Paget’s disease of the breast or nipple involves dry skin, flaking, or changes in the color or shape of the nipple. It may look like eczema or psoriasis, but it can be a sign of breast cancer.

Paget’s disease of the breast typically occurs as a manifestation of a type of precancerous lesion known as ductal carcinoma in situ (DCIS) or an underlying invasive cancer.

The symptoms of Paget’s disease of the breast can resemble those of a skin condition, such as eczema or psoriasis. This sometimes delays diagnosis, increasing the risk of the condition advancing.

Read on to learn more about Paget’s disease of the breast.

Paget’s disease of the breast causes skin symptoms on the breasts or nipples because of underlying breast cancer. In 80% to 90%Trusted Source of people with Paget’s disease of the breast, the underlying cancer is either ductal carcinoma in situ (DCIS) or invasive breast cancer.

Only 8% of people with Paget’s disease of the breast have no other underlying cancer.

Paget’s disease of the breast may resemble other common skin issues, such as wounds, breastfeeding-related injuries, or eczema.

Paget’s disease of the breast is a rare type of breast cancer.

This disease can affect anyone, but it occurs more commonly in postmenopausal females in their 50s.

According to the National Health Service in the United Kingdom, about 1% to 4% of females with breast cancer have Paget’s disease of the breast.

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Paget’s disease of the breast causesTrusted Source changes in the texture or appearance of the skin of the breasts or nipples. Usually, the changes occur on the nipple or areola.

Some signs to look for include:

  • discoloration on the nipples or areola
  • crusting or discharge from the nipple
  • swelling or changes in the texture of the skin
  • marks that look like wounds or injuries on the nipple

The skin changes may hurt or itch, and the changes in the appearance of the breast tissue range from subtle to dramatic.

Early stage

In the early stages of Paget’s disease of the breast, a person may experience subtle symptoms. They might mistakenly believeTrusted Source that they have eczema, skin irritation, or a breastfeeding-related infection.

One of the most common early signs is an itchy growth that disappears or gets better but then comes back. It may have tiny blisters. Some other signs to look for include:

  • any patch of dry or bumpy skin that does not go away
  • any apparent injury that either does not heal or heals but comes back
  • eczema on the breast or nipple that does not heal
  • any change in the nipple or the skin of the breast
  • changes in the way the nipple feels

When Paget’s disease of the breast occurs due to an underlying cancer, the aggressiveness of the cancer depends on the type a person has.

Usually, Paget’s disease of the breast is due to DCIS. With treatment, the outlook for most people with DCIS is very goodTrusted Source.

When Paget’s disease is a result of more advanced or aggressive cancers, especially invasive ductal carcinoma, there is a higher mortality rate.

The factor that plays the most significant role in determining the outcome is early diagnosis. By the time there is a large mass or the cancer has spread to lymph nodes, the disease is more advanced and has a worse prognosisTrusted Source.

The symptoms of Paget’s disease vary depending on the stage of development.

According to the American Cancer SocietyTrusted Source, Paget’s disease usually appears in one breast or nipple. The most common symptoms include:

  • itching, tingling, or burning around the nipple and areola
  • skin discoloration
  • flaking, thickening, or scaling of the skin around the nipple that does not heal over time
  • nipple discharge, which may be yellow or contain blood
  • flattened or inverted nipples
  • a crusted lesion with irregular edges
  • a mass in the nipple
  • ulceration, in some cases

Cancer Research UK indicates that about half of all people with Paget’s disease of the breast also have a breast lump behind the nipple. This usually means that a person has invasive breast cancer.

There is no reliable way for a layperson to differentiate Paget’s disease of the breast from eczema.

If a person has any nipple or skin changes on the breast, they should tell a doctor right away, even if they think Paget’s is unlikely.

Some warning signs that a rash on the nipple could be more serious than eczema include:

Paget’s disease also will not respond to treatments for eczema.

Learn about the differences between Paget’s disease of the breast and eczema.

Doctors do not know the exact cause of Paget’s disease of the breast. One theoryTrusted Source is that it may be a result of a person already having breast cancer, and that Paget’s disease occurs when some cancer cells migrate through the milk ducts.

Another possible explanation is that the skin cells of the nipple spontaneously transform into cancer cells. Some people with Paget’s disease of the breast have no underlying breast cancer or the tumor has no links to the disease in the nipple.

Risk factors

The risk factors for Paget’s disease are similar toTrusted Source those for other types of breast cancer. They include:

  • a person’s age, as the risk increases over time
  • having a personal history of breast cancer or certain breast conditions
  • having a close relative with breast cancer
  • having denser breast tissue
  • having genetic differences that link to breast cancer, such as BRCA1 or BRCA2 genes

According to Cancer Research UK, hormone replacement therapy (HRT) slightly increases the risk of breast cancer. However, the increased risk depends on how long a person takes HRT and begins declining when they stop.

Learn more about HRT and breast cancer.

A doctor will examine any unusual areas of the breast, especially the skin on and around the nipples, and feel for any lumps or areas of thickening.

To confirm the diagnosis, a doctor may recommendTrusted Source:

If breast cancer is present, the characteristics and stage of the condition will determine the treatment options. These may include surgery, radiation therapy, targeted therapy, and chemotherapy.

There are several types of treatment doctors may recommend for Paget’s disease of the breast.

Surgery

A person with this condition will need surgery whether or not they have underlying breast cancer. However, the type of surgery depends on each person’s situation.

For example, if cancer is present but only affects the nipple or the surrounding area, the doctor may suggest surgery to conserve the breast.

This type of surgery, known as lumpectomy, involves removing the nipple, the areola, and the entire portion of the breast that contains the cancerous cells. Most people will then have radiation therapy to help prevent the cancer from returning.

After surgery, breast reconstruction can restore the appearance of the breast.

Hormone treatment, targeted therapy, and chemotherapy

Depending on the type of cancer, a doctor may recommend drug therapy with either hormones or medications that target genes specific to cancerous cells.

These treatments can reduce the risk of the cancer spreading.

Chemotherapy may help prevent the cancer from returning after treatment, especially if:

  • the tumor was large
  • the cells had spread to the lymph nodes
  • the cells are of an aggressive type

After treatment finishes, it is essential to attend all follow-up appointments and to continue to monitor for changes.

The outlook for Paget’s disease of the breast will depend on various factors, such as whether there is a tumor, which type of cancer a person has, and social and environmental factors.

Statistics on survival

According to data from 2000 to 2013, the overall 5-year survival rate for Paget’s disease of the breast with DCIS was 97.5%.

The overall survival rate after 5 years for those with a different type of underlying cancer, concomitant infiltrating duct carcinoma, was less, at 84.1%.

However, each case is unique. The type, stage, and location of the cancer can all influence a person’s outlook, as well as their age and overall health.

It is also important to remember that cancer treatment is constantly evolving. Today, over 10 years later, survival rates may be better than these figures suggest.

Breast cancer and race

Although Paget’s disease of the breast is more common in white people, Black people in the United States have more negative outcomes. A 2023 study found this was true even when treatment approaches were the same or similar.

The authors of the study noted that Black people with more invasive or aggressive diseases were more likely to be adversely affected by social determinants of health, such as living in a lower-income neighborhood. They were also more likely to have more advanced disease.

This suggests that structural inequity is influencing the outcomes for Black people with this disease. However, because Paget’s disease of the breast is rare, the authors emphasize that more research is necessary.

Paget’s disease of the breast is not usually an aggressive breast cancer. However, it can spread if a person does not seek prompt treatment.

As Paget’s disease of the breast can mimic other skin conditions, a person may delay care, which could allow the cancer to spread. People should seek advice as soon as possible if they notice any changes in a breast or nipple, even if they think a serious underlying medical condition is unlikely.

With early diagnosis and treatment, Paget’s disease of the breast is typically curable.

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