health care provider.

We would all like to think that our health care providers are knowledgeable in their field. We would all like to think that if presented with a situation outside their scope of practice, a referral would be made.

Unfortunately, this isn't always the case and the patient is the one who suffers.

Some health care providers make bad judgment calls as their egos get in the way. Paget's disease of the nipple can resemble a skin irritation or eczema to an unknowledgeable health care provider.

A prescription for an antibiotic or cream may be prescribed and perhaps others when the condition does not respond favorably.

This can be tragic as the disease has more time to progress. A health care provider should suspect Paget's disease of the nipple when only one nipple is affected. A referral to a specialist should be made immediately. A biopsy should be scheduled to confirm the disease. The disease will progress without proper treatment.

Surgery is the usual treatment for the disease, followed by other therapies depending upon the progress of the disease.

Most patients diagnosed with Paget's disease of the nipple are over age 50, but rare cases have been diagnosed in patients in their twenties.

Paget's disease of the nipple cannot be seen on a mammography; it is observed by you. You observe the changes and symptoms and convey your findings to your health care professional.

Paget's disease of the nipple mostly affects women; however, cases affecting men have been documented.

Your relationship with the specialist is very important as you will be seeing him or her for years to come. If you don't feel a connection with your specialist, find another one. If your questions aren't answered in terms you understand, find another specialist. If you don't feel you're being taken care of and understood by your specialist, find another one.

Compassion, competence, and care are the three "C" words that will get you through a very turbulent and emotional time.

Marsha Goldstein, L.C.S.W., BCD, is a licensed clinical social worker, board certified diplomate. She has a private practice here in Pahrump and can be reached at 751-9579.