Most Ultrasound Cysts in Menopausal Women Are Not Cancerous: News from the North American Menopause Society Meeting

Steven Goldstein, MD Gyncecologist at NYU Medical School addressed the opening session of the North American Menopause Society Meeting and addressed what should happen when a gyno sees a small ovarian cyst in a menopausal aged woman or older. He ased the question canseeing too much be a bad thing for your provider? He points out that in thepast we used the very low risk and non-invasive techniques of inspection,palpation and auscultation and he was trained to talk to the patient for thehistory, did the exam by looking, touching and listening, and then we orderedsome blood tests. Now we have very sophisticated technologies that give usthings we couldn’t see before. He coined “sonomicroscopy” meaning that we seethings that aren’t visible to the naked eye, like when we see a 2 mm embryowith a visible heart rate. So we are discovering things that are normal and socalled “incidental” such as small endometriomas and small dermoids that arewithin the ovary and asymptomatic. 1971 Dr. Hugh Barber published the PPMOPalpable Post Menopausal Ovary it was not normal and cancerous, he was stillsaying this in 1984, and thus if a gyno felt the ovary on pelvic exam  then the gyno should recommend that the ovaryshould be removed, and for many years this was the standard practice. Dr.Goldstein has been pointing out that you have to take what you see with one eyeto the fact that it might not be abnormal.  Ultrasounds have helped us peer withinabdomens and into the pelvis like we never have before.  And ultrasound has helped us see that in factnot every ovary in a menopausal woman is just small and quiet.  By the late 1990s we began to change how gynosmade recommendations to women. So in 1999 Dr. Goldstein was saying if the cystin a post menopausal woman was <5 cm you could watch.  And around that same time an article by a Dr.Baily found that about 17% of menopausal women will have a simple cyst. The keyis for your gyno to try to figure out if your cyst has features that would makeher believe that it is cancerous. If a cyst is not cancerous there is still noevidence that anon-cancerous benign cysts become cancerous, so if you aren’t inpain, or have any symptoms, there’s no reason not to just watch. We’ve also nowgot good information as to how long to watch. . Greenless PLCO cancerscreening, showed that of the cysts that develop a full third go away in ayear.  And if you have been told you mayhave an ovarian cyst remember that the cysts you may have been told you have onultrasound or CT scan may not be in your ovary at all. Women wonder if not all pelviccysts are ovarian in origin, what are they: often they are paratubal (attatched or around the fallopian tube) non-cancerouscysts or other structures. Dr. Goldstein was suggesting that if the cysts areso small there is virtually no chance they are cancerous such as if they areunder <1 cm he suggests that gynos not even say they are there, arecommendation that probably is still going to take awhile for gynos to adopt.  And Dr. Goldstein also has reviewed theresearch and cysts that are >1 to <7 cm that are just simple cysts can bedescribed by statement that they are most certainly benign.

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