What is the cause of breast pain near a simple cyst?

From the Guidelines

For patients with near simple cyst breast pain, the most effective treatment approach is to provide reassurance and manage symptoms with over-the-counter pain medications, a good support bra, and ice packs or heating pads, as recommended by the NCCN Panel 1. When evaluating breast pain, it's essential to consider the type of pain, its relationship to menstruation, duration, location, and impact on daily activities. According to the NCCN guidelines 1, if the clinical breast exam (CBE) is normal, and screening mammograms are current and negative, symptomatic management is the recommended approach. Some key points to consider in managing near simple cyst breast pain include:

• Cyclic breast pain may often spontaneously resolve, and reassurance alone has been shown to help resolve the symptom in a significant percentage of women 1
• For focal breast pain, age-appropriate diagnostic imaging, such as a diagnostic mammogram or ultrasound, may be necessary to determine the cause of the pain 1
• If a simple cyst is geographically correlated with focal pain, drainage may be considered for symptom relief, as recommended by the NCCN Panel 1
• It's crucial to note that while simple cysts are typically benign, any new breast lump should be evaluated by a healthcare provider to confirm the diagnosis and rule out other potential causes of breast pain 1

From the Research

Near Simple Cyst Breast Pain

• Simple cysts are the most common disorder of the breast and are not malignant 2
• Patients with symptomatic simple cysts can undergo elective aspiration, and typical cyst fluid can be discarded 2
• Bloody fluid should be sent for cytology, and cysts with thick walls, thick septations, or solid components have a risk of malignancy and should undergo biopsy 2

Classification and Management of Breast Cysts

• Breast cysts are classified into three categories: simple cysts, complicated cysts, and complex cysts 3
• For simple cysts, no further imaging is necessary after ultrasound, and cytology is only considered for analgesic purposes 3
• Complicated cysts require a control at 4-6 months, and the use of cytology depends on the context (familial risk, difficulty of follow-up) 3
• Complex cysts require sampling by cytology or biopsy 3

Breast Cyst Aspiration

• Breast cyst aspiration is a simple, cost-effective, minimally invasive procedure that can be easily learned and practiced 4
• If clear fluid is aspirated and the mass resolves, malignancy is unlikely, and breast cyst is the probable diagnosis 4
• Referral for fine-needle or excisional biopsy is indicated if the aspirate is bloody or extremely tenacious, if no fluid can be aspirated, or if there is residual mass after aspiration 4

Cytology Results and Outcomes

• Noncomplex cysts are benign 99% of the time, and cysts with papillary cytology require no further workup 5
• Atypical cytology requires further workup, as it predicts malignancy in 21% of cases 5
• Malignant cytology is associated with breast cancer in 90.9% of patients, and all patients with malignant cytology require biopsy 5