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Is There More to Breast Cysts?

1 October 2020 | 9 mins read | Is There More to Breast Cysts?

Breast cysts are almost always “just a simple cyst”.

In fact, the chance that a breast cyst is cancerous is far less than one percent. The chance that a person who has just discovered a cystic lump in their breast will call their physician to make an appointment is much higher.

Yet seeing the physician is exactly the right thing to do.

First, confirming that your lump is a harmless cyst will help you sleep better. Second, your lump might not be a cyst, so let the physician make the determination. Even if the lump is not a cyst, it is most likely harmless. If it is not harmless, the phone call to the physician can save your life.

What Is A Breast Cyst?

A breast cyst is a sac of fluid surrounded by a closed membrane within the breast.

  • Cysts develop when fluid gets trapped within the normal breast tissue.
  • Cysts are smooth, discrete (distinct from surrounding breast tissue) lumps that feel firm but not hard.
  • Cysts can feel tender or even painful, particularly just before you get your period.
  • Cysts range in size from microscopic to several centimeters in diameter.
  • Cysts that are large or near the surface of the breast can often be seen and felt through the skin.
  • Smaller cysts might be impossible to see or feel but can still cause breast tenderness.
  • Tiny cysts (called microcysts) often develop in clusters.

Who Gets Breast Cysts?

Approximately half of all women will develop breast cysts.

  • Cysts can develop at any age but are most common in women in their 30s and 40s.
  • Cysts are less common in postmenopausal women
  • Postmenopausal women on hormone replacement therapy have a higher rate of cyst development. One study found breast cysts in 66% of post-menopausal hormone replacement therapy users.
  • Although men can and do develop breast cancer as well as other breast conditions, it is extremely rare for a cisgender man to develop breast cysts.

Trans women who have taken feminizing hormones are thought to be at roughly the same risk of developing breast conditions as cisgender women.

Studies in trans men are limited, but breast cyst development seems to be rare in trans men who have taken androgens.

I Had A Cyst. Do I Have Fibrocystic Breast Disease?

All women with breasts can develop cysts, but approximately half of all women of childbearing age women have “fibrocystic” changes to their breasts before each menstrual period.

These changes are common and not dangerous; therefore, the word “disease” is not used anymore in relation to fibrocystic breast changes. Symptoms of fibrocystic breast changes include:

  • Lumpy, heavy, and/or swollen breasts.
  • Breast tenderness or pain.
  • Thicker or more ropelike breast tissue.
  • A clear, straw-colored, or brown discharge from the nipples.
  • Cyst development or enlargement

For many women, the lumpiness and other symptoms resolve after their period and re-occur a few days before their next period. Some women have symptoms most of the time.

Whether or not you have fibrocystic breasts, you might not know that you have a cyst until you have a routine mammogram or ultrasound. Mammography is very good at finding masses that are potentially cancerous, but it is not as good at showing if a mass is a fluid-filled cyst or a solid tumor.

If your mammogram shows an abnormality that is not clearly diagnosable, you will probably be given an ultrasound. Unlike mammograms, ultrasounds can show the difference between fluid and solid.

fibrocystic breast changes mammography ultrasound halza digital health

Mammography is also not as good at finding abnormalities in dense breasts with little fatty tissue. Younger women, whose breasts tend to be denser, should ask their doctor if they would benefit from an ultrasound instead of or in addition to a mammogram.

fibrocystic breast changes mammography ultrasound halza digital health

How Does My Doctor Know Which Cysts Are Worrisome?

Cysts fall into one of three categories: simple, complicated, and complex. Usually, a physical exam plus imaging (mammography plus ultrasound, and/or MRI) will provide enough information to know if further testing is needed.

  • Simple Cysts

Most cysts are ‘simple’ cysts. This means that they are plain fluid surrounded by an enclosed membrane. Simple cysts are not cancerous, and they can be left alone. Multiple tiny cysts sometimes form clusters. If they are each smaller than 2-3mm and are filled only with fluid, they are considered simple.

If a cyst is particularly large, annoying, inflamed, or infected, the physician can insert a needle into the cyst and withdraw the fluid in a relatively painless and quick procedure. This procedure, called fine-needle aspiration, is sometimes done with ultrasound. This lets the physician see that the membrane has completely collapsed and all the fluid is removed.

  • Complicated cysts

A complicated cyst usually just means that there is some buildup of harmless debris within the fluid.

Complicated cysts are considered benign, and usually don’t require fine needle aspiration unless there is inflammation, infection, or they are causing significant discomfort.

  • Complex cysts

Complex cysts have thicker walls than either simple or complicated cysts and there is solid tissue within the fluid. The fluid may be bloody.

Because fine needle aspiration will only remove fluid, a complex cyst should be evaluated in a procedure called a core needle biopsy. A core needle biopsy is done under ultrasound guidance. A hollow needle is inserted into the solid tissue and 3-4 samples are removed. At the same time, a small metal marker is placed at the biopsy site. This makes it easier to find the area again during follow-up exams or surgery, if necessary.

simple cysts complicated cysts complex cysts biopsy tissue samples breast cysts halza digital health

The tissue samples are sent to a pathologist for evaluation. Further treatment, if any, will depend on the results of the pathology report. If the pathology report and the ultrasound or other imaging studies are inconsistent, the physician might recommend surgical removal of the cyst.

What Is A BI-RADS Category?

If you live in a higher income country you might have seen a BI-RADS category on your mammogram, breast ultrasound, or breast MRI report. BI-RADS (Breast Imaging and Reporting System) is a standardized way to describe the recommended follow-up after a mammogram or ultrasound.

Simple cysts and the most complicated cysts are BI-RADS category 2: Benign. No follow up is needed and the patient continues their routine mammography screening schedule.

Some complicated cysts are BI-RADS category 3: Probably benign, with a 2% or less chance of malignancy. Follow up imaging is recommended in six months to see if/how the cyst has changed. Some women prefer to have a biopsy sooner rather than wait six months for repeat imaging.

Complex cysts are BI-RADS category 4: Suspicious, or BI-RADS category 5: Highly suggestive of malignancy. A biopsy is recommended as the next step.

How Can I Reduce the Symptoms of Fibrocystic Breast Changes?

Unfortunately, again, there is not yet a good answer. Suggestions include:

reduce symptoms of fibrocystic breast changes wear a supportive bra apply hot cold compress halza digital health

  • Wearing a supportive bra.
  • Applying hot or cold compresses around your breasts.
  • Minimizing ing salt intake.
  • Taking ibuprofen or acetaminophen (paracetamol) as needed.
  • Following a healthy diet and get enough sleep and exercise (do be sure to wear that supportive bra).
  • Minimizing alcohol and caffeine intake. No one knows why this helps, but many women find that it does.
  • Asking your doctor before taking any supplements you might see recommended on the internet.

hormonal treatment to reduce symptoms of fibrocystic breast changes halza digital health

For severe cases only, hormonal treatment can be tried.

How Can Something So Normal Be So Annoying?

We hear you.

Cystic breasts can affect every aspect of your day. Your breasts hurt sometimes, or much of the time. You’d appreciate some empathy at work, but the topic is off-limits.

You keep looking – unsuccessfully – for a supportive bra that’s also attractive. You hesitate over a cup of coffee no matter how little sleep you got the night before. You may have gotten too little sleep because your breasts were too swollen to lie on. Your partner may have gotten plenty of sleep because you didn’t want him or her touching your breasts.

But when you find a lump in your breast and visit the doctor, the best news is “It’s just a simple cyst”.

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Sources: Cancer.orgCDCMedscapeIAMEScience DirectUpToDate

Jill Garner
Jill GarnerRegistered Nurse and Diabetes Educator

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