Paget Disease of the Breast: Symptoms, Diagnosis and Treatment Guide

Receiving a diagnosis of Paget disease of the breast can be overwhelming, but understanding the condition is the first step toward managing your care. This rare form of breast cancer involves the skin of the nipple and the dark circle of skin around it, known as the areola.

The following information is designed to help you prepare for discussions with your oncology team.

Overview of Paget disease of the breast

Paget disease of the breast occurs in approximately 1% to 4% of all breast cancer cases. It is often associated with an underlying tumor elsewhere in the same breast, either ductal carcinoma in situ (DCIS) or invasive breast cancer.

The condition begins in the milk ducts and spreads to the surface of the nipple. While it is a cancerous condition, it is highly treatable, especially when identified early. Patients often first notice changes that resemble common skin conditions like eczema or dermatitis.

Symptoms of Paget disease of the breast and diagnosis

Because the symptoms of Paget disease often mimic benign skin irritations, a thorough diagnostic process is essential to distinguish it from non-cancerous conditions.

• Symptoms: Signs may include redness, scaling, crusting or flaking of the nipple skin. Some patients experience itching, tingling, increased sensitivity or a straw-colored or bloody discharge from the nipple.
• Physical Exam: An oncologist will check for lumps or skin thickening in the breast and lymph nodes.
• Biopsy: This is the definitive way to diagnose Paget disease. A small sample of the nipple skin is removed and examined under a microscope for "Paget cells," which are large, malignant cells characteristic of the disease.
• Imaging: Mammograms and ultrasounds are standard to determine if there is an underlying tumor. In some cases, a breast MRI may be used to get a more detailed view of the breast tissue.

Treatment options for Paget disease of the breast

Treatment plans are personalized based on whether an underlying tumor is present and the extent of the cancer.

Surgery

Surgery is the primary treatment for Paget disease.

• Breast-conserving surgery (Lumpectomy): This involves removing the nipple, the areola and the affected area of the breast tissue. This is often followed by radiation.
• Mastectomy: If the underlying cancer is more extensive, a total mastectomy (removal of the entire breast) may be recommended.

Adjuvant therapies

Depending on the biopsy results and the status of any underlying tumors, additional treatments may include:

• Radiation therapy: High-energy beams are used to destroy any remaining cancer cells after surgery.
• Chemotherapy: If the cancer is invasive or has spread to the lymph nodes, systemic medication may be used.
• Hormone therapy: If the cancer cells have receptors for estrogen or progesterone, medications can block these hormones to reduce the risk of recurrence.

Side effects of treatment for paget disease of the breast

Treatments for Paget disease can cause side effects. Understanding these can help you manage your quality of life during recovery.

• Surgical recovery: Common issues include localized pain, swelling and changes in breast shape or sensation.
• Radiation effects: Patients often experience skin redness or irritation similar to a sunburn in the treated area, along with fatigue.
• Systemic treatment effects: Chemotherapy may lead to hair loss, nausea and a weakened immune system, while hormone therapy can cause symptoms similar to menopause, such as hot flashes.

Always report new or worsening symptoms to your care team, as many side effects can be mitigated with supportive care.

What patients should understand about paget disease of the breast

A diagnosis of Paget disease of the breast is a significant life event, but the prognosis is generally favorable when the disease is localized. Your oncology team is your best resource for navigating these options and deciding on a path that aligns with your health goals.

Consider asking your doctor:

• Is there an underlying tumor in addition to the nipple changes?
• Am I a candidate for breast-conserving surgery?
• How will these treatments affect my daily life and long-term health?

Knowledge is a powerful tool in your cancer journey. By staying informed, you can play an active role in your treatment and recovery.

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice, as your own experience will be unique. Use this article to guide discussions with your oncologist. Content was generated with AI, reviewed by a human editor, but not independently verified by a medical professional.

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