What is Paget's disease of the breast?

Paget’s disease of the breast is a condition that causes a scaly rash on the skin of the nipple. This can look like eczema. 

Most people who have Paget’s disease also have breast cancer. So it is sometimes called a rare type of breast cancer. The breast cancer may be:

  • Ductal carcinoma in situ (DCIS)

    DCIS cancer cells are contained inside the milk ducts. It is non-invasive.

  • Invasive breast cancer

    Invasive breast cancer starts in the ducts or lobules of the breast, and spreads into the surrounding breast tissue.

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 and over. But it can happen at a younger age. It can affect men, but this is very rare.

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Symptoms of Paget's disease

The first symptom of Paget's disease is usually a red scaly, rash on the nipple. This might be harder to see if you have black or brown skin. The skin in the area may look darker than your usual skin tone.

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. Paget’s disease usually only affects 1 nipple.

Other symptoms may include:

  • the skin of the nipple and areola becoming inflamed
  • the skin of the nipple and areola crusting, bleeding and ulcerating (becoming like an ulcer)
  • skin thickening on the nipple or areola
  • an itching or burning sensation in the area
  • 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 they can feel at diagnosis.

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Causes of Paget's disease

Doctors do not know what causes Paget's disease. The risk factors are similar to those for DCIS and invasive breast cancer.

Diagnosis of Paget's disease

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. Paget’s disease can be difficult to diagnose just by looking at it.

Paget’s disease usually affects the nipple first. After a few weeks, it spreads to the areola. Other skin conditions usually affect the areola first and then the nipple.

Tests for Paget's disease

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

    The doctor removes a small sample of skin from the affected nipple and tissue from 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

    The doctor gently scrapes or presses 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

    The doctor removes a core of skin from the nipple and a small piece of tissue from the breast ducts underneath. They inject some local anaesthetic into the skin to numb the area first.

As well as some of these tests, you usually have the same tests you have for any other type of breast cancer. You usually have the following scans:

  • A mammogram

    A mammogram is an x-ray of the breast.

  • An ultrasound scan

    An ultrasound uses sound waves to produce a picture of the breast tissue and the lymph nodes (glands) in the armpit.

  • An MRI scan of the breast

    An MRI uses magnetism to build up a detailed picture of the breast area.

Breast biopsy

You will also have a biopsy. This is when your cancer doctor takes small samples of cells or tissue from your breast. You will have an injection of local anaesthetic to numb the area first.

The samples are looked at under a microscope to check for cancer cells. This is to find out whether there are any DCIS or invasive breast cancer cells.

If invasive breast cancer cells are found, you doctor will arrange other tests. This is to find out whether the cancer cells have receptors (proteins) for hormones or for HER2.

Your cancer doctor and breast care nurse will explain which type of biopsy is best for you.

Staging and grading of Paget's disease


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 the earliest stage of breast cancer. This is when changes are happening to cells which might become breast cancer. Invasive breast cancer is usually staged using a number system from 1 to 4.


The grade of breast cancer is how the cancer cells look under a microscope. The grade gives an idea of how slowly or quickly the cancer may develop.

Treatment for Paget's disease

The main treatment for Paget’s disease is surgery. The type of operation you have depends on:

  • the size of the area of Paget’s disease
  • whether there is DCIS or invasive breast cancer.
  • where the affected area is in the breast.

Some people may have other treatments after surgery. For example, you may have radiotherapy to the breast.

Further treatment will depend on whether the cancer is DCIS or invasive breast cancer. Your cancer doctor or nurse will explain more about your treatment options.

Macmillan is also here to support you. If you would like to talk, you can:

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Rebecca Roylance, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

  • use plain English
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 October 2023
Next review: 01 October 2026
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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