Paget Disease of the Breast

Paget disease of the breast is a rare form of breast cancer involving the nipple and areola. Cancer cells may begin in milk ducts and travel to the nipple surface, so visible skin changes can occur alongside an underlying breast tumour. The condition is also called Paget disease of the nipple.

Breast Skin Changes are a very common presentation of Paget disease of the breast. The nipple or areola may become red, scaly, crusted, itchy, irritated or sore, and the change may resemble eczema. Nipple Discharge is a common presentation and may be clear or blood-stained. The nipple can flatten or turn inward, and a lump may be felt deeper in the breast. These signs also have non-cancerous causes, but a persistent nipple change should be assessed.

The precise cause is not known. In many cases, abnormal cells in a milk duct move toward the nipple and affect its skin. Some people have an underlying ductal carcinoma in situ or invasive breast cancer, while others have disease limited to the nipple area. It is not caused by poor hygiene or by touching the breast.

The condition can develop gradually and may be mistaken for dermatitis. Its behaviour depends on whether cancer is present beneath the nipple, whether it has invaded surrounding tissue, and whether lymph nodes contain cancer cells. Imaging and biopsy establish these details, allowing the care team to discuss the next step and monitor response during treatment.

Risk is shaped by the same factors that influence other breast cancers, including increasing age, inherited gene changes, a close family history and certain previous breast conditions. Having a risk factor does not mean that someone will develop Paget disease. A specialist can discuss personal and family history and whether genetic counselling is appropriate.

A clinician examines the nipple, areola and the rest of the breast, then asks how the change began and whether discharge or a lump is present. Mammography and ultrasound can look for an underlying mass or duct change; MRI may be useful when other imaging is unclear. A skin or nipple biopsy examines tissue under a microscope. If an underlying tumour is found, further tests help describe its type and extent.

Treatment is tailored to the biopsy findings and imaging. Breast-conserving surgery, such as a Lumpectomy, may remove the nipple-areola area and the underlying tumour when this is suitable. A Mastectomy removes most or all breast tissue and may be considered when disease is extensive or breast conservation is not appropriate. Radiotherapy, hormone therapy, chemotherapy or targeted medicines may be added according to tumour features, lymph-node findings and overall health. The team explains reconstruction and recovery choices before surgery.

Recovery can involve wound care, arm movement exercises and support with body-image changes. A well-fitting bra, a breast-care nurse and a rehabilitation professional may help with comfort and movement. Keep follow-up appointments so the team can review healing, treatment effects and any new breast or chest changes.

The condition itself can involve an underlying invasive cancer. Treatment may lead to temporary pain, fatigue, skin irritation, altered breast shape, arm swelling or changes in sensation. Report a new lump, worsening redness, fever, wound drainage or persistent swelling promptly so it can be assessed.

There is no known way to prevent Paget disease completely. Knowing how your breasts normally look and feel can help you notice a nipple or skin change early. Do not treat a persistent eczematous nipple change with creams alone without medical review, especially if it affects one breast or is accompanied by discharge.

A breast surgeon, breast physician or medical oncologist can coordinate assessment. Bring a list of medicines, previous breast imaging and relevant family history. Ask which biopsy is planned, whether an underlying tumour was found, and how surgery, radiotherapy or medicines fit together.