Breast Cancer Awareness Month: Is there a link between late menopause and breast cancer?

Among the most common cancers in the world, breast cancer has been a global health concern for decades now. As per the World Health Organization, 2.3 million women were diagnosed with breast cancer and 670,000 deaths globally in 2022. To raise awareness about this deadly disease and promote early detection and prevention, October is observed as Breast Cancer Awareness Month around the globe. While there are a range of risk factors from genetics to lifestyle, one prominent factor that can influence breast cancer risk and has often been overlooked is the timing of menopause.

To delve deeper into how hormonal changes during menopause can impact breast health and proactive measures women can undertake, we contacted Dr. Poonam Patil, consultant in medical oncology at Manipal Hospital (Old Airport Road), and Dr. Geeta Kadayaprath, senior consultant in breast surgery at Apollo Cancer Centre (New Delhi). Below, the medical experts answer pressing questions about breast health.

How do hormonal changes during menopause affect breast health?

Patil: Menopause signifies the end of a woman's reproductive years, characterised by a reduction in estrogen and progesterone production by the ovaries. Estrogen is crucial for the development and maintenance of breast tissue, and its reduction during menopause can lead to various changes in the breasts.

Breast tissue is made of glandular and fatty tissue, and as estrogen reduces, glands start shrinking, the breast becomes less dense and fattier. This transition may lead to sagging in the breasts and size may change. The decrease in hormone levels can make breast tissue less resilient and more prone to various changes.

Are there specific risk factors for breast cancer during menopause?

Patil: Yes, several risk factors for breast cancer become particularly relevant during menopause.

• Age: The risk of developing breast cancer increases with age, with the majority of cases diagnosed in women over 50. However, in the last few years, there has been a shift in age groups and even younger women are diagnosed with breast cancer.
• Family history: A family history of breast cancer is a risk factor, regardless of menopausal status, especially if close relatives were diagnosed with breast or ovarian cancer at an early age.
• Genetic mutations: Women with mutations in the BRCA1 or BRCA2 genes have a higher risk of breast and ovarian cancer.
• Hormonal factors: Long-term exposure to estrogen, such as those who started menstruating early or went through late menopause, is a risk factor.
• Body weight: Postmenopausal obesity is associated with higher estrogen levels due to fat tissue's ability to produce estrogen, increasing breast cancer risk.
• Lifestyle choices: Factors like alcohol consumption, smoking, and lack of physical activity can also contribute to increased risk.

What are the key hormonal changes that occur during menopause and how do they impact breast tissue?

Patil: During menopause, there occurs a significant drop in estrogen and progesterone levels because of the non-functioning of the ovaries. Estrogen plays a critical role in the growth and maintenance of breast tissue, and bone health, and its decline leads to the following effects:

• Loss of glandular tissue: The glandular components of the breast shrink, leading to an increase in fatty tissue. The breast size also may reduce and may sag.
• Altered breast density: As glandular tissue diminishes, breast density decreases.
• Increased fatty tissue: With the reduction of estrogen, there may be an increase in fat deposition in the breasts, which can alter their texture and appearance.

Also Read: ‘I was always exhausted': Things about menopause that no one prepares you for

What are some common misconceptions about breast cancer during menopause?

Kadayaprath: During menopause and otherwise, women believe that painless lumps are not a concern. On the contrary, a new lump which is painless and is of recent origin, should be investigated.

With menopause, the probability of developing breast cancer goes up. About 75-80% of breast cancers happen in women over the age of 50. Any change in the breasts should not be ignored. Other than a painless lump, spontaneous bloody or clear nipple discharge, dimpling of the skin, orange peel appearance of the skin and nipple retraction could all indicate breast cancer. Menopausal women and even younger women should not ignore any of these symptoms if these are of recent origin.

What are the early signs and symptoms of breast cancer in menopausal women?

Patil: Early detection of breast cancer is crucial for effective treatment. Breast cancer is curable if detected early. Women should be vigilant for specific signs and symptoms, including:

• Lump or mass: The most common symptom is often a painless lump or mass in the breast or underarm area.
• Changes in breast size or shape: Any noticeable change in the size or shape of the breast requires an evaluation.
• Skin changes: Dimpling, puckering, or changes in skin texture (e.g., redness or scaling) should be evaluated.
• Nipple changes: Spontaneous blood-stained discharge or changes in the appearance of the nipple can be concerning.
• Persistent pain: While breast pain is common, persistent pain in one breast or localized to a specific area warrants investigation.

What role does hormone replacement therapy (HRT) play in breast cancer risk?

Patil: Hormone Replacement Therapy (HRT) is often prescribed to alleviate menopausal symptoms by replenishing estrogen mainly. However, HRT has been linked to an increased risk of breast cancer, especially with some preparations. The impact of HRT on breast cancer risk varies based on individual factors, including family history and personal medical history. It is essential for women considering HRT to discuss the potential risks and benefits with their doctor, especially concerning breast cancer risk.

What are the most effective methods for early detection of breast cancer in menopausal women?

Patil: Regular screening for breast cancer is crucial for all women, particularly those who are postmenopausal.

• Breast self-exams: Breast self-exams can help women become familiar with their breast tissue and detect any unusual changes early.
• Mammograms: Women aged 40 or older should have mammograms annually, along with an ultrasound of the breast or an MRI of breasts in some situations.
• Clinical breast exams: Regular check-ups with a doctor can help identify changes that might not be evident during self-exams.

Screening is vital because early-stage breast cancer often presents with minimal or no symptoms. Regular mammograms and clinical evaluations significantly increase the chances of early detection, leading to more effective treatment and better outcomes.

Also Read: Breast Cancer Awareness Month: Fear of test results delays breast cancer diagnoses, say Mumbai doctors

How can women maintain a healthy lifestyle to reduce their risk of breast cancer during and after menopause?

Kadayaprath: To reduce the risk of breast cancer, one must focus on lifestyle changes. The most important changes one can incorporate in one's lifestyle are regular and moderate-intensity exercises and inculcating healthy food habits. Moderate-intensity exercise, means about 3.5 hours of exercise during the week. It is also essential to keep one's body weight in check as it is now quite well-known that obesity is associated with a higher risk of cancer.

For nutritional needs, it is important to seek the services of a trained nutritionist to advise according to the body type and the specific needs of the individual. While one should include more coloured fruits and vegetables in their diet, one must also pay attention to the source of the food on the plate.

How can women with a family history of breast cancer manage their risk during menopause?

Kadayaprath: If there is a strong family history of breast cancer, and one of the first-degree (mother, sister, daughter) relatives with breast cancer has had a genetic test done and found to have a mutation (an error in the gene), then the lady in question should undergo genetic counselling and testing. Family history alone contributes to about 5 to 10 per cent of all breast cancer cases.

The history of significance is when one of the first-degree relatives has got breast cancer and is of a certain subtype called triple-negative breast cancer or ovarian cancer or there is a first-degree relative with cancer in both breasts. Or, if there is a male relative with breast cancer and so forth. Even with a high-risk family history, one should focus on lifestyle changes and seek a consultation with a genetic counsellor to ascertain the risk of developing breast cancer.