Navigating breast cancer risk factors in menopausal women

October 3, 2023

Healthcaretoday, Breast Cancer, Cancer, Cancer care, cancer deaths, cancer prevention, cancer diagnosis, cancer cures, breast lump, menopausal women, breast care, cancer awareness, fighting cancer, cancer survivor, diet for cancer, cancer caregivers, women after 40, women in 40s,

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By Dr Hafizah Zaharah Ahmad,
Consultant Clinical Oncologist,
Sunway Medical Centre Velocity (SMCV)

Breast cancer remains a pressing health concern for women across the globe, and there have been much discussion on how its impact may fluctuate when a woman is entering her menopause phase in life. In Malaysia, breast cancer holds the unfortunate distinction of being the leading cancer among women. Statistics reveal that 1 in 19 Malaysian women face the risk of developing breast cancer at some point in their lives, resulting in approximately 3,500 lives lost annually. Amidst these sobering figures, there is a critical need for comprehensive awareness and understanding of the risk factors that contribute to this disease.

Hormone changes in menopause
First and foremost, it is essential to understand that menopause itself does not inherently increase the risk of developing breast cancer. Rather, the risk of breast cancer increases with age, and different seasons in a woman's life bring distinct hormonal changes.

These changes do play a significant role in breast cancer risk, primarily due to the influence of hormones like estrogen and progesterone on the breast tissue.

High levels of estrogen, especially over a prolonged period, can stimulate the growth of breast cells and increase the risk of mutations that may lead to cancer. This is why factors such as early onset of menstruation, late onset of menopause, and hormone replacement therapy are associated with a higher risk, as they expose the breast tissue to estrogen for longer durations.

Pregnancy and breastfeeding temporarily reduce a woman’s exposure to estrogen and may have a protective effect against breast cancer. However, the risk may increase slightly after giving birth if the first full-term pregnancy occurs later in life.

This risk can be categorized into two key types of Breast Cancer: Premenopausal, which is associated with a higher risk for Hormone-Receptor-Positive (HR+) Breast Cancer, and Postmenopausal, where there is an increased risk for Hormone-Receptor-Negative (HR-) Breast Cancer.

Breast cancer tends to be more aggressive in younger, premenopausal women than in older, postmenopausal women. Menopause matters in terms of the specific treatments that might work for a patient. Premenopausal HR+ women may benefit from medicines that block the action of estrogen.

Fortunately for postmenopausal HR+ women, alternative medicines that lower estrogen level may also be used. When premenopausal HR+ women are considered to benefit from estrogen lowering medicine, chemical menopause can be achieved by using a drug that acts on the brain to suppress ovulation and production of ovarian hormones.

Moreover, it is known that the longer a woman is exposed to female hormones (either made by the body or obtained as a drug or patch), the more likely they are to develop breast cancer. Some women may suffer greatly from perimenopausal symptoms such hot flashes, sleep problems and vaginal dryness. They may opt to use combination of hormone replacement therapy which will alleviate their symptoms but it can slightly increase the risk of breast cancer. Thus, the breast cancer risk gets bigger, the longer hormone replacement therapy is used.

Weight gain and obesity
A heathy lifestyle is key to managing a host of health issues, but it is even more essential in cancer care. Fat in a woman’s body converts certain substances in the blood into female hormones, which in return drive breast cancer growth. Thus, eating well, staying active and maintaining a healthy weight decreases the risk for cancer development.

Obesity disturbs the hormonal balance in the body. As we gain excess weight, more insulin, a hormone produced by an organ known as the pancreas has to be secreted to prevent excessive rise in sugar level. Apart from controlling the sugar level, insulin increases cell production and reduces cell death. That means there is more opportunity for something to go wrong in the body and for cancer to develop.

Common misconceptions, debunked
When it comes to the incidences of menopause and breast cancer, many are not able to distinguish fact from fiction due to the plethora of information being shared on this matter. For instance, some may be of the impression that menopause acts as a shield against breast cancer, or that mammograms are no longer necessary for menopausal women.

Breast cancer risk does increase with age, and the risk is higher for women who have not experienced menopause, but it does not mean that menopausal women are completely immune – in fact breast cancer can and does occur during and after menopause. Another dangerous misconception about mammograms no longer being necessary is far from the truth. Regular mammograms remain a crucial part of breast cancer screening for menopausal women, and early detection through mammograms can be life-saving.

Another misconception is that many women panic when they discover a breast lump, assuming it must be cancer. However, not all breast lumps are malignant (cancerous). In fact, the majority of breast lumps found during menopause are benign (non-cancerous). Nevertheless, any new lump should be evaluated by a healthcare provider to rule out cancer.

A patient in her early 70’s who was diagnosed with early breast cancer after her children brought her for a screening mammogram and ultrasound.

Through staging investigations, we were able to confirm that the cancer was only localised in her breast. She was sent for a cardiorespiratory assessment and subsequently counselled for surgery. As her cancer was small, her surgery was uncomplicated and she recovered well. Laboratory testing showed that her cancer was hormone receptor positive (HR+), hence she was started on hormone therapy. Now, after a few years, she is still free of cancer and living her life to the fullest amongst her loved ones.

Early detection for better treatment outcomes
Regardless of menopausal status, early diagnosis methods for breast cancer do not differ. Mammograms and breast ultrasounds are pivotal for early detection, often identifying cancer years before it becomes palpable, and a definitive diagnosis relies on tissue biopsy. Treatment for breast cancer typically involves a combination of surgery, chemotherapy, radiotherapy, hormone/endocrine therapy, and targeted therapy, tailored to the specific characteristics of the cancer.

It's essential to remember that while hormonal factors are significant, breast cancer risk is multifactorial. Genetics, family history, and other environmental factors also play roles in determining an individual's risk. Regular breast cancer screening and consulting with healthcare professionals can help assess and manage this risk effectively.

Adopting a healthy diet, typically high in fibre and low in fat may indirectly lower a woman’s risk of getting breast cancer through the lower incidence of obesity. Women who were treated for early stage of breast cancer are also less likely to suffer a relapse of the cancer if they adopt a healthy lifestyle with high fibre and low fat diet. Together with adequate exercise and avoiding excessive weight gain, the woman can reduce her risk of getting breast cancer.

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