Five years ago I felt a lump in my right breast and was later diagnosed with stage 3 breast cancer. The cancer was hormone positive, so in addition to chemotherapy, radiation, and double mastectomy, I took medication to block the production of estrogen in my body – and went into early menopause at the age of 33.
Since there was this pesky cancer to deal with, it wasn’t until one afternoon that I really thought about menopause. I was at work typing away when an intense warmth spread through my body – as if my insides were being turned over hot coals. The heat was palpable and streams of sweat gathered in the space between my breasts. I made my way quickly to the bathroom, avoiding eye contact with colleagues, when droplets of sweat rolled down my knees southward.
In many menopausal women, symptoms such as hot flashes and vaginal dryness can be intense and last for years. And for some women, breast cancer risk may increase when they enter menopause.
A recent study by the Susan G. Komen Foundation found that the risk of breast cancer increases in women who later enter menopause. The risk of breast cancer increases by about 3% each year as a woman ages through menopause.
Dr. Sabrina Sahni, a clinical assistant professor in the Department of Gynecology and Reproductive Biology at Cleveland Clinic’s Lerner College of Medicine and a member of HealthyWomen’s Women’s Health Advisory Board, said the study shows that certain risk factors are simply beyond our control. “But what can we do to reduce our risk – that should really be the focus,” she said.
Risk factors and menopause
Many factors in breast cancer development cannot be changed, including age, family history, and race.
However, there are risk factors that you can control starting with the diet. The 2019 Women’s Health Initiative Study, the first randomized clinical trial to link diet changes and a lower risk of dying from breast cancer, found that postmenopausal women who had less fat in their diet had a 21% lower diet Are at risk of dying from breast cancer.
It is important to note that no food or diet can prevent breast cancer. However, if the general goal is to keep your body healthy, dieters recommend consuming more than five cups of fruits and vegetables a day and avoiding processed meats, charred or smoked foods.
Smoking and alcohol can also increase the risk of breast cancer. A 2017 study published in Breast Cancer Research found that women who smoke for more than 30 years increased their risk of developing breast cancer by 22%.
Alcohol consumption has been linked to an increased risk of breast cancer in both pre-menopausal and post-menopausal women, in many cases because alcohol reduces your liver’s ability to control the levels of the hormone estrogen in your blood, which can increase your risk.
Perhaps the most important factor that women need to consider when entering menopause is weight. Research has shown that a high body mass index (BMI) is linked to a higher risk of postmenopausal breast cancer because postmenopausal adipose tissue becomes the main source of estrogen in the body, which can increase the risk.
“Obesity is a major contributor to cancer risk and it is becoming one of the most serious health problems in the world,” Sahni said. “Weight management and increasing physical activity are the two most important things women can do to reduce their risk of cancer.”
The American Cancer Society recommends 45 to 60 minutes of exercise five or more days a week. Recent research suggests that physical activity significantly reduces the risk of breast cancer in both pre-menopausal and post-menopausal women.
The link between obesity and breast cancer particularly affects black women. According to the U.S. Department of Health, black women are 50% more likely to be obese than non-Hispanic white women. According to research by the American Cancer Society, black women are twice as likely to die of breast cancer as white women when they are over 50 years old. This is roughly the age at which most women begin menopause.
Social and economic differences, such as access to health care and treatment options, also play an important role for black women, along with the risk factors to which all women are exposed.
“My biggest concern is the impact of the obesity epidemic on the African American population,” Sahni said. “It all goes back to weight management, optimizing physical activity, and emphasizing the importance of routine mammography screening.”
The question of hormone replacement therapy
Sahni, who also specializes in treating perimenopausal and menopausal disorders, said hormone replacement therapy (HRT) is a safe and effective treatment for many women. Symptoms – including insomnia, osteoporosis, and irregular periods – may improve with HRT, and women should discuss options with their doctor.
The use of systemic hormone therapy is generally not recommended in women with a history of breast cancer. However, this doesn’t mean you need to sweat in silence.
“Things like vaginal estrogen specifically for vaginal and urinal symptoms may actually be considered in conjunction with a woman’s medical oncologist,” Sahni explained. “Try the non-hormonal options first. If that’s not enough, you know we have many different options to help you.”
For those of us who still soak our sheets at night, Sahni said new non-hormonal agents are on the way. “There’s one in the pipeline that’s in clinical trials. I hope we have another exciting option for treating menopausal symptoms in women with a history of breast cancer,” Sahni said.
Menopause is difficult enough, and while there is no surefire way to prevent breast cancer, women can reduce their risk by quitting smoking, limiting alcohol levels, and maintaining a healthy lifestyle.