breast cysts

I am 59 yrs old, at least 10 years past menopause and have never been on HRT. I was recently diagnosed with multiple breast cysts. I underwent about a dozen mammograms and ultrasound at a routine check-up last month where I was told that the ultrasound revealed cysts and not to worry about them. I decided to seek a 2nd opinion and was referred to a surgeon who specializes in breast surgery. He identified one of the cysts as being complex. It is 8mm in size and he said it was too small for a needle biopsy and to return in 4 months for another exam. He did not mention FNA (fine needle aspiration). My question is- should this cyst have been aspirated as a routine precaution given the fact of my age and history which includes a mother and a younger sister who have both had breast cancer? I have read (since my visit with the surgeon) that if the woman is postmenopausal and never on HRT the fluid from the cyst should always be analysed. My most recent previous mammogram was 4 yrs ago and I was never told about anything abnormal before now. Also, do you know of a source for information on the percentage of similar cases which develop into cancer?

[CCF-RN,MSN-rf]

Dear mhfkc:  Although cysts are most common before menopause, they can occur anytime.  Typically an ultrasound is very good at differentiating a cyst from a solid mass.  However, if one is to be certain, a cyst can be aspirated (although these are typically large enough to feel).  This may be what the surgeon meant by too small for needle biopsy which is a fine needle aspiration.  If there is concern that this is NOT a cyst (and your family history could be considered here), then it can be biopsied as any other radiographically visualized lump is.  This may involve surgery, though, and it is typically overkill for a cyst.  Only about one percent of cysts contain any cancer and this is usually contained within the cyst.  If the doctors are certain that this is a cyst, watching it may be the best approach.  If there is doubt, then maybe a third opinion is warranted.  Regarding analyzing fluid, it is not usually done unless the fluid is bloody.  Cystic fluid contains old dead cells and can be misleading as a diagnostic tool.

[D670]

A related discussion, cyst lump versus cancer lump was started.