Cervical Cancer - Causes and Preventive Measures

Causes

In recent years, scientists have made much progress toward understanding what happens in cells of the cervix when cancer develops. In addition, they have identified several risk factors that increase the odds that a woman might develop cervical cancer.

The development of normal human cells mostly depends on the information contained in the cells’ chromosomes. Chromosomes are large molecules of DNA. DNA is the chemical that carries the instructions for nearly everything our cells do. We usually resemble our parents because they are the source of our DNA. However, DNA affects more than our outward appearance.

Some genes (packets of our DNA) have instructions for controlling when our cells grow and divide. Certain genes that promote cell division are called oncogenes. Others that slow down cell division or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA mutations (gene defects) that turn on oncogenes or turn off tumor suppressor genes. Scientists now think that HPV causes the production of 2 proteins known as E6 and E7. When these proteins are produced, they turn off some tumor suppressor genes. This may allow the cervical lining cells to grow uncontrollably, which in some cases will lead to cancer.

But HPV does not completely explain what causes cervical cancer. Most women with HPV don’t get cervical cancer, and certain other risk factors, like smoking and HIV infection, influence which women exposed to HPV are more likely to develop cervical cancer

Prevention

Since the most common form of cervical cancer starts with pre-cancerous changes, there are 2 ways to stop this disease from developing. The first way is to prevent the pre-cancers, and the second is to find and treat pre-cancers before they become cancerous.

Things to do to prevent pre-cancers

Avoid being exposed to HPV:You can prevent most pre-cancers of the cervix by avoiding exposure to HPV. Certain types of sexual behavior increase a woman's risk of getting HPV infection, such as:

having sex at an early age
having many sexual partners
having a partner who has had many sex partners
having sex with uncircumcised males

Delay sex: Waiting to have sex until you are older can help you avoid HPV. It also helps to limit your number of sexual partners and to avoid having sex with someone who has had many other sexual partners. Remember that someone can have HPV for years yet have no symptoms - it does not always cause warts or any other symptoms. Someone can have the virus and pass it on without knowing it.

Use condoms: Condoms provide some protection against HPV. One study found that when condoms are used correctly they can lower the HPV infection rate by about 70% - if they are used every time sex occurs. Condoms cannot protect completely because they don't cover every possible HPV-infected area of the body, such as skin of the genital or anal area. Still, condoms provide some protection against HPV, and they also protect against HIV and some other sexually transmitted diseases.

Don’t smoke: Not smoking is another important way to reduce the risk of cervical precancer and cancer.

Get vaccinated: Vaccines have been developed that can protect women from HPV infections. So far, a vaccine that protects against HPV types 6, 11, 16 and 18 (Gardasil®) and one that protects against types 16 and 18 (Cervarix®) have been studied.

Gardasil® has been approved for use in this country by the FDA. It requires a series of 3 injections over a 6-month period. The second injection is given 2 months after the first one, and the third is given 4 months after the second. Side effects are said to be mild. The most common one is short-term redness, swelling, and soreness at the injection site. In clinical trials, Gardasil prevented genital warts caused by HPV types 6 and 11 and prevented pre-cancers and cancers of the cervix caused by HPV types 16 and 18. This vaccine only works to prevent HPV infection -- it will not treat an infection that is already there.

To be most effective, the HPV vaccine should be given before a person starts having sex. The Federal Advisory Committee on Immunization Practices (ACIP) has recommended that the vaccine be given routinely to females aged 11 to 12. It can be given to younger females (as young as age 9) at the discretion of doctors. ACIP also recommended women ages 13 to 26 who have not yet been vaccinated get "catch-up" vaccinations.

The American Cancer Society also recommends that the vaccine be routinely given to females aged 11 to 12 and as early as age 9 years at the discretion of doctors. The Society also agrees that “catch-up” vaccinations should be given to females aged 13 to 18. The independent panel making the Society recommendations found that there was not enough proof of benefit to recommend catch-up vaccination for every woman aged 19 to 26 years. As a result, the American Cancer Society recommends that women aged 19 to 26 talk with their health care provider about the risk of previous HPV exposure and potential benefit from vaccination before deciding to get vaccinated. Research is now being done on using Gardasil in older women and in males. The American Cancer Society guideline focuses on Gardasil at this time. As new information on Cervarix®, Gardasil®, and other new products becomes available, these guidelines will be updated.

Gardasil is expensive - the vaccine series costs around $360 (not including any doctor’s fee or the cost of giving the injections). It should be covered by most medical insurance plans (if given according to ACIP guidelines). It should also be covered by government programs that pay for vaccinations in children under 18. Because this vaccine costs so much, you may want to check your coverage with your insurance company first.

It is important to realize that the vaccine doesn’t protect against all cancer-causing types of HPV, so routine Pap tests are still necessary. One other benefit of the vaccine is that it protects against the 2 viruses that cause 90% of genital warts.

You Might Also Like:

Cervical Cancer - Risk Factor

A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But having a risk factor, or even several, does not mean that you will get the disease.

Several risk factors increase your chance of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease. When a woman develops cervical cancer or pre-cancerous changes, it may not be possible to say with certainty that a particular risk factor was the cause.

In thinking about risk factors, it helps to focus on those that you can change or avoid (like smoking or human papilloma virus infection), rather than those that you cannot (such as your age and family history). However, it is still important to know about risk factors that cannot be changed, because it's even more important for women who have these factors to get regular Pap tests to detect cervical cancer early.

Cervical cancer risk factors include:


Human papilloma virus infection: The most important risk factor for cervical cancer is infection by the human papilloma virus (HPV). HPV is a group of more than 100 related viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma. Papillomas are not cancers, and are more commonly called warts. HPV is passed from one person to another during skin-to-skin contact. HPV can be spread during sex - including vaginal intercourse, anal intercourse, and even during oral sex.

Doctors believe that women must have been infected by HPV before they develop cervical cancer. Certain types of HPV are called "high-risk" types because they are often the cause of cancer of the cervix. These types include HPV 16, HPV 18, HPV 31, HPV 33, and HPV 45, as well as some others. About two-thirds of all cervical cancers are caused by HPV 16 and 18.

Different types of HPVs cause warts on different parts of the body. Some types cause common warts on the hands and feet. Other types tend to cause warts on the lips or tongue.

Still other types of HPV may cause warts on or around the female and male genital organs and in the anal area. These warts may barely be visible or they may be several inches across. The medical term for genital warts is condyloma acuminatum. Two types of HPV, HPV 6 and HPV 11, cause most cases of genital warts. These two types are seldom linked to cervical cancer, and so are called "low-risk" types of HPV. Other sexually transmitted HPVs have been linked with genital or anal cancers in both men and women.

Many women become infected with HPV, but very few will ever develop cervical cancer. In most cases the body's immune system fights off the virus, and the infection goes away without any treatment. For reasons that we don't understand, the infection persists in some women and can cause cervical cancer. Although there is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes.

The Pap test looks for changes in cervical cells caused by HPV infection. Newer tests look for HPV infections by finding genes (DNA) from HPV in the cells. Some doctors use the test for HPV to help decide what to do when a woman has a mildly abnormal Pap test result. If the test finds a high-risk type of HPV, it may mean she will need a full evaluation with a colposcopy procedure.

HPV infections occur mainly in young women and are less common in women over 30. The reason for this is not clear. Uncircumcised men are thought to be more likely to have the virus and be able to pass it on to someone else. HPV infection can be present for years without any symptoms. Even when someone doesn't have visible warts (or any other symptom), he (or she) can still be infected with HPV and pass the virus to somebody else.

Condoms ("rubbers") do provide some protection against HPV, but they cannot completely protect against infection. This is because HPV can still be passed from one person to another by skin-to-skin contact with an HPV-infected area of the body that is not covered by a condom - like the skin in the genital or anal area. Still, it is important to use condoms to protect against AIDS and other sexually transmitted illnesses that are passed on through some body fluids.

Vaccines have been developed to help prevent infection with some types of HPV. Right now, there is an HPV vaccine that has been approved for use in the United States by the Food and Drug Administration (FDA). This vaccine is called Gardasil®, and it protects against HPV types 6, 11, 16, and 18. More HPV vaccines are being developed and tested.

Although it is necessary to have had HPV for cervical cancer to develop, most women with this virus do not develop cancer. Doctors believe that other factors must come into play for cancer to develop. Some of the known factors are listed below.

Smoking: Women who smoke are about twice as likely as non-smokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals that affect more than the lungs. These harmful substances are absorbed by the lungs and carried in the bloodstream throughout the body. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer.



Immunosuppression: Human immunodeficiency virus (HIV), the virus that causes AIDS, damages the body's immune system and seems to make women more at risk for HPV infections. This may be what increases the risk of cervical cancer in women with AIDS. Scientists believe that the immune system is important in destroying cancer cells and slowing their growth and spread. In women with HIV, a cervical precancer might develop into an invasive cancer faster than it normally would.



Chlamydia infection: Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Some studies have seen a higher risk of cervical cancer in women whose blood test results show past or current chlamydia infection (compared with women with normal test results). Infection with chlamydia often causes no symptoms in women. A woman may not know that she is infected at all unless she is tested for chlamydia when she gets her pelvic exam. Long-term chlamydia infection can cause pelvic inflammation, leading to infertility.



Diet: Women with diets low in fruits and vegetables may be at increased risk for cervical cancer. Also overweight women are more likely to develop this cancer.



Oral contraceptives (birth control pills): There is evidence that taking oral contraceptives (OCs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCs, but the risk goes back down again after the OCs are stopped. In a recent study, the risk of cervical cancer was doubled in women who took birth control pills longer than 5 years, but the risk returned to normal 10 years after they were stopped.



The American Cancer Society believes that a woman and her doctor should discuss whether the benefits of using OCs outweigh the potential risks. A woman with multiple sexual partners should use condoms to lower her risk of sexually transmitted illnesses no matter what other form of contraception she uses.



Multiple pregnancies: Women who have had many full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is true. One theory is this may be because some of the women may have been exposed more to HPV through un-protected sexual contact. Also, studies have pointed to hormonal changes during pregnancy as possibly making women more susceptible to HPV infection or cancer growth. Another thought is that the immune system of pregnant women might be weaker, allowing for HPV infection and cancer growth.



Low socioeconomic status: Poverty is also a risk factor for cervical cancer. Many women with low incomes do not have ready access to adequate health care services, including Pap tests. This means they may not get screened or treated for pre-cancerous cervical disease.



Diethylstilbestrol (DES): DES is a hormonal drug that was given to some women to prevent miscarriage between 1940 and 1971. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected. There is about 1 case of this type of cancer in every 1,000 women whose mothers took DES during pregnancy. This means that about 99.9% of "DES daughters" do not develop these cancers.
DES-related clear cell adenocarcinoma is more common in the vagina than the cervix. The risk appears to be greatest in women whose mothers took the drug during their first 16 weeks of pregnancy. The average age of women when they are diagnosed with DES-related clear-cell adenocarcinoma is 19 years. Since the use of DES during pregnancy was stopped by the FDA in 1971, even the youngest DES daughters are older than 35 - past the age of highest risk. Still, there is no age cut-off when these women are safe from DES-related cancer - doctors do not know exactly how long women will remain at risk.



DES daughters may also be at increased risk of developing pre-cancerous changes of cervical squamous cells and squamous cell cancer of the cervix. These pre-cancers and cancers seem to be linked to HPV.



Although DES daughters have an increased risk of developing clear cell carcinomas, women don’t have to be exposed to DES for clear cell carcinoma to develop. In fact, women were diagnosed with the disease before DES was developed.



Family history of cervical cancer: Cervical cancer may run in some families. If your mother or sister had cervical cancer, your chances of developing the disease are increased by 2 to 3 times. Some researchers suspect that some instances of this familial tendency are caused by an inherited condition that makes some women less able to fight off HPV infection than others. In other instances, women from the same family as a patient already diagnosed may be more likely to have one or more of the other non-genetic risk factors previously described in this section

Next

You Might Also Like:

Cervical Cancer - Detailed guide

Introduction

The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body (upper part) of the uterus, is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The place where these 2 parts meet is called the transformation zone. Most cervical cancers start in the transformation zone.

Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. There are 2 main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers are from the squamous cells that cover the surface of the exocervix. Under the microscope, this type of cancer is made up of cells that are like squamous cells. Squamous cell carcinomas most often begin where the exocervix joins the endocervix.

The remaining 10% to 20% of cervical cancers are adenocarcinomas. Adenocarcinomas are becoming more common in women born in the last 20 to 30 years. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with precancers of the cervix will develop cancer. The change from precancer to cancer usually takes several years - but it can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. Treating all pre-cancers can prevent almost all true cancers.

Pre-cancerous changes are separated into different categories based on how the cells of the cervix look under a microscope.

Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can start in the cervix. These other types, such as melanoma, sarcoma, and lymphoma, occur more commonly in other parts of the body. This document discusses the more common cervical cancer types, and will not further discuss these rare types

Next

Nipple Discharge

Nipple discharge refers to any fluid that seeps out of the nipple in a nonlactating woman. Nonmilk discharge comes out of your breasts through the same nipple openings that carry milk.

One or both breasts may produce a nipple discharge, either spontaneously or when you squeeze your nipples or breasts. A nipple discharge may look milky, or it may be yellow, green, brown or bloody. The consistency of nipple discharge varies from thick and sticky to thin and watery.

Nipple discharge is a symptom that largely affects women. However, nipple discharge in a man under any circumstances is problematic and should be investigated.

Causes

Sometimes, nipple discharge is just a normal (physiological) part of your breast's function. If that's the case, the discharge might resolve on its own.

Most often, nipple discharge stems from a noncancerous (benign) condition. However, breast cancer is a possibility, especially if:

You are over age 40
You have a lump in your breast
The discharge contains blood
Only one breast is affected
Possible causes of nipple discharge include:

Abscess
Breast cancer
Breast infection
Excessive breast stimulation
Fibroadenoma
Fibrocystic breasts
Ductal carcinoma in situ (DCIS)
Galactorrhea
Hormone imbalance
Injury or trauma to the breast
Intraductal papilloma
Mammary duct ectasia
Medication use
Paget's disease of the breast
Pregnancy
Prolactinoma

When to see a doctor

Rarely is nipple discharge a sign of breast cancer. But it might be a sign of an underlying condition that requires treatment. If you're still having periods and your nipple discharge doesn't resolve on its own after your next menstrual cycle, or if it's particularly bothersome, make an appointment with your doctor to have it evaluated. If you're postmenopausal and experience nipple discharge at any time, see your doctor right away.

In the meantime, take care to avoid nipple stimulation — including frequent checks for discharge — because stimulation actually makes the discharge persist.


References

Non-cancerous breast conditions. American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Non_Cancerous_Breast_Conditions_59.asp?sitearea. Accessed Jan. 5, 2009.
Golshan M, et al. Nipple discharge. http://www.uptodate.com/home/index.html. Accessed Jan. 6, 2009.
Breast disorders. The Merck Manuals Online Medical Library: The Merck Manual Home Edition. http://www.merck.com/mmhe/sec22/ch251/ch251a.html. Accessed Jan. 6, 2009.

Adapted from: Mayo Foundation for Medical Education and Research

You Might Also LIke:

Mastitis

Mastitis is an infection of the breast tissue that causes pain, swelling and redness of the breast. Mastitis most commonly affects women who are breast-feeding, although in rare circumstances this condition can occur outside of lactation.

Often, mastitis occurs within the first six weeks after birth (postpartum), but it can happen later during breast-feeding. The condition can leave you feeling exhausted and rundown, making it difficult to care for your baby.

Sometimes mastitis leads a mother mistakenly to wean her baby before she intends to. But you can continue breast-feeding while you have mastitis.

Symptoms

With mastitis, signs and symptoms can appear suddenly and may include:

Breast tenderness or warmth to the touch
General malaise or feeling ill
Swelling of the breast
Pain or a burning sensation continuously or while breast-feeding
Skin redness, often in a wedge-shaped pattern
Fever of 101 F (38.3 C) or greater
Although mastitis usually occurs in the first several weeks of nursing, it can happen any time during breast-feeding. Mastitis tends to affect only one breast — not both breasts.

Causes

Mastitis occurs when bacteria enter your breast through a break or crack in the skin of your nipple or through the opening to the milk ducts in your nipple. Bacteria from your skin's surface and baby's mouth enter the milk duct and can multiply — leading to pain, redness and swelling of the breast as infection progresses.

Risk factors

Things that put you at increased risk of mastitis include:

Sore or cracked nipples, although mastitis can develop without broken skin.
A previous bout of mastitis while breast-feeding — if you've experienced mastitis in the past, you're more likely to experience it again.
Using only one position to breast-feed, which may not fully drain your breast.
Wearing a tightfitting bra, which may restrict milk flow.
When to seek medical advice
In most cases, you'll feel ill with flu-like symptoms for several hours before you recognize that there's a sore red area on one of your breasts. As soon as you recognize this combination of signs and symptoms, it's time to contact your doctor.

Your doctor will probably want to see you to confirm the diagnosis. Oral antibiotics are usually very effective in treating this condition. If you've had mastitis before, your doctor may prescribe antibiotics over the phone. If your signs and symptoms don't improve after the first two days of taking antibiotics, see your doctor right away to make sure your condition isn't the result of a more serious problem.

Tests and diagnosis

Your doctor diagnoses mastitis based on a physical examination, taking into account signs and symptoms of fever, chills and a painful area in the breast. Another clear sign is a wedge-shaped area on the breast that points toward the nipple and is tender to the touch. As part of the examination, your doctor will make sure you don't have a breast abscess — a complication that can occur when mastitis isn't treated promptly.

Complications

Complications that may arise from mastitis include:

Recurrence. Once you've had mastitis, you're more likely to get it again, either breast-feeding the same infant or a future child. Delayed or inadequate treatment is usually to blame for mastitis recurrence.
Milk stasis. When the milk isn't completely drained from your breast during breast-feeding, milk stasis can occur. This causes increased pressure on the ducts and leakage of milk into surrounding breast tissue, which can lead to pain and inflammation.
Abscess. When mastitis is inadequately treated, or if it's related to milk stasis, a collection of pus (abscess) can develop in your breast. An abscess usually requires surgical draining. To avoid this complication, talk to your doctor as soon as you develop signs or symptoms of mastitis.

Treatments and drugs

Mastitis treatment usually involves:

Antibiotics. Treating mastitis usually requires a 10- to 14-day course of antibiotics. You may feel well again 24 to 48 hours after starting antibiotics, but it's important to take the entire course of medication to minimize your chance of recurrence.

Self-care remedies. Resting, continuing breast-feeding and drinking extra fluids can help your body overcome the breast infection.

If your mastitis doesn't clear up after taking antibiotics, check back with your doctor. A rare form of breast cancer — inflammatory breast cancer — can also cause redness and swelling that could initially be confused with mastitis. You may need a biopsy to make sure you don't have breast cancer.

Prevention

Minimize your chances of getting mastitis by fully draining the milk from your breasts while breast-feeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses only for a few minutes on the second breast — or not at all — start breast-feeding on that breast the next time you feed your baby.

Alternate the breast you offer first at each breast-feeding, and change the position you use to breast-feed from one feeding to the next. Make sure your baby latches on properly during feedings. Finally, don't let your baby use your breast as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they're not hungry.

Lifestyle and home remedies

If you have mastitis, it's safe to continue breast-feeding. Breast-feeding helps your breast clear the infection.

To relieve your discomfort:

Maintain your breast-feeding routine.
Avoid prolonged engorgement before breast-feeding.
Use varied positions to breast-feed.
Drink plenty of fluids.
If you have trouble emptying a portion of your breast, apply warm compresses to the breast or take a warm shower before breast-feeding or pumping milk.
Wear a supportive bra.
While waiting for the antibiotics to take effect, take a mild pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).
If breast-feeding on the infected breast is too painful, try pumping or hand-expressing milk.

Adapted from: Mayo Foundation for Medical Education and Research

Galactorrhea

Galactorrhea (say: "gal-act-tor-ee-ah") is a condition that occurs when a woman's breast makes milk (or a milky discharge) even though she is not breast feeding a baby. The milk may come from one or both breasts. It may leak with no stimulation or it may leak only when the breasts are touched.

Although less common, galactorrhea can occur in men.

What causes galactorrhea?

Galactorrhea has many causes. Here are some of them:
• Tumors (usually benign), especially tumors of the pituitary (say: "pit-too-it-terry") gland, which is located in the brain
• Medicines such as hormones, antidepressants, blood pressure medicines and certain tranquilizers
• Herbal supplements such as nettle, fennel, blessed thistle, anise and fenugreek seed
• Drugs such as marijuana and opiates
• Pregnancy
• Clothing that irritates the breasts (like scratchy wool shirts or bras that don't fit well)
• Doing very frequent breast self-exams (daily exams)
• Stimulation of the breast during sexual activity
• Kidney disease
• Oral contraceptives
• An underactive thyroid (also called hypothyroidism), which is a gland that produces hormones
Sometimes the cause of galactorrhea can't be found.

Galactorrhea produces a white fluid. If the fluid coming from your breast is reddish, your doctor may want to check you for cancer. Blood in the discharge is not galactorrhea.

What are the symptoms of galactorrhea?

The symptoms of galactorrhea can include the following:
• Milky discharge from one of both nipples (discharge may also be yellow or greenish in color)
• An absence of menstrual periods or periods that are not regular
• Headaches
• Vision loss
• Less interest in sex
• Increase in hair growth on your chin or chest
• Acne
• Erectile dysfunction and less interest in sex in men

What tests might my doctor order?

Your doctor might order blood tests to check your hormone levels and to see if you are pregnant. Your doctor might also want you to have an MRI (magnetic resonance imaging) scan of your head to see if you have a tumor or abnormality of the pituitary gland.

Tests are not always needed if you and your doctor can figure out what is causing your galactorrhea.

How is galactorrhea treated?

Most tumors that cause galactorrhea are not cancerous. They can be treated with medicine or surgery, depending on the cause. If a certain medicine you are taking is causing your galactorrhea, your doctor may prescribe a different medicine.

In many cases, no treatment is necessary and the condition goes away on its own with time. Until it goes away, here are some things you can do to help:
• Avoid stimulating your breasts.
• Avoid touching your nipples during sexual activity.
• Don't do breast self-exams more than one time a month.
• Avoid tight-fitting clothing or clothing that causes friction.

Adapted from: American Academy of Family Physicians

Breast Cysts

Breast cysts are fluid-filled sacs within your breast. You can have one or many breast cysts. They're often described as round or oval lumps with distinct edges. In texture, a breast cyst usually feels like a soft grape or a water-filled balloon, but sometimes a breast cyst feels firm.

Breast cysts are common in women in their 30s and 40s. If you have breast cysts, they usually disappear after menopause, unless you're taking hormone therapy.

Breast cysts don't require treatment unless a cyst is large and painful or otherwise uncomfortable. In that case, draining the fluid from a breast cyst can ease your symptoms.

Symptoms

Signs and symptoms of breast cysts include:

A smooth, easily movable round or oval breast lump with distinct edges
Breast pain or tenderness in the area of the lump
Increased lump size and tenderness just before your period
Decreased lump size and resolution of other signs and symptoms after your period
Having one or many simple breast cysts doesn't increase your risk of breast cancer.

Causes
Each of your breasts contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. The lobes are further divided into smaller lobules that produce milk during pregnancy and breast-feeding. Small ducts conduct the milk to a reservoir just beneath your nipple. Supporting this network is a deeper layer of connective tissue called stroma.

Breast cysts develop when an overgrowth of glands and connective tissue (fibrocystic changes) block milk ducts, causing them to dilate and fill with fluid.

Microcysts are too small to feel but may be seen during imaging tests, such as mammography or ultrasound.
Macrocysts are large enough to be felt and can grow to about 1 to 2 inches (2.5 to 5 centimeters) in diameter. Large breast cysts can put pressure on nearby breast tissue, causing breast pain or discomfort.
The cause of breast cysts remains unknown. Some evidence suggests that excess estrogen in your body may play a role in breast cyst development.

When to seek medical advice
Normal breast tissue in healthy women often feels lumpy or nodular. If you detect the presence of any new breast lumps, however, or if a previously evaluated breast lump seems to have grown or otherwise changed, make an appointment with your doctor to get it checked out.

Tests and diagnosis
Screening and diagnosis of a breast cyst usually begins after you or your doctor has identified a breast lump. The process may involve the following tests or exams:

Clinical breast exam. Your doctor physically examines the breast lump and checks for any other problem areas in your breasts. Questions to anticipate include when you first noticed the lump, whether its size has changed, if you have any breast pain associated with the breast lump, whether you have nipple discharge and how your menstrual cycle affects the lump. However, your doctor can't tell from a clinical breast exam alone whether a breast lump is a cyst, so you'll need another test, either an ultrasound or fine-needle aspiration — or maybe both.
Breast ultrasound. Breast ultrasound can help your doctor determine whether a breast lump is fluid-filled or solid. The radiologist — a doctor who specializes in imaging methods — performing the ultrasound makes this determination based on certain characteristics seen during the imaging exam. A fluid-filled area usually indicates a breast cyst. A solid-appearing mass most likely is a fibroadenoma, but it could also be breast cancer.

Some doctors skip breast ultrasound and perform fine-needle aspiration instead.

Fine-needle aspiration. During this procedure, your doctor inserts a thin needle into the breast lump and attempts to withdraw (aspirate) fluid. If fluid comes out and the breast lump goes away, your doctor can make a breast cyst diagnosis immediately.

Unless there appears to be blood in the fluid, it requires no further testing or treatment after draining. If the fluid is bloody, a laboratory may need to test it. Lack of fluid or a breast lump that doesn't disappear after aspiration suggests that the breast lump — or at least a portion of it — is solid, and a sample of cells may be collected and sent for analysis to check for the presence of cancer (fine-needle aspiration biopsy).

Mammography usually isn't indicated for a breast cyst. However, you may undergo a mammogram if your doctor suspects, during the course of evaluating your breast lump, that the lump is caused by something other than a breast cyst.

Treatments and drugs
No treatment is necessary for simple breast cysts. Your doctor may recommend nothing more than closely monitoring a breast cyst to see if it resolves on its own.

Fine-needle aspiration
Fine-needle aspiration, the procedure used to diagnose a breast cyst, also may serve as treatment, if your doctor removes all the fluid from the cyst at the time of diagnosis.

First, your doctor feels your breast to locate the cyst and hold it steady. Next, he or she inserts a thin needle into the breast lump and withdraws (aspirates) the cyst fluid. Often, fine-needle aspiration is done using ultrasound to guide accurate placement of the needle.

If the fluid is nonbloody and the breast lump disappears, you need no further treatment. Your doctor will probably recommend a visit in four to six weeks to see if the cyst returns.
If the fluid appears bloody or the breast lump doesn't disappear, your doctor may send a sample of the fluid for laboratory testing and refer you to a breast surgeon or to a radiologist — a doctor who specializes in imaging studies — for follow-up.
If you have breast cysts, you may need to have fluid drained more than once. Recurrent or new cysts are common.

Hormone use
Using oral contraceptives to regulate your menstrual cycles may help reduce the recurrence of breast cysts. Discontinuing hormone replacement therapy during the postmenopausal years may reduce the formation of cysts as well.

Surgery
Surgical removal of a breast cyst is an option only in a few unusual circumstances. If an uncomfortable breast cyst recurs month after month, or if a breast cyst contains blood-tinged fluid and displays other worrisome signs, surgery may be considered.

Lifestyle and home remedies
Wear a supportive bra. If you have breast pain from a breast cyst, good support to surrounding breast tissue may help relieve some discomfort.
Avoid caffeine. There's no scientific proof that caffeine consumption is linked to breast cysts. However, many women find relief from their symptoms after eliminating caffeine from their diets. Consider reducing or eliminating caffeine — in beverages as well as in foods such as chocolate — to see if your symptoms improve.
Reduce salt in your diet. Although studies on salt restriction and cyst formation aren't conclusive, some experts suggest that reducing salt in your diet may help. Consuming less sodium reduces the amount of excess fluid in your body, which in turn may help alleviate symptoms associated with a fluid-filled breast cyst.

Alternative medicine
Evening primrose oil is a fatty acid (linoleic acid) supplement that's available over-the-counter. Some evidence suggests that evening primrose oil may help minimize discomfort associated with breast cysts. Although the exact mechanism isn't clear, some experts believe that women deficient in linoleic acid are more sensitive to hormonal fluctuations during the menstrual cycle, resulting in breast pain associated with breast cysts.

Adapted from:Mayo Foundation for Medical Education and Research