How Is Breast Cancer Different Before and After Menopause?

With 1 in 8 women devel­op­ing breast can­cer at some point in their life, breast can­cer is the most com­mon form of can­cer in women in the US oth­er than skin can­cer. But despite how com­mon it is, it affects each woman differently. 

One sig­nif­i­cant fac­tor in how breast can­cer affects a woman is her age and whether or not she has reached menopause — the time in her life where her men­stru­al peri­ods have ended. 

Breast can­cer is most often diag­nosed in mid­dle-aged and old­er women, with the medi­an age being around 63. While rare, it’s pos­si­ble for women younger than 45 to be diag­nosed with it. Since the tran­si­tion into menopause typ­i­cal­ly begins in a wom­an’s mid-to-late 40s, and the aver­age age of menopause is 52, this means that younger women with breast can­cer most like­ly have not gone through menopause yet. 

Being pre- or post­menopausal can shape a woman’s entire expe­ri­ence with breast can­cer. Here are some of the dif­fer­ences women may notice based on their age and when in their life they are diag­nosed with breast cancer: 

The Stage of the Can­cer When Diagnosed 

Women who are diag­nosed at a younger age are more like­ly to have can­cer that is at a lat­er stage when it is more dif­fi­cult to treat. Among women over age 65 who are diag­nosed with breast can­cer, 68% have can­cer in only the breast (mean­ing it hasn’t spread through­out the body). But that per­cent­age drops to only 47% among women ages 15 to 39. 

The Type of Breast Cancer 

There are sev­er­al types of breast can­cer, and some are more com­mon at cer­tain ages. 

Often, breast can­cer cells con­tain pro­teins called recep­tors” that attach to the hor­mones estro­gen or prog­es­terone, and allow the can­cer to grow. 

Around 80% of breast can­cers in post­menopausal women are dri­ven by estrogen. 

Pre­menopausal women are more like­ly to have estro­gen recep­tor-neg­a­tive can­cer and triple-neg­a­tive can­cer. The cells in these types of can­cer do not have estro­gen recep­tors, so their growth isn’t relat­ed to estrogen. 

So, why does estro­gen play a larg­er role in breast can­cers after menopause? 

Most estro­gen that a woman pro­duces comes from her ovaries, but that pro­duc­tion stops after menopause. By the time a woman has stopped men­stru­at­ing, she has like­ly been exposed to more estro­gen than a younger woman who has not been men­stru­at­ing for as long — and exces­sive or long-term expo­sure to estro­gen has been linked to an increased risk for breast cancer. 

This expo­sure is also a rea­son why women who got their first peri­od ear­ly (before age 12), or go through menopause after age 55, have a high­er like­li­hood of devel­op­ing breast cancer. 

If you have any con­cerns about breast can­cer, the providers at Duly Health and Care are here for you. Sched­ule an appoint­ment with your pri­ma­ry care provider or OBG­YN to dis­cuss your risks for breast cancer. 

Risk Fac­tors for Breast Cancer 

In women who have gone through menopause, one of the biggest risk fac­tors is tak­ing menopausal hor­mone ther­a­py — a form of ther­a­py used to treat symp­toms like hot flash­es and vagi­nal dry­ness. The ther­a­py may involve tak­ing estro­gen alone or tak­ing estro­gen com­bined with prog­estin (a syn­thet­ic hor­mone that mim­ics the effects of prog­es­terone). The com­bi­na­tion treat­ment has been linked to an increased risk of breast cancer. 

In pre­menopausal women, it’s less about hor­mones. The risk fac­tors are a lit­tle dif­fer­ent. They include: 

  • A per­son­al his­to­ry of breast can­cer or oth­er breast prob­lems, like atyp­i­cal duc­tal hyperplasia 
  • A fam­i­ly his­to­ry of close rel­a­tives with breast can­cer diag­nosed before age 45 
  • Muta­tions (changes) in the breast can­cer genes BRCA1 and BRCA2 
  • Dense breasts

Also read, Com­mon Ques­tions About Breast Can­cer Screen­ing & Risk Fac­tors 

The Rela­tion­ship Between Weight, Breast Can­cer, and Menopause 

Being over­weight after menopause can increase the risk of breast can­cer. After menopause, most of your estro­gen comes from fat tis­sue — and the more fat tis­sue you have, the more estro­gen you may be exposed to. 

Here’s where it gets a lit­tle com­pli­cat­ed: The risk for breast can­cer is actu­al­ly slight­ly low­er in women who were over­weight before menopause. How­ev­er, don’t reach for the cook­ies and piz­za just yet. Being over­weight comes with plen­ty of oth­er health risks, like heart dis­ease or type 2 diabetes. 

Treat­ing Breast Cancer 

The type of treat­ment often depends more on the stage of the can­cer. Most women with breast can­cer in stages I, II, and III are treat­ed with surgery. Many then go on to receive radi­a­tion and medication. 

Still, age can play a role, espe­cial­ly when it comes to hor­mone therapy. 

Women who have gone through menopause may be prescribed: 

  • Selec­tive estro­gen recep­tor mod­u­la­tors (SERMs), which stop estro­gen from con­nect­ing to can­cer cells 
  • Selec­tive estro­gen recep­tor degraders (SERDs), which bind tight­ly to estro­gen recep­tors and break them down 
  • Aro­matase inhibitors (AIs), which stop the body from pro­duc­ing most of its estrogen

Women who are pre­menopausal may be prescribed: 

  • SERMs
  • Ovar­i­an sup­pres­sion, which removes or shuts down the ovaries — the main source of estrogen 
  • SERDs or AIs, but only if also paired with ovar­i­an suppression

In addi­tion, pre­menopausal women often under­go fer­til­i­ty preser­va­tion (remov­ing and sav­ing their eggs so they can get preg­nant in the future) before treat­ment. Cer­tain breast can­cer treat­ments, like chemother­a­py, can dam­age a woman’s ovaries and cause tem­po­rary infer­til­i­ty or dif­fi­cul­ty get­ting preg­nant after treat­ment. Oth­er treat­ments involve remov­ing the ovaries entire­ly, which makes a woman post­menopausal and caus­es per­ma­nent infertility. 

Also read, The Care Team Who Sup­ports Your Breast Can­cer Treat­ment 

At any age, and no mat­ter the stage of the can­cer, it’s over­whelm­ing to be met with a can­cer diag­no­sis. There is a long road ahead of you — but with a team of providers who have your back the entire way, it isn’t a road you will walk alone. 

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