Paget's disease of the breast

Paget's disease of the breast is a rare form of breast cancer that affects the nipple. Paget's disease of the breast often causes scaly or crusty skin on the nipple. The affected area may slowly grow to involve the skin around the nipple, called the areola.

Paget's is pronounced PAJ-its. Paget's disease of the breast also is called mammary Paget's disease.

Paget's disease of the breast refers to breast cancer in the nipple. But most people with this condition also have breast cancer in the breast tissue. If your healthcare team thinks you have Paget's disease of the breast, you'll likely have tests to look for cancer in other parts of the breast.

Treatment for Paget's disease of the breast is similar to treatment for other forms of breast cancer. Treatments may include surgery, radiation therapy and medicines.

Paget's disease of the breast isn't related to Paget's disease of the bone, which is a metabolic bone disease.

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

It's not clear what causes Paget's disease of the breast. It also isn't clear where this breast cancer starts. One theory is that Paget's disease of the breast starts in the breast tissue. Breast cancer might form in the breast tissue and then spread through the milk ducts to the nipple. Another theory is that Paget's disease of the breast starts in the nipple.

Despite the questions about how Paget's disease of the breast happens, healthcare professionals know that it starts with DNA changes. All breast cancers start when breast cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells. In Paget's disease of the breast, the cancer cells build up in the nipple.

Paget's disease of the breast is a form of breast cancer. Factors that may increase the risk of breast cancer include:

• A family history of breast cancer. If a blood relative, such as a parent, sibling or child, had breast cancer, your risk of breast cancer is increased. The risk is higher if your family has a history of getting breast cancer at a young age. The risk also is higher if you have multiple blood relatives with breast cancer. Still, most people diagnosed with breast cancer don't have a family history of the disease.
• A personal history of breast cancer. If you've had cancer in one breast, you have an increased risk of getting cancer in the other breast.
• A personal history of breast conditions. Having certain breast conditions raises your risk of breast cancer. These conditions include lobular carcinoma in situ, also called LCIS, and atypical hyperplasia of the breast. If you've had a breast biopsy that found one of these conditions, you have an increased risk of breast cancer.
• Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
• Beginning menopause at an older age. Beginning menopause after age 55 increases the risk of breast cancer.
• Dense breast tissue. Breast tissue is made up of fatty tissue and dense tissue. Dense tissue is made of milk glands, milk ducts and fibrous tissue. If you have dense breasts, you have more dense tissue than fatty tissue in your breasts. Having dense breasts can make it harder to detect breast cancer on a mammogram. If a mammogram shows that you have dense breasts, you have an increased risk of breast cancer. Talk with your healthcare team about other tests you might have in addition to mammograms to look for breast cancer.
• Drinking alcohol. Drinking alcohol increases the risk of breast cancer.
• Female sex assigned at birth. Women are much more likely than men are to get breast cancer. But everyone is born with some breast tissue, so anyone can get breast cancer.
• Having your first child at an older age. Giving birth to your first child after age 30 may increase the risk of breast cancer.
• Having never been pregnant. Never having been pregnant increases the risk of breast cancer. Having been pregnant one or more times lowers the risk.
• Increasing age. The risk of breast cancer goes up as you get older.
• Inherited DNA changes that increase cancer risk. Certain DNA changes that increase the risk of breast cancer can be passed from parents to children. The most well-known changes are BRCA1 and BRCA2. These changes can greatly increase your risk of breast cancer and other cancers, but not everyone with these DNA changes gets cancer.
• Hormone therapy for menopause. Taking certain hormone therapy medicines to control the symptoms of menopause may increase the risk of breast cancer. The risk is linked to hormone therapy medicines that combine estrogen and progesterone. The risk goes down when you stop taking these medicines.
• Obesity. People with obesity have an increased risk of breast cancer.
• Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is higher.

Making changes in your daily life may help reduce your risk of Paget's disease of the breast and other forms of breast cancer. Try to:

• Ask about breast cancer screening. Talk with your healthcare professional about when to begin breast cancer screening. Ask about the benefits and risks of screening. Together, you can decide which breast cancer screening tests are right for you.

• Become familiar with your breasts. You may choose to become familiar with your breasts by occasionally inspecting them during a breast self-exam for breast awareness. If there is a new change, a lump or something not typical in your breasts, report it to a healthcare professional right away.

  Breast awareness can't prevent breast cancer, but it may help you to better understand the look and feel of your breasts. This might make it more likely that you'll notice if something changes.

• Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day if you choose to drink. For breast cancer prevention, there is no safe amount of alcohol. So if you're very concerned about your breast cancer risk, you may choose to not drink alcohol.
• Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask a healthcare professional whether it's OK and start slowly.

• Limit hormone therapy for menopause. Combination hormone therapy may increase the risk of breast cancer. Talk with a healthcare professional about the benefits and risks of hormone therapy.

  Some people have symptoms during menopause that cause discomfort. These people may decide that the risks of hormone therapy are acceptable in order to get relief. To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.

• Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask a healthcare professional about healthy ways to lower your weight. Eat fewer calories and slowly increase the amount of exercise.