Does Menopause Affect Breast Cancer Risk?
Donna Scott wasn’t expecting her life to change when she showed up for a routine mammogram at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System. When the radiologist noted “an area of concern” that turned out to be ductal carcinoma DCIS breast cancer, she was overwhelmed. Fortunately, Scott was diagnosed early, and her health care providers quickly circled the wagons.
“Two surgeons, a radiation oncologist, and a medical oncologist formed a team. Their kindness, patience, and optimism helped me get through my diagnosis,” she says.
After a lumpectomy and radiation, Scott was prescribed tamoxifen, an estrogen-blocking medication often given to women with hormone receptor-positive breast cancer. Estrogen and progesterone hormones stimulate growth in this type of cancer.
Although Scott was just 50 and still having regular periods, her physician told her the drug would probably initiate menopause. The tamoxifen didn’t bring on hot flashes or sleep disturbances, but her periods did become irregular.
“My oncologist did a hormone panel (blood test) which showed I was perimenopausal,” Scott says, adding, “She discussed the importance of maintaining a healthy body weight – the risk of breast cancer is higher when a person carries excess weight. My oncologist also emphasized exercise and healthy eating.”
The link between lifestyle and health
Scott listened. “Once I was diagnosed, I completely changed my lifestyle. I lost 30 pounds and began walking daily. I participate in Sylvester survivorship programs like yoga and music therapy to manage stress. I truly feel all the changes I have made are preventing a recurrence thus far.” She was diagnosed in 2019 and remains cancer-free to this day.
It sounds simple, but as Amanda Rivera, M.D., a radiation oncologist at Sylvester, says, “Lifestyle is a huge component, especially for women with estrogen receptor-positive breast cancer. Obese patients are especially at risk because estrogen is partly produced in adipose (fatty) tissue. And in addition to maintaining a healthy weight and eating healthy, not drinking or drinking in moderation is advised.” Studies show at least seven different cancers are linked to alcohol use. “Cancer doctors have known this a long time,” Dr. Rivera says.
The chances of getting breast cancer increase with age, often just as a woman enters perimenopause or menopause.
“Most of my patients are menopausal, but if not, cancer treatments such as endocrine therapies and chemotherapy can send them into menopause,” Dr. Rivera says. These complicating factors are why Dr. Rivera and her colleague, Catherine Welsh, M.D., a medical oncologist at Sylvester, want to increase awareness of this topic.
“Menopause itself does not cause breast cancer,” Dr. Welsh says. However, “Prolonged, uninterrupted exposure to estrogen is associated with an increased risk.”
If you started menstruating early (before age 12) and/or started menopause late (after 55), your risk is higher. Likewise, Dr. Welsh says that “Long-term hormone replacement therapy (HRT) during menopause has been shown to significantly increase the risk of breast cancer.”
Estrogen exposure isn’t the only reason a woman is more likely to get breast cancer.
Genetics is also a factor. About 10% of breast cancers are heredity or linked to genetics. “A family history of breast cancer in a first-degree relative (parent, full sibling, or offspring) or multiple family members with breast cancer present a much higher risk than early menarche/late menopause – whether or not a genetic cause is identified,” Dr. Welsh says. If a close blood relative or family member developed the disease before age 50, Dr. Rivera says, this also increases your risk.
Several genes are associated with an increased likelihood of breast cancer.
“This can range from a slight to very high increased risk, depending on the gene and other factors. Patients without breast cancer who test positive for the BRCA 1 or 2 genes fall into the very high-risk category and should seek advice from a physician experienced in genetics and breast cancer,” Dr. Welsh says.
Depending on the patient, Dr. Welsh says a physician may recommend “risk reduction surgeries, estrogen-lowering medications and hypervigilant surveillance with advanced imaging to detect tumors at an early stage.”
Mammograms usually begin at age 45 but can start earlier in high-risk individuals. For people with the BRCA 1 or 2 gene, Dr. Welsh says, “A breast MRI is usually performed in addition to a diagnostic mammogram to increase surveillance sensitivity.”
The Tyrer-Cuzick Risk Calculator is another tool to assess and mitigate the danger. “Used under a doctor’s supervision, we enter a person’s individual risk factors into the calculator to determine their level of risk,” Dr. Rivera says.
As Scott learned, there’s a catch-22 when you’re a woman of a certain age diagnosed with breast cancer.
Dr. Welsh explains the conundrum. “Since most breast cancers are sensitive to estrogen, a common treatment is ovarian suppression or use of anti-estrogen medications. As a result, these patients often experience premature or worsening menopausal symptoms because we’re suppressing ovarian function. However, we generally do not recommend estrogen replacement therapy because it may oppose our treatment.”
Does that mean you have to live with hot flashes, sleep disturbances and other menopausal annoyances?
Not necessarily.
“There are several nonhormonal solutions. Sylvester has an entire clinic dedicated to helping cancer patients with menopausal symptoms and sexual dysfunction. Known as the Menopause, Urogenital, Sexual Health and Intimacy (MUSIC) Program, it was established and is run by Dr. Kristin Rojas, a nationally known breast cancer surgeon. This clinic is extremely popular and a huge help to patients suffering from menopausal symptoms,” Dr. Welsh says.
Some of the solutions offered at the clinic include low-dose vaginal estrogen, which Dr. Rivera says is safer than oral HRT medication. “Coconut oil or hyaluronic acid lubricant applied to the genital tissue can help relieve vaginal dryness. For hot flashes, sleep difficulties and irritability, we see success with some antidepressant medications such as venlafaxine,” Dr. Rivera says. When she sees a patient struggling with menopausal symptoms, she refers them to the MUSIC clinic.
Another problem associated with early menopause is the rapid loss of bone density, which can lead to osteoporosis and decreased muscle mass. “Getting adequate nutrition, including vitamin D, calcium and protein, as well as regular weight-bearing exercise helps alleviate these losses. Sometimes, bone-strengthening medications are also recommended,” Dr. Welsh says.
Though Scott is beginning to experience “mini” hot flashes and sleep disturbances, her menopausal symptoms aren’t extreme.
She attributes this to daily exercise, “eating healthy, avoiding sugar and alcohol,” a positive mental outlook and Sylvester. “It’s not easy getting a cancer diagnosis, but I’m blessed to take part in Sylvester’s survivorship program.”
She recently participated in a practice 5K walk at Fairchild Tropical Botanic Gardens as part of the Believe in You training program. The program helps prepare Scott and other participants to join the Dolphins Cancer Challenge 5K on February 22, 2025. The annual NFL event raises funds for cancer research at Sylvester.
“We met every Saturday for free training. It was a great feeling to be with everyone. I try to encourage people who are just diagnosed, and they inspire me,” Scott says. When newly diagnosed patients see Scott, a breast cancer survivor living her best life, they must feel inspired just when they need it most.
To learn more about cancer support services, visit the Sylvester Cancer Survivorship website or call 305-243-4922.
Nancy Moreland is a regular contributor to the UHealth Collective. She has written for several major health care systems and the Centers for Disease Control. Her writing also appears in the Chicago Tribune and U.S. News & World Report.
Watch Donna talk about her experience.
Read more about Sylvester’s survivorship program on InventUM.
Tags: Lifestyle changes for cancer prevention, Menopause and cancer treatment, Perimenopause symptoms, Sylvester Comprehensive Cancer Center
