Paget’s disease of the nipple

Paget’s disease of the nipple, also known as Paget’s disease of the breast, is a rare type of breast cancer.

The term Paget’s disease of the nipple is used to distinguish the condition from Paget’s disease of the bone, which occurs when the normal cycle of bone growth is disrupted, leading to the bones becoming weak and deformed.

A similar type of skin cancer can also occur in other parts of the body.

The rest of this section will use the term Paget’s disease to refer to Paget’s disease of the nipple or breast.

Symptoms of Paget's disease

Paget's disease usually affects the skin of one nipple and produces eczema-like symptoms, appearing as an itchy, red rash on the nipple that can extend to the darker area of surrounding skin (the areola).

It can also appear as a small ulcer or dry, red, flaky patches of skin similar to psoriasis.

Other possible symptoms include:

itchiness or a burning sensation – alongside visible changes to the nipple (see above)
bleeding from the skin of the nipple

If you're experiencing itchiness, burning or bleeding but the nipple looks normal and isn't red, dry or scaly – this is extremely unlikely to be Paget's disease but should still be checked by a doctor.

Causes of Paget's disease

Paget’s disease is usually a sign of breast cancer in tissue behind the nipple, or breast tissue away from the nipple.

The breast cancer can either be:

invasive – where cancerous cells invade the surrounding breast tissue
non-invasive – where the cancerous cells are contained in one or more areas of the breast and are unable to spread

In a small amount of cases, the only evidence of Paget's disease is the nipple changes.

In about half of all cases of Paget’s disease of the nipple, a lump is found in the breast. The majority of people with a lump will have invasive breast cancer, although this does not necessarily mean it has spread.

Most people with Paget's disease of the nipple who don't have a lump will have non-invasive breast cancer.

Diagnosing Paget's disease

You should visit your GP if you notice any changes in the skin of your nipple or areola (the darker area of skin around the nipple).

As Paget’s disease is a form of breast cancer, the sooner it's diagnosed, the better the outcome is likely to be.

See your GP if you develop a lump in your breast. While most breast lumps are not cancerous, it's important you have it checked out.

Treating Paget's disease

Paget’s disease is treated in the same way as breast cancer.

Surgery is usually the first line of treatment but unlike other forms of breast cancer, it involves removing breast tissue that includes the nipple and areola.

This may be followed by a combination of:

chemotherapy – where powerful medication is used to destroy cancerous cells
radiotherapy – where controlled doses of high-energy radiation are used to destroy cancerous cells
biological or hormone therapy – which can be used to treat certain types of cancer

If Paget's disease is detected and treated in its early stages, there's a good chance of recovery. Read more about how Paget's disease is treated.

Preventing Paget's disease

Modifying certain lifestyle factors, such as reducing alcohol intake and regular exercise, may reduce your risk of developing certain types of cancer, including breast cancer. However, these factors remain controversial.

Screening is also used to help detect breast cancer early. The NHS Breast Screening Programme provides free breast screening every three years for all women in the UK who are 47 years of age or over.

Read more about preventing breast cancer.

Risk factors for breast cancer

There are a number of factors that can increase your risk of developing breast cancer. These include:

age – your risk of developing breast cancer increases as you get older
family history – if you have a number of close relatives with breast cancer, your chances of also developing the condition are increased
previously being diagnosed with breast cancer
previously having a benign breast lump – certain types of benign lump may slightly increase your risk but this is only seen in a small number of women
being overweight – which is especially significant in post-menopausal women (use the BMI healthy weight calculator to find out whether you are overweight or obese)
alcohol – your risk of developing breast cancer can increase with the amount of alcohol you drink

Read more about the risk factors for breast cancer.