What are Breast Cysts?

So my friend went to the doctor and found out she indeed had a breast cyst. But what are they, where do they come from, and should you be concerned?

What are breast cysts?
Cysts are fluid-filled sacs that grow inside the breasts. These sacs form when normal milk glands and connective tissue block milk ducts, causing them to dilate and fill with fluid. A woman can have a single cyst or many cysts at a time. Breast cysts range in size from smaller than a pea to larger than a ping pong ball.

1. Microcysts: too small to feel but may be seen during imaging tests, such as mammography or ultrasound


2. Macrocysts: large enough to be felt and may cause breast pain and discomfort.

The cause of breast cysts remains unknown. Some evidence suggests that excess estrogen in your body may play a role in breast cyst development. Breast cysts are common, particularly in women age 40-60.
When a mammogram shows a possible cyst, a breast ultrasound is usually done. An ultrasound shows whether the lump is a fluid-filled cyst or a solid lump. It also shows whether a cyst is a "simple cyst" or a "complex cyst." Breast ultrasound is the best way to identify and diagnose breast cysts because it is accurate 95 to 100% of the time.

Do cysts lead to cancer?
Almost all breast cysts identified as "simple cysts" by ultrasound are benign and never become cancerous. It is estimated that 1 in 1,000 cysts contain a tumor (but they are usually benign). These tumors can be identified by ultrasound in most cases. Women with cysts are not at a greater risk for cancer although this risk may be higher if there is a family history of breast cancer (mother, sister, or daughter)

Do cysts need to be aspirated (drained)?
When a breast lump is found your doctor may use a simple and effective technique called needle aspiration to find out what is in the lump. If the lump is a fluid-filled cyst, the needle can remove the fluid which usually makes the lump disappear. Aspirated cysts often recur (come back) and need a second aspiration. When a cyst is discovered by ultrasound, aspiration may be suggested. The procedure can be done in an office or clinic - by a doctor who is trained in the technique and has access to a pathology lab that can examine the resulting fluid.
Also known as:
Breast cyst aspiration, fine needle aspiration of breast, breast FNA, fine needle aspiration biopsy, FNAB

What to expect with a FNAB
Getting ANY breast lump checked out is a wise move. Having a fine needle aspiration may seem scary, but it can give you the clearest information about the nature of the lump. You will be awake during the procedure. You should get a local anesthetic to numb the area of your breast that the needle will enter. Your skin will be cleaned to prevent infection. Your doctor will locate the lump by feeling for it, or by using an ultrasound to see it. The doctor will then immobilize the lump and use a very fine-gauge needle, to pierce the lump, and draw fluid out with a syringe. Once the fluid is captured, the needle is removed, pressure is applied to prevent a bruise, and a bandage is used to cover the site.

Getting results & accuracy
The color of the fluid draw out of the lump will give some clues about its nature. Clear or watery and not bloody it is most likely a cyst. Sometimes the fluid can be white, yellow-green, brown, or bloody - but only in rare cases will this mean that the lump is cancerous. If the needle draws out small bits of tissue and very little fluid, that indicates a solid mass. Those tissue samples should be examined by a pathologist to determine their nature.
A needle aspiration is 80 - 85% accurate in giving a clear indication as to whether a breast lump is a cyst or a solid mass.

What will happen if the cyst is left alone?
Breast cysts often change in size. They can look different or disappear entirely on mammograms from one year to the next. This is why diagnostic rather than screening mammograms may be suggested for women with "cystic breast" and changing lumps. Diagnostic mammograms allow the doctor to complete an ultrasound at the same appointment as the mammogram to make sure the changes are actually due to cysts and not solid lumps.

Symptoms
Signs and symptoms of breast cysts include:

• A smooth, easily movable round or oval lump with distinct edges


• Breast pain or tenderness in the area of the lump


• Increased lump size and tenderness just before your period


• Decreased lump size and resolution of other signs and symptoms after your period

When to seek medical advice
My friend still isn't sold on doing self exams. Moreover, as I've begun to ask around I am floored by how many women do not do this simple, yet critical, self assessment. Once again here is the "How To Do A Breast Self Exam"from the ACS and a Breast Self Exam Tool from WebMD. PLEASE check them out, then try soaping yourself up and even doing them in the shower. What performing this simple act is doing is making you aware of the normal consistency of your breasts and the underlying tissue. Say, for example, you feel a noticeable area of thickening in the upper area of your breast, next to your arm. If you've become familiar with how your breasts look and feel, you know your breast usually feels completely smooth in that area. Without a tactile memory from having done frequent breast exams, you might not notice a difference. Detecting any changes should prompt you to contact your doctor.

I do self exams regularly and I found a lump. I suspect this lump is just a cyst, like my friends, and have scheduled an appointment for a mammogram.

Sources: American Cancer Society: Fine needle aspiration biopsy (FNAB) 09/19/2007; National Cancer Institute: Understanding breast changes; www.mayoclinic.com ; and www.cpmc.org/services/women/breast/breast_cyst.html ; and webmd.com Breast Self Exam Tool