Cases Are Rising
“Every year around 55,000 women in the UK are diagnosed with breast cancer (the equivalent of one woman being diagnosed every ten minutes) and over 40,000 of these are post-menopausal women. The risk of breast cancer has been rising every year for several decades – since the 1990s, incidence rates have increased in those over 50, with the greatest increase in rate being in the 65-69 age group. In fact, the incidence of breast cancer is strongly related to age, with eight out of ten cases in the UK being women over the age of 50. Between 2015 and 2017, almost a quarter of new cases of breast cancer occurred in those aged 75 and over.” – Dr Christina Papadopoulos, GP at digital healthcare company Livi
… But Post-Menopausal Breast Cancer Tends To Be Less Aggressive
“In general, post-menopausal breast cancer is less aggressive than cancers in younger women. According to the Office for National Statistics, around 7% of women diagnosed with breast cancer are under the age of 40 and are more likely to have a family history of breast cancer or certain genes that are more associated with it. Younger women tend to be diagnosed at later stages and have lower survival rates than older women. Sometimes, this is due to the type of breast cancer they have, as ‘triple negative’ breast cancer is more common, more aggressive and harder to treat. Post-menopausal breast cancer, on the other hand, is often more oestrogen-receptor positive and treatment protocols are very well established as there has been more research into it.” – Dr Monica Lascar, hormone and sexual health expert at The Marion Gluck Clinic
Hormones Play A Part
“The majority of post-menopausal breast cancer is thought to be due to the cumulative exposure to oestrogen during a woman’s lifetime. This is because oestrogen stimulates breast tissue. During puberty, ovaries start to produce oestrogen, to help regulate the menstrual cycle. Oestrogen levels then fall following the menopause, and going through the menopause after the age of 55 is associated with an increased risk of developing breast cancer, as is an earlier start to menstruation (i.e., younger than 12). Having your first child later in life – i.e., after the age of 30 – is also thought to increase the risk.” – Christina
How You Metabolise Oestrogen Matters
“Whilst we all make estradiol (one of the main oestrogen hormones) from the ovarian follicle, there are differences in how we metabolise and eliminate it over time, depending on our individual genetic pathways, which may be very efficient or quite sluggish and can lead to high levels of oestrogen. For example, we know oestrogen is broken down in the liver and eliminated in the gut, with the help of the right bacteria. Alcohol is also broken down in the liver, as are many other medicines and toxins. If these detoxification pathways are sluggish, we may be more likely to build up oestrogen excess (a good analogy is the M25 at rush hour). Have you noticed alcohol tolerance also diminishes during the menopause and the years after? Plus, increasing studies show gut bacteria plays a role in oestrogen elimination.” – Monica
The Science Surrounding HRT Is Complicated
“The results of one infamous study made headlines in 2002 about breast cancer risks and HRT. That data was recycled and re-published in different formats over the years, and the headlines have remained a concern for women ever since. The study found an increase in breast cancer risk in women using oestrogen together with synthetic progesterone, but a lower cancer risk when taking oestrogen on its own. For every 10,000 women in the study taking HRT, there were eight more breast cancer cases than in women not on HRT. Similarly, there were seven more heart attacks, and 18 more blood clots, but six less cases of colon cancer. Even in this study, which led to a rapid decline in HRT prescriptions and fear around HRT, 97% of women were fine with no adverse events. The later HRT was started, the higher the risks seemed to be (the average age of starting was 63), which led us to the understanding of the optimal window period for starting HRT, which should ideally be within 10 years after menopause. There is now increasing recognition for the benefits of human-like hormones (aka bioidentical hormones), such as the estradiol gel or patch, and oral micronised progesterone, which are now available on the NHS.” – Monica
There’s Plenty You Can Be Doing Later In Life
“Staying active can help lower your risk of breast cancer. In fact, regular exercise can halve your risk and maintaining an optimal weight is also crucial. Around the time of menopause, resistance exercise is often more beneficial than intensive exercise. Regular exercise both significantly reduces the risk of breast cancer as well as reduces risks of recurrence after breast cancer treatment. Plus, excess body fat can also mean excess levels of estrone, one of the more inflammatory types of oestrogen. Insulin resistance is also at the root of obesity, and as well as its role in blood sugar regulation, insulin can also send growth signals to other cells in the body, and its role in developing different types of cancer is increasingly being recognised. Lowering sugar intake and refined carbs can be helpful.” – Monica
Supplements Could Also Be Worth Taking
“Studies show adequate vitamin D3 levels may have some protective effect against breast cancer. Foods rich in beta carotene, such as carrots, lentils and mangoes, also reduced the risk by 17% in one study. While more research is needed, eating antioxidant-rich foods and eating a rainbow of vegetables is undoubtedly beneficial.” – Monica
Mammograms Aren’t Faultless
“Although not perfect, mammograms remain the gold standard for screening. In England, you will be invited for a mammogram every three years between the age of 50 to 71, but you can ask to continue to have one after that age, too. A mammogram does not detect all breast cancer, but the chance of detecting an underlying cancer increases with age, as the breast becomes less dense. In postmenopausal women, a mammogram will pick up more than 80% of all breast cancers. Mammography is the only validated screening test for detecting breast cancer in asymptomatic women, and women deemed to be at a high risk of breast cancer are also offered MRI screening. Breast ultrasound is not a valid test for screening.” – Professor Gordon Wishart, chief medical officer and CEO of Check4Cancer
Symptoms Are The Same, Regardless Of Age
“The symptoms of breast cancer are the same pre- and post-menopause. For many women, it can appear as a lump or thickening in the breast tissue. This may be in the breast itself, upper chest, or armpit. Other signs include dimpled skin, swelling of all or part of the breast, nipple changes, redness and heat, skin irritation or texture change, and bloody discharge from the nipple. For every ten women with breast cancer, nine will have surgery, six will have radiotherapy and three will have chemotherapy.” – Lester Barr, consultant breast surgeon and founder and chairman of Prevent Breast Cancer
Checking Yourself Remains Imperative
“Get into the habit of checking your breasts for lumps on the same day every month. Most lumps are harmless but, if they are cancerous, then the earlier they are diagnosed and treated, the better. Use your right hand to feel your left breast, and your left hand to feel your right breast. Keeping your index and middle fingers flat and together, using circular motions, feel your breast – from side to side, from the collarbone to the top of your abdomen and from your armpit to your cleavage. Begin at the nipple, moving towards the outer edge of the breast. Make sure you cover the whole breast. Do the same in your armpit area too. If you notice any lumps, bumps, swellings, discharge or abnormalities, including changes in colour or texture to your breasts, armpits or nipples, see your GP.” – Gordon
MY BREAST CANCER EXPERIENCE: Kerri, 67
“I had always thought breast cancer was one of those things that happened to other women, not me, so was shocked to discover I had an eight-month-old tumour following a mammogram five years ago. Breast cancer wasn’t something that ran in my family and I was vaguely aware of the risk factors, such as alcohol intake and weight. However, despite several of my friends having been diagnosed and treated, I was always in the ‘it will never happen to me’ group, and breast cancer wasn’t something I gave much thought to.
“I was called back for scans and biopsies following a routine mammogram and, once my cancer had been diagnosed, I was given the option of radiotherapy. My surgeon and oncologist explained that the type and size of my tumour meant that the best course of action was an excision (lumpectomy), radiotherapy and hormone therapy. I knew nothing about radiotherapy before I started and, to this day, I cannot thank the staff at the radiotherapy unit enough – they were fantastic and helped me every step of the way.
“The biggest shock was having to have two tattoos – these were effectively two small dots which acted as a marker for the radiotherapy. I had 15 sessions of radiotherapy over a month – each session took 15 minutes and, of that, only two minutes were radiotherapy. It was painless, and the only issue was that after around ten sessions it became sore around the bra area – but wearing wire-free bras helped. I kept myself positive by thinking each session was killing off any stray cancer cells.
“In the time since my diagnosis – it’s been four-and-a-half years – I am now much more aware of my body and what I can do to be in the best place, healthwise. I still go for a mammogram every year and, the first year, my results weren’t quite normal. I was called back for further scans, but this just showed some scarring from the original operation. When you’re diagnosed, you’re allocated a ‘breast care nurse’, and she is still my go-to person if I have any questions or worries. Next year will be the fifth anniversary of my diagnosis, and after that I’ll revert to the usual three-yearly mammograms. Even though I’m older, there is still a chance it will come back. Keeping fit has kept me strong, both physically and mentally – studies show staying active will strengthen the body and keep it from a relapse. Prevent Breast Cancer has been a huge support throughout my journey, too.”
MY BREAST CANCER EXPERIENCE: Angela, 60
“I was 58 when I was diagnosed with breast cancer, and received my diagnosis on 11th March 2020, the day coronavirus was declared a pandemic. Around 12 years ago, I discovered a harmless cyst, leading to a diagnosis of fibrocystic breasts (benign changes in breast tissue that can cause lumps), but had never previously had a cancer scare. Breast cancer runs in my family – both my aunt and cousin have had it – however I had been tested for the hereditary gene and this came back negative. My cancer was diagnosed after attending a routine mammogram.
“Following my diagnosis in March, I underwent a mammoplasty in June, which was followed by five sessions of radiotherapy at specialist cancer care provider, GenesisCare, which took place once a day over the course of a week. The following September, I had a symmetry reconstruction surgery. My experience of undergoing surgery and treatment during a national lockdown meant support from friends and family was virtual and limited to screens. This wasn’t easy and, as a result, meant I relied much more on medical staff to help me through the process.
“Getting a mammogram may be temporarily uncomfortable, but it’s nothing compared to the potential consequences of skipping it and letting something go undetected. At the same time, checking yourself is still vital – get to know what’s normal for you so you can better spot any abnormalities or changes.”
For more information and support, visit PreventBreastCancer.org.uk, Livi.co.uk, MarionGluckClinic.com and GenesisCare.com. Check4Cancer is available via myGP, the UK’s largest independent healthcare management app.
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