Paget’s disease of the breast
স্তনের প্যাগেট রোগ
Overview
Paget’s disease of the breast is a condition that causes a scaly rash on the skin of the nipple. This can look like eczema.
Most people who have Paget’s disease also have breast cancer. This means it’s sometimes called a rare type of breast cancer.
The breast cancer may be:
- ductal carcinoma in situ (DCIS) – this is non-invasive and cancer cells are contained inside the milk ducts
- invasive breast cancer – starts in the ducts or lobules of the breast, and spreads into the surrounding breast tissue
Paget’s disease affects about 1 to 2 out of every 100 women with breast cancer (1 to 2%).
It’s most common in women aged 50 and over but it can happen at a younger age. It can affect men, but this is very rare.
Macmillan Cancer Support have more information on what cancer is.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
Doctors and scientists still aren't sure exactly why Paget's disease develops. What we do know is that the things that raise someone's chances of getting it are much the same as the risk factors for DCIS and invasive breast cancer.
Diagnosis
Diagnosing Paget’s disease
It may be possible to confuse Paget’s disease with other skin conditions like eczema, dermatitis and psoriasis. This is because they look similar.
Paget’s disease can be difficult to diagnose just by looking at it.
Paget’s disease usually affects the nipple first. After a few weeks, it spreads to the areola. Other skin conditions usually affect the areola first and then the nipple.
Tests for Paget’s disease
Your first test will usually be to check the skin changes on your nipple. Your specialist breast cancer doctor may also do the following tests.
A skin or punch biopsy is when a doctor removes a small sample of skin from the affected nipple and tissue from under the skin. They inject some local anaesthetic into the skin to numb the area first. The sample is looked at under a microscope for cancer cells.
A nipple scrape is when a doctor gently scrapes or presses cells from the skin of the affected nipple onto a glass slide. These are looked at under a microscope.
A core biopsy through the nipple is when the doctor removes a core of skin from the nipple and a small piece of tissue from the breast ducts underneath. They inject some local anaesthetic into the skin to numb the area first.
As well as some of these tests, you’ll usually have the same tests you have for any other type of breast cancer.
You’ll usually have the following scans.
A mammogram is an x-ray of the breast.
An ultrasound uses sound waves to produce a picture of the breast tissue and the lymph nodes (glands) in the armpit.
An MRI uses magnetism to build up a detailed picture of the breast area.
Breast biopsy
You’ll also have a biopsy. This is when your cancer doctor takes small samples of cells or tissue from your breast. You’ll have an injection of local anaesthetic to numb the area first.
The samples will be looked at under a microscope to check for cancer cells. This is to find out whether there are any DCIS or invasive breast cancer cells.
If invasive breast cancer cells are found, you doctor will arrange other tests. This is to find out whether the cancer cells have receptors (proteins) for hormones or for HER2.
Your cancer doctor and breast care nurse will explain which type of biopsy is best for you.
Macmillan Cancer Support has more advice on cancer tests and waiting for results.
Staging and grading of Paget’s disease
Stage
The stage of a cancer describes its size and how far it has spread. Knowing this helps your cancer doctor plan the best treatment for you.
DCIS is the earliest stage of breast cancer. This is when changes are happening to cells which might become breast cancer.
Invasive breast cancer is usually staged using a number system from 1 to 4.
Grade
The grade of breast cancer is how the cancer cells look under a microscope. The grade gives an idea of how slowly or quickly the cancer may develop.
Treatment
Treatment for Paget’s disease
The main treatment for Paget’s disease is surgery.
The type of operation you have depends on:
- the size of the area of Paget’s disease
- whether there is DCIS or invasive breast cancer
- where the affected area is in the breast
Some people may have other treatments after surgery. For example, you may have radiotherapy to the breast.
Further treatment will depend on whether the cancer is DCIS or invasive breast cancer. Your cancer doctor or nurse will explain more about your treatment options.
Further information and support
Macmillan Cancer Support has further information to support you. You can:
- phone the Macmillan Support Line on 0808 808 00 00
- chat to Macmillan specialists online
- use the Macmillan breast cancer forum – you can talk to others affected by breast cancer, ask questions and share your experience
Don’t include personal information e.g. name, location or any personal health conditions.