Paget's disease of the breast
This page is for women diagnosed with Paget’s disease of the breast. We recommend that you read it along with our booklet Understanding Cancer of the Breast, which you can download here (pdf, 2.6MB).
- What is Paget’s disease of the breast?
- How common is Paget’s disease?
- What are the signs and symptoms of Paget’s disease?
- How is a diagnosis made?
- What treatments will I be offered?
- What if the cancer has spread to another part of my body?
- Coping with breast cancer
What is Paget’s disease of the breast?
The first sign of Paget's disease is often a red rash around the nipple area. It is also common to have an underlying lump in the breast, which means the cancer has the potential to spread within the breast and to other parts of the body (invasive cancer).
If there is no lump, most people will have a non-invasive cancer known as DCIS. This means that the cancer cells are inside the milk ducts and have not developed the ability to spread.
How common is Paget’s disease?
Paget’s disease is a rare type of breast cancer and occurs in around 1 per cent of women with breast cancer. Men can also get Paget's disease but this is extremely rare.
What are the signs and symptoms of Paget’s disease?
The most common sign of Paget’s disease is a red, scaly rash involving the nipple, which may spread to the areola (the darker skin around the nipple). The rash can feel itchy or you may have a burning sensation. In some cases the nipple may be inverted (pulled in) or there may be some discharge which can form a crust.
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.
How is a diagnosis made?
Because Paget’s disease can look like other skin conditions, it can be difficult to make a diagnosis. Once you have seen your GP (family doctor), you will be referred to a specialist breast unit where you will be seen by a doctor or specialist nurse. Following a physical examination of your breasts, you may have other tests including the following:
You will usually have a mammogram (breast X-ray) to check if there is any underlying cancer in the breast.
This involves scraping some cells from the skin of the nipple. The cells are put on a slide so that they can be looked at under a microscope.
This is when an area of the affected nipple is pressed onto a slide. The cells on the slide can then be examined under a microscope.
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?
As with most types of breast cancer, surgery is usually the first treatment. The type of surgery will depend on whether or not you have a lump and the extent of the cancer.
If the cancer is confined to a small area, your surgeon may suggest a wide local excision. This is the removal of the affected area and a section of normal tissue around it. It is usually followed by radiotherapy.
In many cases, you may be advised to have a mastectomy, or removal of the whole breast.
In some cases you may be given the choice between a wide local excision and a mastectomy. If you are given a choice, it means your doctor believes that both treatment plans offer you equal benefits.
A sentinel lymph node biopsy is usually done at the time of surgery to find out if the cancer has spread to the lymph nodes in the axilla (glands in your armpit). Click here for more information on sentinel lymph node biopsies and surgery for breast cancer.
Adjuvant treatment is treatment given in addition to surgery and includes radiotherapy, chemotherapy, and hormone therapy. The aim of adjuvant treatment is to reduce the risk of the cancer coming back in the same breast (local recurrence) or elsewhere in the body.
If you have a wide local excision, you will usually 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 more information on radiotherapy, see our factsheet on radiotherapy and breast cancer (pdf, 292KB).
Chemotherapy is often given as part of the treatment for Paget’s disease. Click here for more information on chemotherapy and breast cancer.
If your tumour is oestrogen receptor positive, you may be offered hormone therapy. This means that your tumour depends on the hormone oestrogen for growth. Hormone therapies work in different ways to block the effect of hormones on cancer cells. Click here for more information on hormone therapies.
What if my cancer has spread to another part of my body?
If your cancer has spread to another part of your body, this is called advanced or secondary breast cancer. You will be offered treatment to help control the disease. Your doctor may offer chemotherapy, hormone therapy, biological therapies or a combination of these treatments. Click here for more information on secondary breast cancer.
Coping with breast cancer
Being diagnosed with Paget’s disease of the breast can be an anxious and frightening time. But everyone responds differently to their diagnosis and has their own way of coping. It is important that you feel able to talk to your specialist or breast care nurse about any questions or concerns you may have.
You may feel alone, particularly as Paget’s disease of the breast is a rare form of breast cancer. Remember that there are people who can support you, so don’t be afraid to ask for help.
You can let other people know how you are feeling, including your family and friends, so that they can be more supportive. It can also help to discuss your feelings or worries with your breast care nurse or your specialist. Alternatively, a counsellor or psychotherapist might be more appropriate if you want to talk through your feelings in more depth over a period of time. Your breast care nurse, specialist or GP can usually arrange this.