Paget Disease of the Breast: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Paget Disease of the Breast?
A breast surgeon, a doctor who operates on the breast, and a medical oncologist, a doctor who treats cancer, usually lead care for Paget disease of the breast. A radiation oncologist, a doctor who uses radiation to treat cancer, may also help. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is Paget disease of the breast?
Paget disease of the breast is a rare type of cancer involving the nipple and usually the areola, the darker circle of skin around the nipple. About 1 to 3 percent of all breast cancers are Paget disease of the breast.
It is also called Paget's disease of the nipple or mammary Paget's disease. It almost always affects women, but rare cases have been reported in men. It is not related to Paget disease of the bone. They are two different disorders.
Symptoms
Paget disease of the breast can look like skin conditions such as dermatitis and eczema, which are common itchy skin rashes. Symptoms may include:
- Itching, tingling, or redness in the nipple or areola.
- Flaking, crusty, or thickened skin on or around the nipple.
- A flattened nipple.
- Discharge from the nipple that may be yellowish or bloody.
- Burning, oozing, or bleeding of the skin, and later pain or sensitivity.
People with Paget disease may also have a tumor or lump in the same breast. Early on, the skin symptoms may get better and then get worse again.
Causes and who gets it
Scientists do not fully understand what causes Paget disease of the breast. Cancer cells from a tumor inside the breast may travel through the milk ducts to the nipple and areola. Or the cancer may begin in the nipple and spread from there. Most women with this disorder have an underlying cancer in the milk ducts.
The risk factors are the same as those for other types of breast cancer. It most often affects people between 50 and 60 years old. It has been reported in people in their 20s.
How doctors diagnose it
The skin changes can be missed, because people often blame a skin condition or infection. Diagnosis may be delayed by six months or more. Your doctor will need to find out if the symptoms are due to Paget disease or another condition. A doctor may:
- Do a physical exam, including a clinical breast exam, and ask about your personal and family medical history.
- Order imaging tests such as a mammogram, breast ultrasound, or breast MRI to look for a tumor or abnormal area inside the breast.
- Do a skin biopsy, which means taking a small sample of tissue to look at under a microscope.
Sometimes a skin biopsy shows Paget disease but imaging finds no abnormal area in the breast. Then you will likely be diagnosed with stage 0 breast cancer. This is called ductal carcinoma in situ, or DCIS. It means the cancer cells stay inside the milk ducts. Some people with Paget disease and no abnormal area in the breast also have invasive breast cancer. If cancer is found, tests check the cancer cells for hormone receptors and HER2 protein to help plan treatment.
Treatment
Treatment may need a team that includes cancer doctors, radiation doctors, and surgeons. If you have Paget disease and DCIS, treatment is like that for DCIS, but you may have more extensive surgery on the nipple to remove Paget cells. If you have Paget disease and invasive breast cancer, it is treated as invasive breast cancer. Treatment depends on how far it has spread and other features.
Surgery has traditionally meant a mastectomy, which removes the breast. In selected cases, a lumpectomy may be advised. This surgery removes the nipple and areola along with a small section of breast tissue. Radiation therapy follows a lumpectomy. Other therapy to help keep the cancer from coming back may include radiation, chemotherapy, and hormone therapy.
When to see a doctor
Get checked right away if you notice redness, itching, flaking, or crusting of the nipple, a flattened nipple, or bloody discharge. These changes can look like eczema, so a doctor needs to check whether they are Paget disease or another condition. Do not wait if the skin gets better and then worsens again, because early symptoms can come and go and diagnosis is often delayed. Also tell your doctor about any lump in the breast.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can start the evaluation of nipple skin changes and refer you to a breast specialist.
Common questions
Is Paget disease of the breast the same as Paget disease of the bone?
No, they are two different disorders.
Can Paget disease of the breast be mistaken for eczema?
Yes, it can look like eczema or dermatitis. That is why diagnosis is sometimes delayed.
Can men get Paget disease of the breast?
Yes, but it is rare. It almost always occurs in women.
Is there always a tumor inside the breast?
No, but most women with Paget disease of the breast do have an underlying cancer in the milk ducts.
How serious is Paget disease of the breast?
It is serious because it is a type of cancer. The outlook depends on whether a tumor is present, whether it is DCIS or invasive breast cancer, and the stage if it is invasive.
Sources
- National Cancer Institute - Paget Disease of the Breast
- National Organization for Rare Disorders (NORD) - Paget's Disease of the Breast
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
