Your Breast Cancer and Menopause Questions Answered

“Age, or getting older, is the single greatest risk for getting diagnosed with breast cancer,” says women’s health expert Dr. Ricki Pollycove, M.D.

In fact, while a 30-year-old woman has a one in 227 chance of developing breast cancer during the next 10 years, a 60-year-old woman has a one in 28 chance, according to the National Cancer Institute.

Want to keep your breast cancer risk from mounting into menopause (show of hands, please)?

First, you need to learn the connection between your age, reproductive health, menopause, and breast cancer:

How Does Hormone Replacement Therapy Affect the Risk of Breast Cancer?
Before you let the headlines scare you, remember that not all forms of HRT are created equal, says menopause specialist Dr. Josh Trutt, MD, a healthy aging expert from PhysioAge Medical Group in New York City. Bioidentical hormones are associated with a lower risk of breast cancer—and they can actually lengthen your lifespan. “Avoiding estrogen therapy is killing women by the tens of thousands. Each year, heart disease kills eight times as many women as breast cancer,” Dr. Trutt says. In fact, according to the Kronos Early Estrogen Prevention Study, the average woman believes that breast cancer is the number one killer of women, leading to 39 percent of all deaths among women. However, heart disease is the true leading killer, contributing to 45 percent of all deaths among women. Breast cancer only leads to 4 percent.

How Does Hysterectomy Affect the Risk of Breast Cancer?
Here’s your silver lining: “Surgical menopause actually slightly lowers a woman’s risk for breast cancer. The basis for this lowered risk is not well understood, but it is one of the good-news aspects of the upsetting situation many women feel when they have to give up their uterus due to pain, diseases like severe endometriosis, or abnormal precancerous or cancerous growths,” Dr. Pollycove says. What’s more, one 2011 study from the University of Southern California, Los Angeles shows that removal of one or both ovaries is associated with a decreased risk of breast cancer.

What Is the Breast Cancer Survival Rate Among Menopausal Women?
“The older a woman is when diagnosed, the less likely she is to have a life-threatening cell type of breast cancer,” Dr. Pollycove says. Women with non-invasive cancers of the breast (which are the most common in women who undergo regular screenings) have a survival rate of 93 percent, according to the American Cancer Society. The key here, however, is early detection. (More on that next!)

How Often Should I Be Screened for Breast Cancer?
“The most important thing women can do to lower their chance of having their quality of life or lifespan affected by breast cancer is to get regular mammograms and at least an annual clinical breast exam by a provider,” says Dr. Pollycove. To confuse things, however, in 2009, the U.S. Preventive Services Task Force issued new guidelines stating that women younger than 50 didn’t need routine annual mammograms and those ages 50 to 74 should only get screened every two years. Before that, it said that all women aged 40 and older should get mammograms every one to two years—a recommendation the American Cancer Society, ASBD, ASPRS, many physicians, and, according to a new study, about half of women, still follow. In fact, a new analysis published in Cancer shows that half of all breast cancer deaths occur in women under the age of 50—most of who have never had a mammogram prior to diagnosis. Also, up to 25 percent of invasive breast cancers are found during self-exams, according to Dr. Pollycove.

What Breast Cancer Risk Factors Are Out of My Control?
While a family history of breast cancer or mutated BRCA1 and BRCA2 genes can be scary, knowing—and communicating to your doctor—your inherited, “not-going-anywhere,” risk factors is important in determining the right prevention plan for you, Dr. Pollycove says. Other risk factors include dense breast tissues and previous benign breast conditions such as hyperplasia of ductal or lobular tissue, cysts, and papillomas. What’s more, if you’ve never been pregnant or had your first pregnancy after age 30, your risk for breast cancer increases slightly, according to the American Cancer Society. Pregnancy and breastfeeding may influence cancer risk by altering hormone exposure to the breast tissues.

What Lifestyle Factors In Menopause Increase the Risk of Breast Cancer?
Anything that’s bad for your health is bad for your breasts. Some examples: smoking, being overweight or gaining weight at mid-life, living a sedentary or stressful lifestyle, eating a diet high in saturated fat, drinking more than seven to 10 alcoholic drinks per week, and eating few fruits and vegetables, says Dr. Pollycove. Her prevention prescription: Perform aerobic exercise for at least 20 minutes a day. That alone can cut your risk of breast cancer in half, she says. While you’re at it, check out these five ways to fight menopausal weight gain.

What Kinds of HRT Options Are Available for a Breast Cancer Survivor?
“All sorts of well-tolerated and easy-to-use therapies are available in the U.S. for breast cancer survivors. In a nutshell, local-only vaginal therapies are appropriate for virtually every woman who has bothersome symptoms and can be safely prescribed,” says Dr. Pollycove, who notes that it’s always best to have an oncologist or a perimenopause and menopause specialist review the particulars of your previous diagnosis before you fill any scripts.