Dear Alice,

My doctor found a lump in my breast recently. She told me not to worry, but have it checked out soon, by another doctor. She said that it did not feel cancerous, but may be a cyst or fibroadenoma. Can you tell me about what these are exactly, and does this mean a greater chance for breast cancer later in life? What should I expect? Thanks for your help.

— Concerned

Dear Concerned, 

Finding a breast lump can certainly be a worrisome experience but rest assured that not all lumps are cancerous. In fact, most breast lumps are benign. People who menstruate undergo a variety of hormonal changes over the course of their menstrual cycle, which can lead lumps such as cysts and fibroadenomas (more on those in a bit). In the process of diagnosing the cyst or fibroadenoma, your health care provider will likely work to rule out cancer as the cause. It’s good to know that there isn’t much evidence to show a correlation between cysts and breast cancer, whereas specific types of fibroadeneomas have been associated with a slight increase in risk. Other factors that may increase the risk of breast cancer include age, reproductive history, inherited genetic mutations, previous radiation treatment, lack of physical activity, certain types of hormone therapy, and reproductive history. That being said, your health care provider’s recommendation to obtain a second opinion is a great idea because lumps and bumps can be erroneously diagnosed as harmless. 

One of the most common types of lumps that can be found in the breast is a benign cyst.  These cysts are fluid-filled sacs that may be described as smooth and easily movable. It’s thought that cysts are a result of hormonal changes, particularly the excess estrogen, that occur throughout the menstrual cycle. If an individual assigned female at birth examines their breasts during various phases of the menstrual cycle, they may find a series of cysts in one or both breasts — especially in the areas near the underarms. Benign cysts are often accompanied by other symptoms such as clear, yellow, or brown nipple discharge, breast pain or tenderness, and change in size based on the menstrual cycle. These cysts are most common among individuals who are close to menopause or those who are postmenopausal and undergoing hormone therapy. 

To diagnose a cyst, a health care provider will use an ultrasound to determine the characteristics of the lump. If it’s fluid-filled, a fine-needle aspiration can be used to check for blood in the lump. If there’s no blood, then it may not require additional testing or treatment. However, if there is blood in the fluid, they may order additional tests. While these cysts will likely go away on their own, there may be situations where it sticks around. If that’s the case, you can talk with your provider about using a fine-needle aspiration to drain the fluid, using oral contraceptives to regulate your menstrual cycles, or undergoing surgery to remove the cysts.   

Another common source of breast lumps is fibroadenomas. While cysts are usually fluid-filled, fibroadenomas are solid and often are rubbery or hard and have a clearly defined shape. These lumps can also be easily moved and are usually painless. Fibroadenomas are most common in individuals who are in their reproductive years, and they could grow bigger during pregnancy or during hormone therapy. Your health care provider may use a mammogram or breast ultrasound to diagnose the fibroadenoma. As far as treatment goes, surgery is an option if it’s abnormal, becomes very large, or leads to other symptoms. In these cases, they may choose to remove the breast tissue and send it for additional testing or use cryoablation, which destroys the tissue by freezing it.   

Even if a cyst or fibroadenoma is treated, it’s possible for additional lumps to form. Scientific consensus indicates that benign fibroadenomas and breast cysts aren’t associated with an increased risk of developing breast cancer. However, it’s good to keep up with regular check-ups to ensure any new lumps that form aren’t cancerous. To effectively monitor any changes in your breasts, the American Cancer Society (ACS) recommends that a breast self-examination (BSE) be done at the same time every month, preferably one week after your period ends when your breasts aren’t swollen or tender. For instructions on how to perform a BSE, check out the ACS website. Additionally, the United States Preventive Services Task Force (USPSTF) recommends that individuals assigned female at birth get mammograms every other year starting at age 50 to monitor their breast cancer risk. Those who are under the age 50 are encouraged to talk with their health care provider about weighing the risks and benefits of starting mammograms earlier. 

Concerned, it’s great that you’re being proactive about your breast health. Here’s hoping this information will put your breast concerns at ease! 

Alice!

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