Patients with macrocysts have a two- to fourfold higher risk of developing breast cancer and should be monitored carefully while on hormone replacement therapy. Estradiol and progesterone seem to enhance the mitotic rate of breast cells and serum levels should be reduced to the lowest levels possible. Investigations are necessary to confirm the stimulatory effect of serum steroids on breast/cyst epithelial cells. The effect of norethisterone on breast tissues must also be considered. The conversion of norethisterone to ethinylestradiol may make this progestogen unsuitable for replacement therapy in breast cyst patients, but this requires conformation in clinical studies.
Recently it was demonstrated that cholic acids accumulate in breast cyst fluid and that their metabolism is influenced by sex steroids. Experimental and clinical studies are necessary to elucidate this breast-gut connection.
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