Paget’s disease of the nipple - Diagnosing Paget's disease of the nipple

As Paget’s disease of the nipple is usually a sign of breast cancer, it's very important you see your GP if you notice changes to the tissue or skin of your breast.

In particular, you should tell your GP if you notice any changes to:

• the skin of your nipple or areola (the darker area of skin around the nipple)
• your breasts, particularly lumps in your breast 

Paget’s disease of the nipple can sometimes be confused with eczema, a skin condition that also causes red, itchy and dry skin.

Therefore, you should visit your GP for a diagnosis rather than assuming you have eczema. Paget’s disease is a form of breast cancer and the sooner it's diagnosed, the better the outcome is likely to be.

Your GP will examine both breasts, even if you only have a problem with one of them. They may also ask you:

• about your symptoms and how long you have had them
• whether you have a history of eczema, or have eczema anywhere else on your body
• whether you have a personal or family history of breast cancer
• your age and whether you have experienced the menopause (when a woman's monthly periods stop)
• whether you're taking any medication, including hormone replacement therapy (HRT), which is used to treat some of the symptoms of the menopause, or the oral contraceptive pill
• how much alcohol you drink
• how much you weigh and if you have recently gained weight

If your GP thinks you may have breast cancer, they will refer you to a specialist breast clinic for tests. 

Breast clinic

When you visit a breast clinic you will have tests to find out whether you have breast cancer and, if you have, what type of breast cancer.

Staff at the clinic may take photographs of your breasts to record their current appearance and to help identify any further changes that may occur.

Tests carried out at the clinic may include the following:

• an examination of your breast to check for lumps or other abnormalities
• a mammogram (if you are 35 years of age or over)
• an ultrasound scan – which is the first line of investigation used in younger women
• a skin biopsy will be carried out if Paget’s disease is suspected

Mammogram

A mammogram is a simple procedure that uses X-rays to create an image of the inside of your breasts. It can identify early changes in your breast tissue when it may be difficult to feel a lump.

Younger women often have denser breasts than older women, which can make identifying changes more difficult. Therefore, mammograms are not as effective in women under 35 years of age. If you're under 35, your doctor may suggest you have a breast ultrasound instead (see below).

However after a diagnosis of Paget’s disease has been confirmed, mammography will become an important part of pre-surgery assessment.

During a mammogram, the radiographer will position one of your breasts on a flat X-ray plate. A second X-ray plate will press down on your breast from above, so that it is temporarily compressed and flattened between the two plates.

An X-ray will be taken, which will give a clear image of the inside of your breast. The procedure will then be carried out on your other breast.

Having a mammogram can be slightly uncomfortable or even painful, but the procedure will only take a few minutes. Your doctor will examine the image produced by a mammogram for indications of cancer.

Breast ultrasound

If you are under 35 years of age, a breast ultrasound may be recommended. This is because your breast tissue may be too dense for a mammogram. Your doctor may also suggest a breast ultrasound if they need to find out whether a lump in your breast is solid or contains liquid.

Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. An ultrasound probe or sensor will be placed over your breasts to create an image on a screen. The image will show any lumps or abnormalities present in your breasts.

Skin biopsy

A skin biopsy is used to diagnose Paget’s disease. A biopsy is where a small sample of tissue is taken for examination under a microscope and tests to see if it is cancerous.

Further tests

There are a number of other tests that can be used if a diagnosis of breast cancer is confirmed and help determine what types of treatment might be used.

Read more about further tests for breast cancer.