Paget’s Disease of the Breast – Symptoms and Causes

ByJanis Updated

Overview

Paget’s disease of the breast is an uncommon type of breast cancer. It starts in the nipple and spreads to the areola, which is the darker skin surrounding the nipple.

This condition usually affects people over 50 years old. Also, it should not be confused with Paget’s disease of bone, which is a different condition that affects the skeletal system.

Most individuals diagnosed with Paget’s disease of the breast also have underlying ductal breast cancer. This may be ductal carcinoma in situ, which stays in its original location.

Or, it may be invasive breast cancer that has spread beyond its origin. Only in rare instances is Paget’s disease confined solely to the nipple area.

Signs and Symptoms

Breast cancer can sometimes show up first in your nipple area. Changes to watch for include:

  • Flaky or scaly skin on the nipple
  • Crusty, oozing, or hardened patches that look like eczema
  • Itching or redness
  • Burning or tingling feelings
  • Discharge from the nipple (clear, straw-colored, or bloody)
  • Nipple turning inward (inversion)
  • Lumps in the breast tissue
  • Skin becoming thicker

These symptoms usually affect just one breast. The problem typically begins in the nipple itself before spreading to the colored area around it (areola) and possibly other parts of the breast.

Early on, these changes might come and go. Your skin might even seem to get better if you use creams or ointments. This can be misleading. Many people experience these symptoms for several months before getting a proper diagnosis.

It’s easy to mistake these signs for common skin problems or irritation. However, persistent nipple changes should never be ignored.

When to See a Doctor

Pay attention to changes in your breasts. If you find a lump in your breast, or if you have itching or skin irritation that lasts for more than a month, you should contact your doctor.

If you’re receiving treatment for a breast skin injury and it doesn’t improve, make sure to schedule a follow-up appointment with your healthcare provider. Quick action helps catch any potential issues early.

Causes

Medical professionals still don’t know the exact cause of Paget’s disease of the breast. However, one leading theory suggests it develops from an underlying ductal breast cancer.

In this scenario, cancer cells migrate through milk ducts, eventually reaching the nipple and surrounding skin areas.

An alternative theory proposes that Paget’s disease might develop independently within the nipple itself, without originating from another breast tumor. Researchers continue to investigate these possibilities to better understand this condition.

Risk Factors

Several factors can increase your chance of developing breast cancer, including Paget’s disease of the breast:

Age-Related Risk

  • Risk increases as you get older
  • Most diagnoses occur in older adults

Medical History Factors

  • Previous breast conditions like LCIS or atypical hyperplasia
  • Personal history of breast cancer in one breast increases risk for the other
  • Previous chest radiation exposure, especially during childhood or young adulthood

Genetic and Family Factors

  • Having a parent, sibling, or child with breast cancer
  • Inherited gene mutations like BRCA1 and BRCA2
  • Most patients don’t have a family history, despite this being a risk factor

Hormonal and Reproductive Factors

Factor How it Affects Risk
Early periods Starting before age 12 increases risk
Later menopause Beginning menopause at an older age increases risk
Pregnancy timing First child after 30 may increase risk
Never pregnant May have a higher risk than those who have had children

Lifestyle Factors

  • Obesity increases breast cancer risk
  • Alcohol consumption raises risk levels
  • Postmenopausal hormone therapy (combined estrogen and progesterone) may increase risk

Some factors, like family history and genetics, can’t be changed. Others, like maintaining a healthy weight and limiting alcohol, are modifiable.

Remember that having risk factors doesn’t mean you’ll definitely develop breast cancer. Many people with several risk factors never develop the disease, while others with no known risk factors do.

Ways to Prevent Breast Cancer

Daily lifestyle changes can help lower your breast cancer risk. Consider these steps:

  • Discuss screening with your doctor. Ask when you should begin breast cancer screening tests like clinical exams and mammograms. Talk about both benefits and risks to create a screening plan that works for you.
  • Know your breasts. Becoming familiar with how your breasts normally look and feel can help you notice changes. If you see new lumps or unusual signs, contact your doctor promptly. While breast awareness doesn’t prevent cancer, it helps you identify potential problems early.
  • Limit alcohol consumption. If you drink alcohol, do so in moderation:
    • Women: Up to 1 drink daily
    • Men: Up to 2 drinks daily
  • Stay physically active. Try to exercise for at least 30 minutes most days of the week. If you’re just starting, check with your doctor and begin slowly.
  • Be cautious with hormone therapy. Combination hormone therapy after menopause may increase breast cancer risk. Discuss benefits and risks with your doctor. If you need hormone therapy for menopause symptoms, use the lowest dose for the shortest time possible.
  • Maintain a healthy weight. Keep your weight in a healthy range. If you need to lose weight, ask your doctor about effective strategies. Focus on:
    • Reducing daily calories
    • Gradually increasing exercise
  • Eat a healthy diet. A Mediterranean diet with extra-virgin olive oil and mixed nuts may reduce breast cancer risk. This eating pattern includes:
    • Plant foods (fruits, vegetables, whole grains, legumes, nuts)
    • Healthy fats like olive oil instead of butter
    • Fish rather than red meat

Reducing Breast Cancer Risk for High-Risk Individuals

If your doctor has determined you have a higher breast cancer risk, you might consider additional preventive options.

Certain medications can reduce breast cancer risk for high-risk individuals. These medications may cause side effects, so doctors typically recommend them only for those at very high risk. Have a thorough discussion with your doctor about potential benefits and drawbacks.

For those at very high risk, some options include:

  • Prophylactic mastectomy: Surgical removal of healthy breast tissue
  • Prophylactic oophorectomy: Removal of healthy ovaries

Both procedures can significantly reduce cancer risk, but come with permanent changes to your body. These options are typically considered only for those with very high genetic or family-related risk factors.

High-risk individuals often follow more intensive screening schedules than those at average risk. This might include:

  • More frequent mammograms
  • Addition of breast MRI
  • Starting screenings at a younger age

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Health Writer

Janis's areas of expertise include nutrition, exercise, stress management, and mental health. She is passionate about educating and empowering people to take control of their health and make positive changes that can last a lifetime. Janis believes that small, sustainable changes are the key to long-term success, and she works with her clients to develop personalized plans that fit their individual needs and lifestyles.