Paget’s disease of the breast

This section is for women diagnosed with Paget’s disease of the breast. We hope it answers some of your questions and helps you discuss your options with your cancer specialist or breast care nurse. We recommend that you read it together with our booklet Understanding Cancer of the Breast.

Page Contents

• What is Paget's disease of the breast?
• What are the signs and symptoms?
• How is a diagnosis made?
• What treatment will I be offered?
• Coping with breast cancer
• Help from Action Breast Cancer

What is Paget's disease of the breast?

Paget's disease of the breast is an uncommon form of breast cancer. This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and the areola the dark circle around the nipple . It occurs in around 1% of all women with breast cancer. Men can also get Paget's disease but this is very rare.

What are the signs and symptoms?

The most common sign is a red, scaly rash involving the nipple, which may spread to the areola the dark circle around the nipple . The rash can feel itchy or you may have a burning sensation. The nipple may be inverted pulled in and there may also be some discharge.

The symptoms of Paget’s disease can look like other skin conditions such as eczema or psoriasis. However, there are differences. For example, Paget’s disease affects the nipple from the start while eczema affects the areola region first and only rarely affects the nipple. Paget’s disease usually occurs in one breast, while other skin conditions usually affect both breasts.

Approximately half of patients with Paget’s disease will also have an underlying lump. Most of these will be invasive cancers, which means the cancer has the potential to spread outside the breast. Where there is no lump, most will be non-invasive or in-situ cancers. This means that the cancer cells are inside the milk ducts and have not developed the ability to spread either within or outside the breast.
Top

How is a diagnosis made?

Because Paget’s disease can look like other skin conditions, it can be difficult to make a diagnosis. Once your GP has referred you to a specialist, certain tests may be done to help make the diagnosis. They include:

Mammogram

You will usually have a mammogram breast x-ray to check whether there is any underlying cancerous tissue in the breast.

Skin Scrapings

This involves scraping some cells from the skin of the nipple. The cells are put onto a slide so that they can be looked at under a microscope.

Imprint cytology

In this case an area of the affected nipple is pressed onto a slide. The cells on the slide can then be examined under a microscope.

Biopsy

You will probably have a biopsy taken to confirm the diagnosis. This means taking a small piece of skin and breast tissue from the affected area so that they can be looked at under a microscope. This is known as a punch biopsy and is usually done under local anaesthetic.

What treatment will I be offered?

Surgery

As for most types of breast cancer, surgery will be the first treatment. The type of surgery will depend on whether or not you have a lump and the extent of the cancer. If you have a lump or the cancer is widespread in the breast then you are likely to be offered a mastectomy removal of the whole breast . If the cancer is confined to a small area, a wide local excision removal of the affected area and a section of normal tissue around it followed by radiotherapy may be suggested. In some cases you may be given the choice. It is important to find out whether cancer has spread to the lymph nodes in the axilla glands in your armpit . This means removing all the nodes clearance and will help to find out if you need any further treatment such as chemotherapy.

Adjuvant treatment

Adjuvant treatments are treatments given in addition to surgery and include chemotherapy, radiotherapy and hormonal therapy. The aim of adjuvant treatments is to reduce the risk of the cancer coming back either in the same breast (local recurrence) or elsewhere in the body. If you have a wide local excision you will probably be offered radiotherapy to reduce the risk of the cancer coming back in the same breast. If you have a mastectomy, you may or may not need radiotherapy. For further information see the section on Radiotherapy.

In some cases chemotherapy is recommended, for example if the cancer has spread to the lymph nodes. For further information see the section on Chemotherapy or Understanding Cancer of the Breast booklet.

If your tumour is oestrogen receptor positive, which means it depends on the hormone oestrogen for growth, hormone therapy will usually be recommended. There are many hormone therapies available. For further information call National Cancer’s Freefone Helpline on 1800 200 700.
Top

You might find it easier to share your feelings with someone who has had a similar experience to you. Reach to Recovery is a programme set up to help and support women who have recently had a breast cancer diagnosis. The programme works on the principal of personal contact between the patient and a Reach to Recovery volunteer a woman who has had surgery for breast cancer . Carefully selected and fully trained volunteers are available to provide advice and reassurance at a time when a woman is most in need of both.

For more information on individual support or support groups in your area, call the National Cancer Helpline on 1800 200 700.
Top

Help from Action Breast Cancer

Action Breast Cancer is a national project established by the Irish Cancer Society to provide breast cancer information and support and to fund breast cancer research. Its services are free, confidential and accessible. For more information call the National Cancer Helpline on Freefone 1800 200 700 or visit www.cancer.ie

Call the National Cancer Freefone Helpline on 1800 200 700.