Cyst Follow-up Recommendations

I'm 42, BF total 3 yrs, mother had DES - exposed invitro.  Have a 4 generation maternal family hist of breast and uterine cancer.  MGM diagnosed 1st at 60; 2nd at 74; recurred at 80 + liver, lung and brain stem.  MA diagnosed at 44.  Nearing 5 year clear mark.  Mother clear thus far.

I've had biannual mamos since my 30s, annual since 40, have dense breasts with occasional cycts.  Found a lump in February.  New mamo in May showed pronounced cyst development (3 new; 1 is well over 1 cm).  Ultrasound last month confirmed cyst, not tumor.  Recommended re-screen in 6 months.  Given my family history, should I push for biopsy?  The radiologist seemed very surprised to see a large cyst appear in such a short period of time (there was no evidence of it last year).  And given the recent reports linking some cysts to future cancerous activity, should I have them removed?

My doctor is quite sensitive to my history and would be willing to proceed if I asked.

Also, I saw another doctor when mine was on holiday who actually suggested I go on birth control to try and alleviate my propensity for cysts.  I was dumbfounded.  I mentioned family history, that my Aunt and Grandmother have been treated at NIH and my Mother and I were brought in as part of a family tracking program.  The doctors were firm during our meeting that I not use the Pill and that my mother halt HRT.  He said there is no proven link to BC and the Pill or HRT.  Is he for real? This is contrary to everything I've been told the last 25 years.

[CCF-RN,MSN-JS]

Dear lfalcon:  In general, cysts are benign. Often, women who develop cysts will develop multiple cysts. As long as everyone is sure they are cysts and they are not causing pain or discomfort, there may be no need to do anything further.  When there is a cystic structure, it is common to aspirate them for two reasons: 1. To be certain they are cysts and 2. Once the fluid is removed, they usually go away.

In terms of the birth control pill issue, one of the most recent studies published on the subject is from the Nurses' Health Study (published in 2005) that states "We've found that the pill has only a modest and temporary effect on a woman's risk of breast cancer. Women have a slightly increased risk while they're on the pill, but this subsides soon after they stop taking it. This means that overall, birth control pills exert their largest influence during the premenopausal years but have little or no effect later on.  You might find the following article interesting on the subject (below).  You may benefit from a discussion with a breast specialist who can make recommendations as they pertain specifically to you.

+U.N. research agency puts hormones on cancer-causing list
Saturday, July 30, 2005
Emma RossAssociated Press
London - The U.N.'s cancer research agency added hormone pills Friday to the list of substances that can cause cancer.
The International Agency for Research on Cancer said that based on consistent evidence from studies in recent years, it was reclassifying hormonal menopause therapy from "possibly carcinogenic" to "carcinogenic."
The declaration from the World Health Organization's cancer agency, which is widely regarded as the international authority on cancer-causing agents, comes after several recent high- profile studies linking combination hormone replacement therapy, or HRT, to breast cancer.
The analysis, conducted by a panel of 21 scientists, concluded that estrogen and progestin therapy for menopause also slightly increases the risk of endometrial cancer when progestin is taken fewer than 10 days a month.
Research has indicated that the chance of a woman developing breast cancer during her lifetime is about 1 in 7. A landmark study used in the U.N. agency's analysis suggested that long- term use of hormones raises the lifetime risk to about 1 in 6.
The cancer research agency also concluded that a common type of birth control pill, taken by about 10 percent of women of reproductive age, increases the risk of more types of cancer than previously thought.
Some doctors cautioned that that conclusion was based on studies of higher-dosage pills, and said they wouldn't change their advice to young women.
The agency had previously determined that the pill combining estrogen and progestin can cause liver cancer. Now, further research has demonstrated that it also slightly increases the risk of breast and cervical cancer, the agency said. However, the investigation also confirmed that the pill protects against endometrial and ovarian cancers.
"It's a complicated picture," said Vincent Cogliano, head of the agency's department that evaluates the cancer risk of chemicals. "There are still other reasons to take it. Each woman has to discuss it with her doctor and weigh the risks and benefits" for either the contraceptive pill or hormone replacement therapy.
The increased cancer risk from the birth control pill was small and transient, the analysis found.