Breast cancer is currently common due to a more Westernized lifestyle, such as eating more fatty foods or exercising less. However, the exact cause is still unknown, making it impossible to prevent breast cancer. Early diagnosis or detection is therefore very important because it leads to the best treatment outcomes. That is why annual physical examinations often include breast examinations!
History Taking… to Identify Risk Factors for Breast Cancer
- Menstruation starting before the age of 12
- Having the first child after the age of 35 or having no children
- Breastfeeding for less than 3 months or not breastfeeding at all
- Using contraceptive pills for more than 5 years
- Menopause occurring after the age of 50
- Having a direct relative with breast cancer
Breast Examination.. to Check for Abnormalities
Besides palpating the breast, the doctor will review breast images. For people under 35 years old, only ultrasound is used, while for those over 35, ultrasound is combined with mammography. After the examination, the patient will be informed about the findings, the percentage chance of cancer, and the next steps.
Usually, lumps that can be felt by hand are larger than 1 centimeter, but ultrasound can detect smaller lumps. The most common finding during annual breast examinations is breast cysts.
Understanding the Term “Breast Cyst”
Breast cysts occur because a woman’s body prepares to breastfeed every month according to the menstrual cycle. Female hormones cause the milk sacs to expand and produce a small amount of milk inside. If fertilization and pregnancy do not occur, hormone levels drop during menstruation, causing these milk sacs to shrink. However, some sacs may remain swollen, which appear as cysts on ultrasound.
Medically, if a cyst seen on ultrasound has smooth edges and contains only fluid without solid parts, we can assure the patient that the chance of cancer is 0%. If the cyst is large enough to be felt, a small needle is used to aspirate the fluid. If the fluid is clear, yellow, or green without blood, and the cyst collapses after aspiration, this further confirms it is not cancerous! Therefore, surgery is not needed because cysts can recur, and removing all cysts surgically would leave scars all over the breast.
Some may wonder why neighbors or relatives had to have breast cyst surgery. This can be explained by the fact that older ultrasound and mammogram machines were less precise in distinguishing between simple cysts and cysts with solid components. Also, there was less research on the cancer risk of cysts, leading to more surgeries. Nowadays, it is a global standard that cysts not suspected of being cancerous do not require surgery.
Symptoms When a Cyst Occurs
A cyst is like a balloon; when fluid increases, the tension increases, causing pain, usually when hormone levels are high before menstruation. The problem can be relieved by taking painkillers.
What to Do… When a Breast Cyst is Found?
When a cyst enlarges to about 1-2 centimeters and can be felt, the problem is solved by aspirating the fluid with a small needle, causing the cyst to collapse and disappear. Sometimes it may recur, and aspiration can be repeated multiple times. Nowadays, if a patient comes for a lump check or a routine check-up at the hospital and a cyst is found, we can assure the patient that the chance of cancer is 0%, and we will follow up as follows:
- If a cyst is aspirated and collapses completely, the doctor will schedule a follow-up physical exam in 2 months.
- If the examination is normal, the next appointment will be yearly.
- If there is a small cyst that cannot be felt, the patient will be scheduled for an annual ultrasound, or if over 35 years old, ultrasound combined with mammography. Surgery is not needed, and there is no medication that can shrink cysts. However, as age increases and hormone levels decrease, cysts may shrink naturally. Exercise and reducing fatty foods can help balance hormones, leading to smaller cysts. Thus, we can peacefully coexist with breast cysts.
