Paget’s disease of the nipple, while rare, is a significant condition often associated with breast cancer. Recognizing changes in your breast tissue, particularly around the nipple area, is crucial for early detection and timely medical intervention. If you observe any unusual symptoms, prompt consultation with a healthcare professional is essential.
Specifically, it’s important to be vigilant for changes affecting:
- The skin of your nipple or areola (the darker skin surrounding the nipple)
- Your breasts in general, including the appearance of any lumps.
Paget’s disease of the nipple can sometimes mimic eczema, a common skin condition characterized by red, itchy, and dry skin. This similarity underscores the importance of seeking professional medical advice for a definitive diagnosis rather than self-diagnosing eczema. Paget’s disease is a form of breast cancer, and early diagnosis is paramount for improving treatment outcomes.
Initial Examination and History Taking
Your General Practitioner (GP) will conduct a thorough examination of both breasts, even if symptoms are present in only one. To gain a comprehensive understanding of your condition, they may ask questions about:
- Your specific symptoms and their duration
- Personal or family history of breast cancer
- Your age and menopausal status
- Current medications, including hormone replacement therapy (HRT) or oral contraceptives
- Alcohol consumption habits
- Weight and any recent weight fluctuations
If your GP suspects breast cancer based on the initial assessment, you will be referred to a specialist breast clinic for further investigations.
Diagnostic Procedures at a Breast Clinic
At a specialist breast clinic, healthcare professionals will perform a series of tests to determine if breast cancer is present and, if so, the specific type.
To monitor changes and document the initial presentation of your condition, clinic staff may take photographs of your breasts.
Common tests conducted at the breast clinic include:
- Clinical breast examination to identify lumps or abnormalities
- Mammogram (X-ray of the breast)
- Ultrasound scan, often the initial imaging method for younger women, pregnant individuals, or those who are breastfeeding
- Skin biopsy, particularly crucial when Paget’s disease is suspected. This involves taking a small skin sample from the nipple and/or areola.
Mammogram Details
A mammogram is a straightforward procedure utilizing low-dose X-rays to create detailed images of the breast’s internal structures. It is effective in detecting subtle changes in breast tissue, sometimes even before a lump is palpable.
However, mammogram effectiveness can be reduced in younger women due to denser breast tissue. For women under 35, a breast ultrasound might be preferred initially. Despite this, mammography becomes a critical component of pre-surgical planning if Paget’s disease is confirmed.
During a mammogram, the breast is positioned on an X-ray plate and gently compressed with another plate from above. This compression, while potentially uncomfortable, ensures a clear image. The process is then repeated for the other breast. Trained specialists, known as film readers, image readers, or radiologists, meticulously analyze the mammogram images for any signs of cancer.
Breast Ultrasound Examination
For individuals under 35, a breast ultrasound may be recommended as an alternative to a mammogram due to breast tissue density. Ultrasound is also valuable for distinguishing between solid lumps and fluid-filled cysts. It is also a safe imaging modality for pregnant and breastfeeding individuals.
Breast ultrasound employs high-frequency sound waves to generate images of the breast’s interior. A handheld probe is moved across the breast surface, and the sound waves create a visual representation on a screen, revealing any lumps or abnormalities.
The Confirmatory Laboratory Result: Skin Biopsy
The definitive laboratory result that confirms a diagnosis of Paget’s disease of the nipple is a skin biopsy. This procedure is essential when Paget’s disease is suspected based on clinical examination and other imaging tests. During a skin biopsy, a small tissue sample is carefully taken from the affected nipple or areola skin.
This tissue sample is then meticulously examined under a microscope by a pathologist. The pathologist looks for specific cellular changes characteristic of Paget’s disease, which involves the presence of Paget cells within the epidermis of the nipple. The identification of these Paget cells in the biopsy sample is the conclusive laboratory confirmation of Paget’s disease. Further specialized tests on the biopsy sample can also be performed to determine the characteristics of the cancer cells, such as hormone receptor status and HER2 status, which guide treatment decisions.
Further Investigations
If breast cancer, including Paget’s disease, is confirmed, additional tests may be conducted to determine the cancer’s characteristics and guide treatment strategies. These may include further imaging, such as MRI or CT scans, and potentially a sentinel lymph node biopsy to assess if the cancer has spread beyond the breast.
Read more about further tests for breast cancer.
Page last reviewed: 06 April 2023
Next review due: 06 April 2026
