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Breast disorders: cysts, fibroadenoma BREAST DISORDERS: CYSTS, FIBROADENOMA
Cysts
A lump in the breast is most likely to be a fluid-filled cyst or one of a variety of benign tumours which can be treated effectively (e.g. a duct papilloma or fibroadenoma).
Cysts are most common in women between the ages of 40 and 50, particularly in those who have not had children. Although the majority of cysts are solitary, some women may have between two and five in one or both breasts.
It is thought that cysts form as an aberration of the normal process of shrinking of the breast which occurs as women get older. Their development appears to be hormone related - possibly associated with the balance between different hormones. Cysts are commonly part of fibroadenosis.
Symptoms
Cysts normally become apparent as smooth lumps in the breast which may be painful. They are usually quite hard, but can be squeezed between the fingertips. A painless cyst may only be discovered during routine screening by mammography.
Diagnosis and treatment
When a cyst is suspected, and ideally its presence has been confirmed by an ultrasound scan, a needle aspiration may be undertaken. The fluid is withdrawn through a needle -the cyst often collapsing like a pricked balloon - and is sent for examination. The remains of the cyst will need to be examined again after about 3 weeks.
Rarely, cancers can form as cysts, and for this reason any aspirated bloodstained fluid needs to be examined under a microscope, and a biopsy may be necessary. Non-cancerous cysts rarely yield bloody fluid.
Cysts are easily identified by ultrasound or a mammogram, and these investigations may be done when a cyst is suspected in a woman over the age of 35. If a cyst is revealed which cannot be felt, a guided needle aspiration may be undertaken.
Although cysts will sometimes refill with fluid after aspiration, further treatment is not normally required. However, surgical removal of a cyst which refills after two or more aspirations is probably advisable as a cyst of this type may be associated with breast cancer. For the same reason, cysts in post-menopausal women (which are uncommon) may need to be surgically removed. There is, however, little evidence to suggest that other types of cyst are linked with breast cancer.
For women with multiple cysts, although drug treatment will not affect those already present, it may help to prevent more developing.
Fibroadenoma
This is the most common type of solid benign breast lump, and is usually found in women between the ages of 15 and 25, although it can occur at any age. A fibroadenoma is a fibrous lump of glandular tissue surrounded by a capsule which can grow to as much as 3 to 4 cm (1 to 1.5 inches) across. Fibroadenomas which develop deep within the breast tissue may remain undetected.
Although fibroadenomas are uncommon after the menopause, they do occur in women in this age group. It may be that as the breast tissue is replaced by fat, a previously hidden lump is revealed. Some post-menopausal women choose to have a fibroadenoma removed to be absolutely sure of its innocence.
Symptoms
A fibroadenoma may appear as a firm, often hard, painless lump. It is likely to be very mobile, and will slip easily out of the fingers when held - hence the name 'breast mouse'. In younger women the tumours rarely grow very large.
Diagnosis and treatment
The results of fine needle aspiration, mammography or ultrasonography may have to be confirmed by excision biopsy. Surgical removal of fibroadenomas is not usually necessary for medical reasons in younger women, but they can be the cause of some anxiety and many women, both young and old, prefer to have them removed. However, very occasionally, a cancer can mimic a fibroadenoma, and for this reason it is probably advisable to remove any persistent lump of this type in older women, particularly if any doubt remains.
Fibroadenomas rarely recur once excised, although others can sometimes form elsewhere in the breast.
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