Many women feel an unusual lump in their breast at some point during their lives; thankfully, only a tiny percentage of those lumps are cancer. A common source of breast lumps is the breast cyst, a benign yet annoying condition experienced by about 1 in 3 pre-menopausal women. What are cysts? If you feel a breast lump, can you tell if it’s a cyst? And what should you do about a cyst in your breast?
Q. I was in the shower this morning, and felt a lump in my breast. I check my breasts most days while showering, and I know this lump wasn’t there yesterday. Can breast cancer appear that quickly?
A. No, breast cancer can’t grow overnight. It’s possible, if a woman is unfamiliar with the usual shape and feel of her breasts, that she may notice a lump that seems to have “just appeared,” and that the lump turns out to be cancer. But most lumps that actually do crop up overnight are cysts.
Q. What’s a cyst? Is it dangerous?
A. A cyst is like an internal blister: a fluid-filled sac. There’s no known cause for cysts, though they’re quite common in younger women; and this leads some researchers to believe that their formation is tied to hormones, particularly estrogen.
A cyst forms when connective tissue and glands in the breast grow too quickly, for some reason; again, this may be hormonal. This overgrowth of tissue can block a milk duct in the breast, causing it to fill with fluid; this fluid-filled duct is called a cyst.
Cysts can be tiny, and disappear on their own; or they may grow as large as a golf ball, become painful, and need to be drained. But cysts aren’t considered dangerous; they don’t signal cancer, nor will a cyst turn into a cancerous tumor.
Q. Can I tell by feeling the lump if it’s a cyst?
A. You can make an educated guess, but only testing can determine for sure whether the lump you feel is a cyst.
Cysts generally feel squishy to the touch (think water balloon), and moveable, rather than firmly fixed in place. Most cysts feel like a smooth round or oval; though at times they may feel irregularly shaped.
Even if the lump you feel seems hard or firm, however, don’t panic; cysts that form deep within the breast can push the tissue around them out of shape, making normal breast tissue feel like a lump.
Another indication that the lump may be a cyst is pain. Cancerous breast lumps are seldom painful; cysts often are. If you don’t see a doctor right away, and notice during the next several weeks that the lump becomes painful at times (particularly in the days before your period), this is another indication that it’s a cyst, not cancer.
Q. So, what’s the next step?
A. It’s perfectly reasonable to wait a few weeks and see if the lump disappears. If it does, then it was most likely something connected with your menstrual cycle; breast cancer doesn’t come and go in synch with your period.
If the lump doesn’t disappear, then you’ll want to see your doctor.
Q. What will the doctor do?
A. The usual first step for any breast lump is a mammogram. However, if the doctor examines the lump and feels there’s a good chance it could be a cyst, s/he may skip the mammogram and perform a fine-needle aspiration: a procedure that draws fluid out of the lump.
This sounds painful; but surprisingly, for most women it’s not. Your skin will be anesthetized, a needle inserted into the lump, and an attempt made to withdraw fluid. If fluid is withdrawn and the lump disappears, your doctor can assume the lump was a cyst, and there’s no need for further tests.
An exception would be if the fluid is bloody; or if the lump doesn’t entirely disappear. In that case, the doctor may want to send some of the fluid to the lab for testing, to see if any cancer cells are present.
Some doctors aren’t ready to do an immediate fine needle aspiration, and will choose to send you for an ultrasound, instead. An ultrasound is an excellent tool for identifying cysts. It’s a painless test that clearly shows whether a mass in your breast is solid, or filled with fluid. If it’s fluid-filled, it’s a cyst. If it’s solid, you’ll need further diagnostic testing – and perhaps a biopsy – to determine just what the lump is.
If the ultrasound shows a fluid-filled mass, then the doctor may or may not drain it; this would depend on how large it is, whether it’s painful, and whether there’s any question about the potential of cancer somewhere within the cyst.
Your doctor will make the call about whether to perform an aspiration; though if the cyst bothers you, speak up – the doctor will probably be willing to drain it if that’s what you want.
Q. I’ve been feeling the lump, and it does feel squishy, plus I can move it around under my fingers. Assuming this is a cyst, what will the doctor do about it?
A. Nothing, unless it’s painful and needs to be drained. Most women, if they have a cyst, find it’s a one-time occurrence. The cyst may persist for quite awhile, but will gradually disappear on its own.
Some women have multiple/recurring cysts; they’re irritating, but not dangerous. In rare cases, cysts may be removed surgically; but this is only if a cyst is painful, and keeps coming back; or if there’s some question about it possibly being cancer.
Q. Can I do anything to prevent future cysts?
A. There’s no proven strategy for preventing cysts, but anecdotal evidence suggests that eliminating caffeine from your diet, and reducing your sodium (salt) consumption, may both be helpful. Since cysts seem to be influenced by hormones, regulating your period via oral contraceptives is also an option.
The best way to prevent cysts is simply to grow older. Few postmenopausal women, unless they’re taking hormone replacement therapy, are bothered by cysts. So the older you get, the less you have to worry about cysts… see, getting old can be a GOOD thing!