What happens if Paget disease of the breast is not treated?

Paget disease affects the nipple and areola and may cause scaling, redness, irritation, crusting, flattening, or discharge. It can occur with cancer in the ducts or deeper breast tissue, even when the visible nipple change seems limited.

Without treatment, abnormal cells may remain in the breast and an associated tumour may enlarge or extend into nearby tissue. Breast skin changes and nipple discharge have other possible causes, but persistent or one-sided changes should be examined.

Arrange a breast assessment promptly for ongoing nipple or skin changes. A clinician may examine the breast, request imaging, and take a small sample of tissue from the nipple or breast. The results help determine whether Paget disease is present and whether deeper cancer is involved.

Treatment is individualised. Surgery may include lumpectomy when appropriate or mastectomy when a wider area is involved. Ask how the diagnosis, imaging, margins, and any associated findings affect the recommendation.

Seek prompt medical advice for a new persistent nipple rash, bleeding or unusual discharge, a lump, nipple inversion, ulceration, or a rapidly changing breast. Seek urgent help for heavy bleeding, severe infection symptoms, or rapidly increasing pain and swelling.

Could the nipple change be Paget disease or another condition? Is there an underlying breast lesion? What biopsy and imaging are needed? Would lumpectomy or mastectomy be suitable, and what would each involve?