Navigating breast cancer risk factors in menopausal women
11 October 2023
KUALA LUMPUR - Breast cancer remains a pressing health concern for women across the globe and there has been much discussion on how its impact may fluctuate when a woman is entering her menopause phase in life.
In Malaysia, breast cancer holds the unfortunate distinction of being the leading cancer among women. Statistics reveal that one in 19 Malaysian women face the risk of developing breast cancer at some point in their lives, resulting in approximately 3,500 lives lost annually.
Consultant Clinical Oncologist from Sunway Medical Centre Velocity (SMCV) Dr Hafizah Zaharah Ahmad said it is essential to understand that menopause itself does not inherently increase the risk of developing breast cancer.
Instead, she said, the risk of breast cancer increases with age and different seasons in a woman's life bring distinct hormonal changes.
These changes do play a significant role in breast cancer risk, primarily due to the influence of hormones like estrogen and progesterone on the breast tissue, she added.
Dr Hafizah Zaharah said high levels of estrogen, especially over a prolonged period, can stimulate the growth of breast cells and increase the risk of mutations that may lead to cancer.
"This is why factors such as early onset of menstruation, late onset of menopause and hormone replacement therapy are associated with a higher risk of breast cancer as they expose the breast tissue to estrogen for longer durations,” she added.
She said pregnancy and breastfeeding temporarily reduce a woman’s exposure to estrogen and may have a protective effect against breast cancer.
However, the risk may increase slightly after giving birth if the first full-term pregnancy occurs later in life,” she said in a statement issued by SMCV.
SMCV Consultant (Breast, Endocrine and General Surgeon) Dr Suziah Mokhtar said the risk can be divided into two key types of breast cancer - premenopausal, which is associated with a higher risk for Hormone-Receptor-Positive (HR+) breast cancer and postmenopausal, where there is an increased risk for Hormone-Receptor-Negative (HR-) breast cancer.
"Breast cancer tends to be more aggressive in younger, premenopausal women than in older, postmenopausal women. Menopause matters in terms of the specific treatments that might work for a patient,” she said.
Dr Suziah said premenopausal HR+ women may benefit from medicines that block the action of estrogen, but fortunately for postmenopausal HR+ women, alternative medicines that lower estrogen levels may also be used.
She said when premenopausal HR+ women are considered to benefit from estrogen-lowering medicine, chemical menopause can be achieved by using a drug that acts on the brain to suppress ovulation and the production of ovarian hormones.
Some women, she said, may suffer badly from perimenopausal symptoms such as hot flashes, sleep problems and vaginal dryness and they may opt to use a combination of hormone replacement therapy which will alleviate their symptoms, but can slightly increase the risk of breast cancer.
Thus, the breast cancer risk gets bigger, the longer hormone replacement therapy is used, she added.
Dr Hafizah Zaharah said a healthy lifestyle is the key to managing a host of health issues, but it is even more essential in cancer care, adding that fat in a woman’s body converts certain substances in the blood into female hormones, which in return drive breast cancer growth.
"Obesity disturbs the hormonal balance in the body. As we gain excess weight, more insulin, a hormone produced by an organ known as the pancreas has to be secreted to prevent excessive rise in sugar levels.
"Apart from controlling the sugar level, insulin increases cell production and reduces cell death. That means there is more opportunity for something to go wrong in the body and for cancer to develop,” she said.
Dr Hafizah Zaharah also shared some of the common misconceptions about incidences of menopause and breast cancer, such as menopause acts as a shield against breast cancer or that mammograms are no longer necessary for menopausal women.
"Breast cancer risk does increase with age, and the risk is higher for women who have not experienced menopause, but it does not mean that menopausal women are completely immune.
"In fact, breast cancer can and does occur during and after menopause,” she said adding that regular mammograms remain crucial and life-saving for menopausal women.
Another misconception, she said, is that many women assume all breast lumps as cancerous when in fact the majority of breast lumps found during menopause are benign (non-cancerous).
However, she cautioned that a healthcare provider should evaluate any new lump to rule out cancer.
Both experts also emphasised the importance of early detection and diagnosis of breast cancer.
According to Dr Suziah, regardless of a woman’s menopausal status, mammograms and breast ultrasounds are pivotal for early detection, often identifying cancer years before it becomes palpable.
Meanwhile, Dr Hafizah Zaharah said it is essential to remember that while hormonal factors are significant, breast cancer risk is multifactorial, ranging from genetics, family history and even environmental factors.
She also said that regular breast cancer screening and consulting with healthcare professionals can help assess and manage risks effectively.
"Adopting a healthy diet, typically high in fibre and low in fat may indirectly lower a woman’s risk of getting breast cancer through the lower incidence of obesity.
"Women who were treated for the early stage breast cancer are also less likely to suffer a relapse of cancer if they adopt a healthy lifestyle with high fibre and low-fat diet,” said Dr Hafizah Zaharah, adding that adequate exercise and avoiding excessive weight gain also helped to reduce the risk of breast cancer.
Sunway Medical Centre Velocity is located at Lingkaran SV, Sunway Velocity, Kuala Lumpur.
For more information and inquiries, please contact Sunway Medical Centre Velocity at +603 9772 9191 or email [email protected]. Visit visit www.sunmedvelocity.com.my and follow on Facebook: Sunway Medical Velocity. - BERNAMA
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