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Is Breast Cancer Less Aggressive After Menopause

Many Older Women With Breast Cancer Dont Die From It

Menopause Symptoms And Breast Cancer Treatment Connection

There are more deaths from breast cancer in older women simply because most diagnoses occur in older women, but most of these women will die from a cause other than their breast cancer. Breast cancer survival rates, for women of any age, depend on the cancers stage and subtype.

Any woman, regardless of age, who has a family history of cancer, particularly breast and ovarian, should bring it to the attention of her physician, who can evaluate potential breast cancer risk, the need for genetic testing, and the proper screening plan to follow.

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Treatment Options And Challenges

While estrogen-related tumors, which are less aggressive and slower-growing, tend to be more common, more aggressive cancers are still a possibility after menopause. One survey of U.S. Medicare patients found that approximately 18 percent of elderly metastatic breast cancer patients had a cancer known as triple negative, which doesnt have estrogen and progesterone receptors.

In some cases, postsurgical treatments for these aggressive cancers, such as radiation and chemotherapy, may not even be considered. Some women who are over 70 may not offered extra therapy because of their age, says Pinkerton. If you have a small or slow-growing tumor, it might not affect your survival rate, and some women are simply too ill or frail to benefit from the extra treatment. On the other hand, an otherwise healthy and fit woman in her 70s who may live an additional 10 or 20 years who is diagnosed with breast cancer that could spread, may be able to tolerate an intensive treatment such as chemotherapy.

To be sure youre getting the best guidance possible, Pinkerton suggests adding a menopause specialist, who may be an ob-gyn or internist, to your team. Go to the North American Menopause Society website and type in your zip code to find a NAMS Certified Menopause Practitioner near you.

Ascertainment Of Cancer Cases

All questionnaires enquired about any cancer occurrence, type of cancer, addresses of physicians and permission to contact them. Only invasive breast cancers were considered, and in situ tumors with no concomitant invasive tumor were censored at the date of diagnosis. Invasive breast cancer cases were confirmed by pathology reports, obtained for 91.5% of cases. Information on oestrogen-receptor status and on the expression of the human epidermal growth factor receptor 2 were extracted from pathology reports. Invasive premenopausal breast cancers were classified accordingly into two categories, ER+ and ER, and invasive postmenopausal breast cancer into eight non-exclusive categories: HER2+, HER2, ER+, ER and their combinations.

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Medications That Stop The Other Glands In The Body From Making Any Estrogen After Menopause

Another type of hormone therapy is called aromatase inhibitors . These substances can reduce the amount of estrogen your body makes. Used in women who have undergone menopause â either naturally or as a result of cancer treatment. They include:

  • Anastrozole : Taken in pill form every day to reduce the risk of cancer recurrence in womem who have been treated for early-stage breast cancer. It can also treat advanced breast cancer.
  • Exemestane : Taken in pill form by women every day to reduce the risk of recurrence after treatment for early-stage breast cancer. Sometimes used after taking tamoxifen for two or three years. Can also treat advanced breast cancer when tamoxifen is no longer working.
  • Letrozole : Taken in pill form every day to reduce the risk of recurrence after treatment for early-stage breast cancer. Can be used alone or given after completing tamoxifen treatment. Also used to treat advanced breast cancer.

How Is Hormone Therapy Used To Treat Breast Cancer

early detection is key for fast growing aggressive

There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:

Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.

Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .

Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .

Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .

Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.

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Breast Examination After Treatment For Breast Cancer

After surgery

The incision line may be thick, raised, red and possibly tender for several months after surgery. Remember to examine the entire incision line.

If there is redness in areas away from the scar, contact your physician. It is not unusual to experience brief discomforts and sensations in the breast or nipple area .

At first, you may not know how to interpret what you feel, but soon you will become familiar with what is now normal for you.

After breast reconstruction

Following breast reconstruction, breast examination for the reconstructed breast is done exactly the same way as for the natural breast. If an implant was used for the reconstruction, press firmly inward at the edges of the implant to feel the ribs beneath. If your own tissue was used for the reconstruction, understand that you may feel some numbness and tightness in your breast. In time, some feeling in your breasts may return.

After radiation therapy

After radiation therapy, you may notice some changes in the breast tissue. The breast may look red or sunburned and may become irritated or inflamed. Once therapy is stopped, the redness will disappear and the breast will become less inflamed or irritated. At times, the skin can become more inflamed for a few days after treatment and then gradually improve after a few weeks. The pores in the skin over the breast also may become larger than usual.

What to do

Tumor Characteristic And Risk Factor Associations By Menopausal Status

Relative to the age patterns described above, associations with menopausal status were attenuated. After restricting to cases 40 years of age, we assessed the association between menopausal status and tumor characteristics. In crude analyses, premenopausal status appeared to be associated with poor-prognosis tumor characteristics similar to those observed when we compared young and older premenopausal women. Premenopausal cases were significantly less likely to have in situ disease and ER positivity and more likely than postmenopausal women to have stage II, III, or IV disease higher histologic and nuclear grade lymph node positivity and greater tumor size . However, after adjusting for age and/or restricting the age range of women to control for nonpositivity , we observed that few changes persisted. Among women aged 4049 years, only PR status and nuclear grade showed differences by menopausal status premenopausal women had higher PR positivity and less marked pleomorphism. Among women aged 4059 years, premenopausal women had a greater likelihood of stage II and PR+ disease as well as larger tumors than postmenopausal women however, strata for premenopausal women over age 50 years were very sparse, leading to some instability of estimates. These results suggest that, while menopausal status may be associated with some tumor characteristics, associations are weaker than those by age.

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Treating Breast Cancer After Menopause

    Most women go through menopause in their 40s or 50s. It officially starts 12 months after your last menstrual period and signals the end of your ability to get pregnant. As a result of your bodys decreased production of the hormones estrogen and progesterone during this time, you may experience a variety of symptoms, such as and a slowed metabolism.

    Women of menopausal age are at an increased risk for breast cancer. Though menopause itself does not cause breast cancer, the chance of developing breast cancer increases the older you get. It also appears the longer your breast tissue is exposed to estrogen, the greater your breast cancer risk. For this reason, women who go through menopause later than the age of 55 and those who take hormone replacement therapy to ease menopause symptoms may be at an increased risk of breast cancer.

    If you are diagnosed with breast cancer after , this can also affect your doctors treatment decisions. Some types of treatment are appropriate for women both before and after menopause. Others, however, are only used to treat postmenopausal women, because women who are still menstruating produce too much estrogen in their ovaries for certain treatments to be effective.

    Does Breast Cancer Affect Women Of All Races Equally

    Breast cancer prevention in high-risk post-menopausal women

    All women, especially as they age, are at some risk for developing breast cancer. The risks for breast cancer in general arent evenly spread among ethnic groups, and the risk varies among ethnic groups for different types of breast cancer. Breast cancer mortality rates in the United States have declined by 40% since 1989, but disparities persist and are widening between non-Hispanic Black women and non-Hispanic white women.

    Statistics show that, overall, non-Hispanic white women have a slightly higher chance of developing breast cancer than women of any other race/ethnicity. The incidence rate for non-Hispanic Black women is almost as high.

    Non-Hispanic Black women in the U.S. have a 39% higher risk of dying from breast cancer at any age. They are twice as likely to get triple-negative breast cancer as white women. This type of cancer is especially aggressive and difficult to treat. However, it’s really among women with hormone positive disease where Black women have worse clinical outcomes despite comparable systemic therapy. Non-Hispanic Black women are less likely to receive standard treatments. Additionally, there is increasing data on discontinuation of adjuvant hormonal therapy by those who are poor and underinsured.

    In women under the age of 45, breast cancer is found more often in non-Hispanic Black women than in non-Hispanic white women.

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    Postmenopausal Hormones Linked To More Aggressive And Deadly Breast Cancers Study Finds

    Back in 2002, the Womens Health Initiative randomized trial found that not only did taking postmenopausal hormone therapy have a deleterious effect on womens cardiovascular systems (more heart at

    Back in 2002, the Womens Health Initiative randomized trial found that not only did taking postmenopausal hormone therapy have a deleterious effect on womens cardiovascular systems , it also raised their risk of developing breast cancer.

    Within 12 months, sales of the hormones had plummeted 32 percent. Bad news for HT manufacturers. But what also dropped over the next few years was the incidence of breast cancer in the United States. Terrific news for women.

    Then came the pushback. HT supporters have been parsing and picking away at the WHI data, trying to discredit its overall findings. Claims were made that women would be OK if they took the hormones for just four or five years. Or if they just took different kinds of hormones . New observational studies were launched, and several suggested that the breast cancers associated with HT werent that bad . The cancers tended to be less advanced, these studies suggested, and had more favorable prognoses .

    Gosh. I guess that means that the trade-off is worth it for women.

    The HT users also had a higher death rate from all causes 0.05 percent per year versus 0.03 percent per year in the placebo group. Again, in absolute numbers that meant 5.3 deaths versus 3.4 deaths per 10,000 women per year.

    Breast Cancer Risk Factors

    A risk factor is anything that affects your chance of getting a disease, such as cancer. Most women who have one or more breast cancer risk factors never develop the disease, while many women with breast cancer have no apparent risk factors . Even when a woman with risk factors develops breast cancer, it is hard to know just how much these factors may have contributed to her cancer.

    There are different kinds of risk factors. Some factors, like a person’s age or race, can’t be changed. Others are linked to cancer-causing factors in the environment. Still others are to related personal behaviors, such as smoking, drinking, and diet. Some factors influence risk more than others, and your risk for breast cancer can change over time, due to factors such as aging or lifestyle.

    Studies have found the following risk factors for breast cancer:

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    How Do Tamoxifen Raloxifene Anastrozole And Exemestane Reduce The Risk Of Breast Cancer

    If you are at increased risk for developing breast cancer, four medications tamoxifen , raloxifene , anastrozole , and exemestane may help reduce your risk of developing this disease. These medications act only to reduce the risk of a specific type of breast cancer called estrogen receptor-positive breast cancer. This type of breast cancer accounts for about two-thirds of all breast cancers.

    Tamoxifen and raloxifene are in a class of drugs called selective estrogen receptor modulators . These drugs work by blocking the effects of estrogen in breast tissue by attaching to estrogen receptors in breast cells. Because SERMs bind to receptors, estrogen is blocked from binding. Estrogen is the fuel that makes most breast cancer cells grow. Blocking estrogen prevents estrogen from triggering the development of estrogen-receptor-positive breast cancer.

    Anastrozole and exemestane are in a class of drugs called aromatase inhibitors . These drugs work by blocking the production of estrogen. Aromatase inhibitors do this by blocking the activity of an enzyme called aromatase, which is needed to make estrogen.

    What Is Breast Cancer

    A Happy Relationship Can Improve Health for Breast Cancer ...

    Cells in the body normally divide only when new cells are needed. Sometimes, cells in a part of the body grow and divide out of control, which creates a mass of tissue called a tumor. If the cells that are growing out of control are normal cells, the tumor is called benign. If, however, the cells that are growing out of control are abnormal and don’t function like the body’s normal cells, the tumor is called malignant .

    Cancers are named after the part of the body from which they originate. Breast cancer originates in the breast tissue. Like other cancers, breast cancer can invade and grow into the tissue surrounding the breast. It can also travel to other parts of the body and form new tumors, a process called metastasis.

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    Is Breast Cancer Less Threatening After Menopause

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    How Much Do Anastrozole And Exemestane Lower The Risk Of Breast Cancer

    Studies have shown that both anastrozole and exemestane can lower the risk of breast cancer in postmenopausal women who are at increased risk of the disease.

    In one large study, taking anastrozole for five years lowered the risk of developing estrogen receptor-positive breast cancer by 53 percent. In another study, taking exemestane for three years lowered the risk of developing estrogen receptor-positive breast cancer by 65 percent.

    The most common side effects seen with anastrazole and exemestane are joint pains, decreased bone density, and symptoms of menopause .

    Last reviewed by a Cleveland Clinic medical professional on 12/31/2018.

    References

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    Who Gets Breast Cancer

    Breast cancer is the most common cancer among women other than skin cancer. Increasing age is the most common risk factor for developing breast cancer, with 66% of breast cancer patients being diagnosed after the age of 55.

    In the US, breast cancer is the second-leading cause of cancer death in women after lung cancer, and it’s the leading cause of cancer death among women ages 35 to 54. Only 5 to 10% of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The majority of breast cancer cases are “sporadic, meaning there is no definitive gene mutation.

    Research Suggests Menopausal Status Better Than Age For Deciding How Often Women Should Have Mammograms

    Triple Negative Breast Cancer

    On Oct. 20, 2015, the American Cancer Society released updated breast cancer screening guidelines for women at AVERAGE risk of breast cancer. The guidelines recommend:

    • All women should become familiar with the potential benefits, limitations, and harms associated with breast cancer screening.
    • Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45.
    • Women who are 45 to 54 years should be screened annually.
    • Women who are 55 and older should transition to biennial screening or have the opportunity to continue screening annually.
    • Women should have the opportunity to begin annual screening between the ages of 40 and 44.
    • Women should continue screening as long as their overall health is good and they have a life expectancy of 10 years or more.
    • The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age.

    These new ACS guidelines reignited the simmering debate about the value of screening mammograms. Several large studies, including a review by the U.S. Preventive Services Task Force in 2009 and a study on the causes of death in the United Kingdom in 2013, questioned the value of screening mammograms.

    Doctors who question the value of mammograms say that while mammograms do save lives, for each breast cancer death prevented, three to four women are overdiagnosed. Overdiagnosis means either:

    • stage IIB or higher
    • 15 mm or larger
    • node-positive

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