Cysts

[dlucas]

I am 40 years old and went for my first mammogram last month.  I was called back for a second mammogram and ultra sound because I have dense breasts.  I noticed the technician stop and measure spots.  She said they were cysts.  I have 3 on my right breast and 8 (!) on my left.  The doctor reviewed my ultra sound and said they were cysts and for me to come back in 6 months for another ultra sound.  He said it would be up to my regular Dr. to decide whether or not to aspirate the cysts.  My Dr. told me not to worry - the cyst were fluid filled and I didn't need to do anything at this point.  
Needless to say, I am very worried.  I know women who took their Dr's advice to do nothing and 6 months later - found out they should have received a second opinion.  I do not have a history of breast cancer in my family.  What does it mean to have dense breasts?  I have heard that women with dense breast should never take hormone treatments.  Also, should I listen to my Dr. and do nothing until my 6 month follow-up ultra sound?  
Thanks.

[CCF-RN,MSN-JS]

Dear dlucas, As women age the ratio of tissue in their breasts changes to more fat tissue.  Breast tissue is more dense than fat tissue, so on a mammogram this dense tissue shows up differently.  The more dense the overall tissue is it makes reading the mammogram for abnormalities a little more difficult.  Women have varying degrees of denseness, and the rate of change in ratio of breast tissue to fat varies among individuals.  If women are on hormone replacement therapy their tissue may remain as dense as it was, or it may become more dense.  You have features to your breast exam (the cysts and that make following you more challenging, you may want to have a physician who specializes in breast problems give a second opinion, and evaluate.

[ritavv]

Fifteen years ago I was like you... I had many cysts each year.  Every time I had a mammogram I also had an ultrasound.  They only aspirated large ones that were uncomfortable for me or that thought needed it.  I went for years this way and in fact I got quite blase' about it.  Then nearly 3 years ago the ultrasound showed a mass that was irregularly shaped and they were fairly confident that it wasn't a cyst.  I had stage 1 cancer.  In one sense, my numerous cysts kept me and the radiologists more vigilant and therefore it was caught early.  So don't panic that you have cysts... it just makes it more difficult for you to identify a new lump with a monthly BSE.

[Liz S]

Same story for me as Rita's - very dense breasts with many aspirations over the years (I'm 46) mostly for comfort.  If you would feel more comfortable having the cysts aspirated now rather than waiting 6 months then ask for it.  In my experience aspiration is a simple, almost pain free procedure and it's very comforting to watch the cysts disappear on the ultra sound.

You might want to ask the radiologist to quantify how dense your breasts are - I went for years without asking that question and in the last year learned there are several measurements (a 1-4 scale or a % scale) - when I asked I was told I had "very" dense (75%+) breasts - that caused me to look into other diagnostic screening tools as mammograms and ultra sounds have a hard time with pre menopausal, very dense breasts.  Long story short, last May, after a clear mammogram and ultra sound, I asked for an MRI (they are having good results using MRIs for screening for very dense breasts) - the results showed I had a 1.5 cm lesion that the mammogram and ultra sound missed.  I had a lumpectomy in July with negative nodes and am almost finished 4 cycles of chemo - a very good diagnosis (if that makes sense!).  

I hope I'm not alarming you - my intent is quite the opposite - I think the important thing if you have dense breasts is to stay on top of the screening as (as I understand it) you don't have a higher propensity for breast cancer, but a higher risk of missing an early diagnosis.

Hope this helps.