Based on the differential diagnoses, the most likely diagnosis for the patient is the presence of a breast cyst. Benign breast cysts are tender to the touch and can cause mild pain, which is different from fibroadenomas that are firm and commonly painless (Mayo Clinic Staff, n.d.) The lump is individual, and a physical exam does not indicate firm fibrous tissue in the area of the breast which would eliminate the possibility of fibrocystic breast disease (American Cancer Society, 2019). To remain vigilant and ensure the accuracy of the diagnosis, an ultrasonography imaging test should be ordered. A physical exam and symptom description by patient is not fully indicative of the structure of the tissue in the breast and the lump, and can only be confirmed via imaging diagnostic (American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology, 2016). Breast cysts are commonly found in women aged 35-50 which fits the patient profile.
Once the imaging confirmed that it is a breast cyst, the guidelines recommend leaving it without treatment. There is also no need for a follow up as this type of benign tissue does not require observation or present any acute risk of breast cancer. If the cyst is large or causes significant discomfort to the patient, it is possible to use fine-needle aspiration to essentially drain the cyst. A clinician may use the ultrasound to accurately guide the needle during the process and aspirate the fluid. The area may remain tender for several days, with over-the-counter pain medication (paracetamol) being an appropriate pain relief. Breast cysts can reappear periodically, and it is recommended the patient see their doctor if it has returned to make sure it is benign. Breast cysts are a result of hormonal changes in females and cannot be prevented (Breast Cancer Now, 2019).
American Cancer Society. (2019). Fibrosis and simple cysts in the breast. Web.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. (2016). Practice bulletin No. 164: Diagnosis and management of benign breast disorders. Obstetrics and Gynecology, 127(6), e141–156. Web.
Breast Cancer Now. (2019). Breast cysts. Web.
Mayo Clinic Staff. (n.d.). Breast cysts. Web.