Paget's Disease of the Breast: Signs & Treatment Guide

Some changes in the body are easy to explain. Others feel less clear, especially when they appear without an obvious reason. Changes in the nipple or the surrounding skin can fall into that second category, leaving many people unsure about what they might mean.

Understanding what these changes could indicate can help reduce uncertainty and guide the next steps. This guide explains the condition, its symptoms, possible causes, how it is diagnosed, and the available treatment options.

What is Paget’s disease of the breast?

Paget's disease is a rare condition that affects the skin of the nipple and sometimes the darker area around it, called the areola. Many people first notice gentle changes such as redness, dryness, or irritation on the nipple.

Because these symptoms can resemble eczema or other common skin conditions, the cause is not always immediately clear.

The condition occurs when abnormal cells affect the surface layer of the nipple and surrounding skin. As a result, the earliest signs often appear on the nipple rather than deeper inside the breast.

These skin changes may seem minor at first, which is why they are sometimes overlooked or mistaken for irritation.

3 types of Paget’s disease of the breast

Paget's disease can appear in different forms depending on whether there is an underlying breast tumour. Understanding these forms helps oncologists determine the stage and plan the most appropriate treatment.

The most common types include:

1. Paget's disease with ductal carcinoma in situ (DCIS)

This is a non-invasive form of breast cancer where abnormal cells remain inside the milk ducts. The cancer has not spread into nearby breast tissue. Many cases of Paget's disease are linked with DCIS.

2. Paget's disease with invasive breast cancer

In some cases, the cancer spreads beyond the ducts into the surrounding breast tissue. When this happens, the stage of the disease may be different, and treatment planning may involve additional therapies.

3. Paget's disease without an underlying tumour (rare)

Occasionally, no tumour is detected in the breast, even though abnormal cells are present in the skin of the nipple.

What are the symptoms of Paget's disease of the breast?

Paget's disease of the breast symptoms often begin with small changes in the skin of the nipple. Common symptoms include:

• •Red or scaly skin on the nipple
• •Persistent itching or irritation
• •Mild burning or tenderness
• •Thickened or flaky skin
• •A flattened or inverted nipple
• •Skin that may crack or form scabs
• •Nipple discharge that may appear clear, yellowish, or bloody
• •In some cases, a lump in breast tissue behind the nipple

These symptoms usually affect only one breast. The changes often begin at the nipple and may gradually extend to the areola.

Symptoms can develop slowly and sometimes come and go before becoming more noticeable. Some people also ask, “Is Paget's disease of the breast painful?” Pain is not always present, although the skin may feel tender or irritated.

What causes Paget's disease of the breast?

Researchers have also identified several Paget's disease of the breast risk factors, including:

• •Increasing age
• •Family history of breast cancer
• •Genetic mutations such as BRCA1 or BRCA2
• •Personal history of breast cancer
• •Certain hormonal or reproductive factors

Having these risk factors does not mean someone will develop the condition, but they may help guide monitoring and early evaluation.

How is Paget's disease of the breast diagnosed?

Nutritional supplements curated by oncologists

A platform for cancer nutrition.
Clinically guided. Built for care.

Shop now

When unusual changes appear on the nipple or areola, an oncologist will usually begin with a careful examination. The skin of the nipple is checked for redness, scaling, crusting, or thickening. The surrounding breast tissue may also be examined to check for lumps or other abnormalities.

Imaging tests are often used to look for changes within the breast. These may include:

• •Mammography,
  which can detect abnormal tissue or tumours
• •Breast ultrasound,
  used to examine suspicious areas
• •MRI,
  which may be recommended when more detailed imaging is needed

To confirm the diagnosis of Paget’s disease of the breast, however, a biopsy is usually required. A small tissue sample is removed and examined under a microscope.

Common biopsy methods include:

• •Punch biopsy of the nipple skin
• •Needle biopsy of deeper breast tissue

How to cure Paget’s disease of the breast

Paget's disease of the breast treatment depends on the stage of the condition, whether there is an underlying tumour, and the person's overall health. The treatment aims to remove the cancer while preserving as much healthy tissue as possible.

Surgery is usually the primary treatment. Common surgical options include:

• •Breast-conserving surgery:
  The nipple, areola, and affected surrounding tissue are removed while the rest of the breast is preserved.
• •Mastectomy:
  The entire breast is removed if the cancer is more extensive.

Additional treatments like Radiation therapy, Chemotherapy, Hormone therapy, and Targeted therapy might also be used. These therapies help reduce the risk of the cancer returning. Early diagnosis and timely treatment offer the best chance for successful outcomes.

Prognosis and stages

Understanding Paget's disease of the breast stages helps oncologists determine how far the cancer has progressed and what treatment may be most appropriate. The stage usually depends on whether there is an underlying tumour and whether the cancer has spread beyond the milk ducts.

The table below explains Paget’s disease of the breast stages associated with the condition:

Encouragingly, survival outcomes are often very good when the condition is detected early, particularly when it is associated with DCIS and treated promptly.

Care pathways for Paget's disease of the breast

Paget's disease of the breast is a rare condition that affects the skin of the nipple and may sometimes be linked with an underlying breast tumour. The symptoms can look similar to common skin conditions, which is why they are not always recognised immediately.

If you notice persistent nipple irritation, redness, or other unusual changes, it is worth having them checked by an oncologist. In many cases, these symptoms are caused by harmless skin conditions.

And even when Paget's disease of the breast is diagnosed, effective treatments are available, and many people respond well to care when the condition is identified early. For cancer treatment guidance, speaking with a specialist should be your next step.