Cysts

QUESTION: I am a 45-year-old woman with multiple small and large cysts in my breasts. I have had several drained. I have recently seen on the Internet that the appearance of palpable cysts does increase the risk of breast cancer. Do you know anything about this? The doctors had always told me that this would not increase my risk. I am worried that my yearly mammogram will not be able to be read properly because a cyst may be hiding a cancer. Is there anything new on helping to get rid of these cysts? My doctor does not want to drain all of them because there are so many. How do I know if a lump that I find is just a cyst or something else? I can't afford to go to the doctor every month but it scares me too much to wait.

ANSWER: There is no increased breast cancer risk with cysts alone. When breast tissue gets overactive and makes a lot of extra cells that start to look a bit unusual, breast cancer risk is somewhat increased. These type of cellular changes can also be present in a woman who tends to make lots of cysts, or they may occur in the absence of any cysts. It's true that cysts can make it hard to examine yourself, since it's hard to feel around and behind them.

For women with multiple cysts, routine mammographic screening is recommended. Ultrasound is added to the work-up if the mammogram is changing (mass increasing in size) to make sure that the mass is a cyst, or if the woman complains of a new mass (again to ensure that it is a cyst). Ultrasound is the best way to see if something is a cyst or something solid. For a woman who has cysts, she should not assume that if she feels a new mass, it is a cyst. She should either see a doctor who can examine her and/or aspirate the cyst or have an ultrasound study to make sure that the mass is just a cyst.

Although there is no proven role for MRI in screening patients with cysts at the present time, I think in the future MRI may be very helpful in the evaluation of women like you, where the mammogram and physical exam are difficult.

—Susan Greenstein Orel, M.D.