Paget's Disease of the Breast

Paget's disease of the breast is a rare type of breast cancer that affects the skin of the nipple, and the surrounding darker area called the Areola. In this video we'll explain: what symptoms to look for; how it is diagnosed; and how it is treated. Paget's disease of the breast is found in approximately one-to-four percent of breast cancers. It usually starts in the nipple, and may spread to the areola. Most people with Paget's disease also have an underlying cancer in the breast tissue behind the nipple. The main symptom is a red, scaly rash on the nipple that does not go away. The skin may look crusty, flaky, or thickened and you may experience itching, tingling, or a burning sensation. The nipple can also become ulcerated, or produce discharge. These symptoms can look very similar to eczema or other skin conditions, which sometimes delays diagnosis. If a rash on your nipple does not improve with standard skin treatments, or if it affects only one nipple, it is important to see your GP for further investigation. Diagnosis usually involves a clinical examination and a skin biopsy, where a small sample of tissue is taken from the nipple. A mammogram, and sometimes an MRI scan are also done to check for any cancer in the breast tissue behind the nipple. Treatment for Paget's disease depends on whether there is underlying cancer in the breast, and how extensive it is. Surgery is the main treatment - which may involve removing the nipple and areola with some surrounding tissue, or a mastectomy if the cancer is more widespread. After surgery - you may need radiotherapy, particularly if you have had breast-conserving surgery. If there is invasive breast cancer, you may also have additional treatments such as chemotherapy, hormone therapy, or targeted therapy depending on the type. If you have breast-conserving surgery that removes the nipple. It is possible to have nipple reconstruction at a later stage. Your breast surgeon can discuss options with you. The goal is to achieve the best outcome while considering your preferences. The outlook for Paget's disease depends on whether invasive cancer is present, and how early it is diagnosed. When caught early, the prognosis is generally good. Regular follow-up appointments and mammograms will monitor for any recurrence. If you have any persistent changes to your nipple, please see your GP. If you have been diagnosed with Paget's disease and have questions, your breast surgeon or breast-care nurse can provide more information and support.