Breast Cysts

A breast cyst is a just 'bag' containing fluid. Breast cysts are most common in women aged 40-50 years and seem to be related to the sex hormone oestrogen. They are found in both breasts in one third of cases. Approximately 7% of all women develop a breast cyst at some time during their life.
Any woman who discovers a lump in her breast should visit her family doctor immediately. He/she will arrange a referral to a local breast specialist. The specialist will perform the usual tests to make a diagnosis - physical examination of the breast and an ultrasound scan and/or a mammogram. Investigations will often reveal the presence of multiple cysts in both breasts. If a solid (non-cystic) lump is detected, it should be appropriately investigated.

What Happens if I Have a Breast Cyst?

Small cysts do not usually require treatment. Cysts that are large or painful can easily be treated using a needle and syringe to remove the cyst fluid. Any lump that remains after this should be investigated with biopsy and mammography. The fluid obtained from the cyst is usually discarded, unless it is blood-stained or there is a residual lump. Blood-stained fluid can sometimes be associated with breast cancer, especially if there is a residual lump. In such cases it will be sent for further tests.

Breast Nodularity

Nodularity refers to the presence of multiple, small lumps in the breast. It can occur in one area of the breast (localised) or throughout the breast (generalised). Nodularity is one of the most frequent reasons for referring a woman to the breast clinic. In fact, pre-menstrual nodularity is normal.

Generalised Nodularity (Lumpiness)

Women with generalised nodularity are examined by the breast specialist who usually arranges a mammogram if the woman is over 35 years old. If no discrete lump is detected and the mammogram does not reveal any suspicious abnormalities, the patient can be reassured and discharged. The condition is entirely harmless and has no relationship to breast cancer.

Localised Nodularity

It can be very difficult to distinguish localised nodularity from a discrete breast lump. So in such cases, an ultrasound examination is often required to exclude a discrete lump. If no discrete lump is found by ultrasound scan or if the mammogram (for women over 35 years) does not reveal any significant abnormalities, the patient can be reassured and discharged. Any discrete lumps detected should be investigated and treated appropriately.
Localised nodularity may be related to hormones and it usually becomes less prominent with age or upon stopping HRT.

Mastalgia

Mastalgia literally means 'pain in the region of the breast'. True breast pain can either be cyclical (getting worse before menstruation) or non-cyclical (unrelated to menstruation). It is important to point out that breast cancer does not usually cause mastalgia.

Cyclical Mastalgia

This type of breast pain typically occurs in young women (under 40 years old) in the days preceding each menstrual period. Women often report that the breasts feel heavy, they may increase in size and become generally uncomfortable. The cause of cyclical mastalgia is thought to be hormonal in nature and is related to abnormal fat levels in the blood. Women suffering from the condition are advised to use a pain chart (Figure 11) to assess the duration and severity of the pain to help the doctor make the appropriate treatment decisions.

The doctor will usually perform a physical examination and inspect the pain chart. If no breast lump is found, the patient is reassured immediately. Such reassurance is sufficient to alleviate anxiety in the majority of cases. Women who suffer from pain lasting longer than seven days each month can be treated.

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