Paget’s disease of the breast is a condition that causes an eczema-like change to the skin of the nipple.
9 out of 10 women who have Paget’s disease (90%) will also have breast cancer. The breast cancer may be:
Paget’s disease affects about 1 to 2 out of every 100 women with breast cancer (1 to 2%).
It is most common in women aged 50 or over. But can happen at a younger age. It can affect men, but this is extremely rare.
The first symptom of Paget's disease is usually a scaly, red rash affecting the nipple. It may also affect the dark area of skin surrounding the nipple (the areola). This can happen after you have had the nipple rash for a few weeks. The rash does not go away, and it may become sore.
Other symptoms may include:
- the skin of the nipple and areola becoming inflamed
- the skin of the nipple and areola crusting, bleeding and ulcerating (so it looks like an ulcer)
- an itching or burning sensation in the area
- some fluid (discharge) leaking from the area
- the nipple turning inwards (becoming inverted).
There may, or may not be a lump in the breast. About half of women with Paget’s disease (50%) have a breast lump that you can feel at diagnosis.
It may be possible to confuse Paget’s disease with other skin conditions such as eczema, dermatitis and psoriasis. This is because they look similar and can make Paget’s disease difficult to diagnose by just looking at it.
Paget’s disease usually affects the nipple first, and after a while spreads to the surrounding tissue. But other skin conditions usually affect the areola first and then the nipple.
Most tests you have are the same as for any type of breast cancer.
Your first test will usually be to check the skin changes on your nipple. Your specialist breast cancer doctor may do the following tests:
A skin or punch biopsy
They remove a small piece of skin from the affected nipple and under the skin. They inject some local anaesthetic into the skin to numb the area first. The sample is looked at under a microscope for cancer cells.
A nipple scrape
They scrape or press cells from the skin of the affected nipple onto a glass slide. These are looked at under a microscope.
A core biopsy through the nipple
They remove a core of skin from the nipple and a small piece of tissue from the breast ducts underneath.
Apart from the tests above, you usually have the same tests as those for any other type of breast cancer. You usually have scans, which include:
You will also have a biopsy. Your cancer doctor or breast care nurse takes small samples of cells or tissue from your breast.
The samples are looked at under a microscope to check for cancer cells. This is to find out if there are any DCIS or invasive breast cancer cells.
They also do other tests to find out if the cancer cells have receptors (proteins) for hormones, or for HER2.
Your cancer doctor and breast care nurse will explain the type of biopsy that is best for your situation.
The stage of a cancer describes its size, and how far it has spread. Knowing this helps your cancer doctor plan the best treatment for you.
DCIS is always the earliest form of breast cancer. Invasive breast cancer is usually staged using a number system that groups it from 1 to 4.