Paget's disease of the breast

Paget’s disease of the breast is an uncommon type of breast cancer. 

It’s sometimes called Paget’s disease of the nipple. It is not the same as Paget’s disease of the bone. 

Paget’s disease of the breast happens in less than 5% of women with breast cancer. Men can also get Paget’s disease, but this is very rare.

The most common symptom of Paget’s disease is a red, scaly rash on your nipple. Redness may be harder to see if you have black or brown skin.

The rash can feel itchy, or you may have a burning sensation. The rash may spread to the darker area of skin around the nipple (areola).

Other symptoms can include:

• The nipple becoming pulled in (inverted)
• Liquid (discharge) coming from the nipple
• A lump behind the nipple

Is it Paget’s disease or eczema?

Paget’s disease can look like other skin conditions such as eczema. But there are differences.

For example, Paget’s disease affects the nipple first and can spread to the areola, while eczema on the breast usually affects the areola before spreading to the nipple.

Paget’s disease also usually occurs in one breast, while most other skin conditions tend to affect both breasts.

Your GP may prescribe a steroid cream first to treat the nipple rash if they think you might have eczema.

It’s important to stay breast aware, so tell your GP as soon as possible if you notice a change in either breast.

Most people with Paget’s disease will have an early form of breast cancer called ductal carcinoma in situ (DCIS) under the nipple or elsewhere in the breast.

DCIS means cancer cells have developed within the milk ducts but have not yet developed the ability to spread outside of the ducts into the surrounding breast tissue or to other parts of the body. As a result, DCIS has a good outlook (prognosis) when treated.

If DCIS is not treated, the cancer cells may develop the ability to spread outside the ducts into the surrounding breast tissue. This is known as invasive breast cancer.

DCIS is graded as either low, intermediate, or high grade, based on what the cells look like under the microscope. If you have Paget’s disease, you’re more likely to have high-grade DCIS.

Although the size and grade of the DCIS may help predict if it will become invasive, there’s currently no way of knowing for certain if this will happen.

Some people with Paget’s disease will also have an underlying invasive breast cancer.

Invasive breast cancer has the potential to spread from the breast to other parts of the body.

In many cases, this will mean a breast lump has also developed in the affected breast.

Even if there’s no lump, it’s still possible to have an invasive cancer.

As Paget’s disease is uncommon and can look like other skin conditions, it’s not always diagnosed straight away.

Once your GP has referred you to a specialist, you may have several tests including:

• A mammogram 
• An ultrasound scan 
• A biopsy

Biopsy

You will usually have a biopsy to confirm the diagnosis.

A biopsy is the removal of tissue to be looked at under a microscope. Local anaesthetic is used to numb the area before the biopsy.

The type of biopsy you have will depend on your symptoms. For example:

• A punch biopsy removes a small circle of tissue from the skin of the breast or nipple
• A core biopsy removes a small sample of tissue from the area of concern if this can be felt within the breast

If your mammogram or ultrasound results show an area of concern within your breast, you may have another biopsy called an image-guided biopsy. This is where a mammogram or ultrasound is used to help locate the area that needs to be sampled. 

The samples of tissue or cells are sent to a laboratory where they are examined under a microscope.

Depending on your results, you may also be offered an MRI scan.

Find out more about the tests you may have.

Treatment aims to remove the area of Paget’s disease from your breast and reduce the risk of it coming back or spreading to other parts of the body.

Surgery

Surgery is usually the first treatment for Paget’s disease of the breast. It’s often the only treatment you’ll need if you have Paget’s disease without DCIS or invasive breast cancer.

If you’ve been diagnosed with Paget’s disease alone, you’re most likely to be offered surgery to remove your nipple and areola. This is known as a central excision.

You may be offered other types of surgery if you have also been diagnosed with DCIS or invasive breast cancer, such as breast-conserving surgery or a mastectomy. You may also need to have surgery to your lymph nodes. Find out more about these types of surgery.

The breast tissue removed during your surgery will be looked at under a microscope by a doctor called a pathologist. You may need more surgery if more Paget’s disease is seen at, or close to, the margin of normal breast tissue.

Other treatments

Depending on the features of your Paget’s disease, you may also be offered radiotherapy after your surgery. Radiotherapy uses high-energy x-rays to destroy cancer cells. It’s used to reduce the risk of the cancer coming back in the same breast.

If you also have DCIS or invasive breast cancer, you may be offered other treatments such as:

Treatments given after surgery are called adjuvant treatments.

If you have invasive breast cancer in addition to Paget’s disease, you may be given some treatments before surgery. This is known as neo-adjuvant or primary treatment.

Read more about treatments for primary breast cancer.

You'll usually continue to be monitored for 5 years after your hospital-based treatments (such as surgery or radiotherapy) finish. This is known as follow-up.

It's important to be aware of any changes to your breast, chest or surrounding area.

It can be difficult to know how your breast or scar should feel. The area around the scar may feel lumpy, numb or sensitive. This means you'll need to get to know how it looks and feels so you know what’s normal for you. This will help you to feel more confident noticing changes and reporting them early to your breast care nurse, treatment team or GP.

Most breast cancers don’t come back after treatment. But sometimes it can return, so it’s important you know what signs and symptoms to look out for.

If you’ve been diagnosed with Paget’s disease, it’s normal to feel lonely or isolated.

You might find it helps to talk to someone who has been through a similar experience. Find out about our Someone Like Me service below.

You can also visit our confidential online forum and talk to other people affected by Paget’s disease.

You can also speak to our nurses on our free helpline, below.