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PAGET'S DISEASE OF THE NIPPLE/ BREAST

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Written by : Dr.M.D.Mazumdar, MD

Paget's disease of the nipple and/or breast is named after Sir James Paget who discovered that the cells on the nipple in this condition was made of large cancerous cells.

Sir James Paget also discovered a disease of the bone known as Paget's Disease of the Bones or Osteitis Deformans. This is not however a cancerous condition but a chronic disorder that typically results in enlarged and deformed bones.

Paget's disease of the breast is relatively uncommon. It occurs in less than 5% of all women with breast cancers. It is frequently seen in combination with an underlying cancer of the breast ducts like Invasive Ductal Breast Cancer or Invasive Lobular Breast Cancer.

Paget's disease can occur in both men and women. But is is more often misdiagnosed in men and passed off as dermatitis or eczema.

Paget's Disease with Underlying Ductal Breast Cancer
Paget's Disease with Underlying Ductal Breast Cancer

Age at which Paget's Disease Occurs:

Paget's Disease is rare in young women under the age of 30. It is most common after the age of 60 years in both men and women. The average age at diagnosis is 62 for women and 69 for men.

Causes of Paget's Disease of the Nipple/Breast:

The exact cause is not known. But there are two theories -

  • The cancerous cells, called Paget's cells, reach the skin of the nipple by breaking off from a tumor inside the breast and moving through the milk ducts to the surface of the nipple, resulting in Paget's disease of the nipple. This theory is supported by the fact that more than 97 percent of patients with Paget disease also have underlying invasive breast cancer or ductal carcinoma in situ (DCIS).

  • The second theory suggests that the cancerous changes in the cells on the skin start spontaneously with no connection to cancer elsewhere on the breast. This is seen in very few cases of Paget's disease of the nipple/breast.

Paget's Disease of the Nipple/Breast
Paget's Disease of the Nipple/Breast

Symptoms of Paget's Disease of the Nipple:

  • Early Symptoms: Early Symptoms include redness and mild scaling and flaking of the nipple skin, which most women do not think is severe enough to merit going to the doctor. In some cases, there may only be a mild irritation and itching, not even scaling and itching.

  • Commonest Symptom: The commonest symptom of Paget's disease of the Nipple is a red, flaky and scaly rash which can spread from the nipple to the surrounding areola. As the disease progresses, there may be tingling, itching, increased sensitivity, burning, and pain over the rash. A thin discharge may be present from the rash, forming a crust as it dries. With more skin destruction, there may flattening of the nipple against the breast.

  • Breast Lump: In some cases, a small lump may be felt under the nipple or areola. Like most other types of breast cancers, these are also non-tender and firm lumps.

  • Nipple Discharge: Some women may have a nipple discharge which may be yellowish, greenish or reddish. Reddish implies the presence of blood while greenish or yellowish may indicate the presence of infection.

  • Pain: Pain is very uncommon. But in the presence of infection of the lump, there may be some amount of pain.

  • Site: In most cases, only one nipple is affected. But sometimes, both the nipples may be affected.

See Page 2 for:

  • Diagnosis of Paget's Disease
  • Treatment of of Paget's Disease
  • Prognosis of Paget's Disease



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