Breast Fibroadenomas, Cysts, and IVF: Key Questions Answered

Fibroadenoma of the breast, cysts, and blisters, while simultaneously undergoing in vitro fertilization (IVF)?

Hello Doctor: In early February of this year, I discovered that I had a total of seven lumps in both breasts, and their shapes were somewhat irregular.
I first underwent a fine needle aspiration biopsy, during which the doctor mentioned that three of the lumps appeared suspicious, but she only performed the biopsy on two of them.
After the examination, she informed me that there was "mucus" in the lump on my right side.
Subsequently, the doctor told me that the fine needle biopsy results indicated atypical hyperplasia for the non-mucous lump.
Since the hospital did not have a breast specialty, I sought treatment at another hospital.
At Hospital B, after an ultrasound examination, they also noted three suspicious lumps, but the doctor similarly performed a core needle biopsy on only two.
The current results indicate that the left side is a fibroadenoma, the right side with mucus is a fibrocystic change, and the other five lumps are cysts.
However, the doctor assured me that all findings are benign and advised me to follow up in three to six months.
Therefore, I would like to ask:
1.
Is it possible for the fine needle biopsy to show atypical results while the core needle biopsy indicates benign findings, so I shouldn't be overly concerned? Or should I consider undergoing another core needle biopsy for more accurate results?
2.
What exactly does "mucus" refer to? The doctor did not provide an explanation.
Is this something that requires closer monitoring?
3.
Due to my age, I have not undergone a mammogram, but online information suggests that calcifications can only be detected through mammography.
Should I request the doctor to perform this test?
4.
I previously underwent in vitro fertilization and would like to continue with it.
Does this increase the risk of cancer? How can I minimize this risk?
5.
Does supplementing with folic acid affect hormone levels?
Thank you very much, Doctor!

mina, 30~39 year old female. Ask Date: 2022/03/18

Dr. Tang Yuxiong reply Surgery

Hello, Ms.
Mina.
I apologize for the wait.

1.
There are three types of fibrocystic changes: simple, complex, and complicated.
If it is the complicated type, minimally invasive excision is recommended.
Based on the previous core needle biopsy and fine needle aspiration, it has been indicated that it is merely a fibroadenoma or cyst, and you can follow the recommendation of the hospital for observation.
Generally, the accuracy of fine needle aspiration is about 80%, while core needle biopsy is approximately 90%.
If there are still concerns, you may come to the hospital for a consultation regarding direct minimally invasive excision.
2.
Regarding the mucinous component, fine needle aspiration may yield some fluid resembling tissue fluid.
The key point is whether the pathological examination results indicate malignancy.
3.
For mammography, based on ultrasound assessment, if there is intraductal calcification, additional imaging can be performed.
4.
Generally, there is little impact.
If there are concerns, it is advisable to first remove the suspicious tumor before considering fertility issues.
5.
There is no impact.
If you have any further questions, you can consult at our Women's Health Center outpatient clinic.

Reply Date: 2022/03/18

More Info

Understanding breast health, particularly in the context of fibroadenomas, cysts, and the implications for fertility treatments such as IVF, is crucial for women navigating these concerns. Based on your inquiry, let’s address your questions systematically.

1. Can a fine needle aspiration (FNA) show atypical cells while a core needle biopsy (CNB) shows benign results?
Yes, it is possible for an FNA to yield atypical results while a subsequent CNB shows benign findings. Atypical hyperplasia indicates that there are some abnormal cells present, but it does not necessarily mean cancer. The core needle biopsy provides a larger tissue sample, which can offer a more definitive diagnosis. If the CNB shows benign results, it suggests that the atypical cells may not represent a significant risk. However, it is essential to follow up with your healthcare provider to monitor any changes over time.

2. What does "mucous" mean in this context?
The term "mucous" in relation to breast lesions typically refers to the presence of mucin, a gel-like substance produced by certain types of cells. In the context of breast pathology, mucin can be associated with certain benign conditions, such as a mucinous cyst or a type of fibroadenoma. While mucinous lesions are generally benign, they should be monitored for any changes. Your doctor should provide more information about the specific implications of this finding.

3. Should I request a mammogram?
Given your age and the presence of multiple breast lesions, it is reasonable to discuss the possibility of a mammogram with your healthcare provider. Mammography is particularly useful for detecting microcalcifications, which can indicate early changes in breast tissue that may not be visible on ultrasound. While younger women may have denser breast tissue that can make mammograms less effective, it is still a valuable tool for comprehensive breast health assessment.

4. Does undergoing IVF increase the risk of breast cancer?
Current research does not conclusively link IVF treatments with an increased risk of breast cancer. However, hormonal treatments used in IVF can influence breast tissue. It is essential to discuss your family history and any other risk factors with your healthcare provider to make informed decisions about your fertility treatments. Regular monitoring and breast health assessments are advisable, especially if you have a family history of breast cancer.

5. Does taking folic acid affect hormone levels?
Folic acid is a B vitamin that is crucial for DNA synthesis and repair, and it is particularly important during pregnancy and for women trying to conceive. There is no strong evidence to suggest that folic acid significantly affects hormone levels. However, it is always best to discuss any supplements you are considering with your healthcare provider, especially in the context of fertility treatments.

In summary, while your current findings indicate benign conditions, ongoing monitoring and communication with your healthcare provider are essential. Regular follow-ups, including imaging studies as recommended, will help ensure that any changes in your breast health are promptly addressed. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can contribute positively to your overall health and well-being as you navigate these concerns.

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