Sunday, November 1, 2009

Breast cancer and menopause

Breast cancer and menopause:
The questions most women ask


MOST women seem to have the same concerns about breast health as they approach menopause. They want to know:
- whether there are increased risks of breast cancer in menopause;
- more about breast pain, breast cysts, breast lumps and swelling;
- whether breast exams and mammograms are necessary anymore;

It’s completely understandable that these questions arise at menopause — a time when many women begin to see the world differently. The way we perceive our breasts is part of this transition. While all changes in our bodies can be cause to pay attention, let’s begin by addressing the most frequently asked questions about breast changes during menopause.

1) Am I more susceptible to breast cancer now that I’m in menopause?

While the chance of getting breast cancer does appear to increase with age when everyone is pooled together, promising research indicates that this history may be about to change: researchers are now discovering that the past increases may actually have been due mostly to exogenous oestrogen exposure in pills — and, since that is now decreasing, breast cancer rates may actually be going down for post-menopausal women.

However, it’s unlikely that the direct cause for every woman with breast cancer is purely oestrogen-related. It seems that way because women get breast cancer far more often than men, causing some to worry about the levels of the hormone in our bodies. But when the body’s hormonal balance is off, it’s essential to approach every woman’s experience holistically. Usually there is no single hormone or aspect of the body to blame: we must consider our changing eostrogen, progesterone, and testosterone levels, alongside many other factors, to paint a complete picture of healthy hormonal balance.

While some risk factors are beyond our control, we can all create better breast health in menopause by getting to know our breasts (and our bodies) as well as we can. Finding a breast lump doesn’t automatically signify cancer — far from it. And being on familiar terms with your breasts to detect anything unusual early on is one of the many ways you can positively influence your breast health. Postmenopausal breast cancers are usually much less aggressive than those of younger women, and often highly treatable. Older women usually have more options — and less invasive options at that. Recent reports also have suggested that some breast cancers may disappear on their own, raising the possibility that we may be over diagnosing and over treating some women.

2) Why are my breasts painful or extra sensitive?

Most breast pain or sensitivity is completely normal and shouldn’t persist for more than a day or two — a week at most — but it can be a very real concern for women who experience it regularly. Although breast pain is highly unlikely to be a sign of cancer, if you have any concerns, visit with your healthcare practitioner to rule this out. At this point, we don’t know enough about why breast pain happens but regular cyclical mastalgia is likely due to the changing hormones we experience with our monthly cycles. Similar to nipple tenderness in pregnancy, increasing breast tenderness may be an early sign of perimenopause.

Breast pain can reach new heights during the perimenopause years but usually diminishes significantly once one’s periods cease. During menopause, breast pain can appear for the first time, or it can happen less, or stop altogether. Some women correlate lots of fatty foods or coffee with how much breast pain or sensitivity they feel, and what we eat truly does influence our hormonal balance. The sheer weight of the breast can cause some women increased pain.

If you’re experiencing breast pain unrelated to menstrual cycles, have it checked out. A new lump that appears suddenly and is painful is most likely a fluid-filled cyst, which is common during perimenopause and can be addressed with an ultrasound or aspiration. General swelling in the breasts after menopause can indicate a fluid problem, thyroid issue, or other metabolic concern and, again, should be looked into by your healthcare provider.

3) Are breast exams and mammograms necessary after menopause?

Studies show that women who perform regular breast self-exams find the vast majority of breast masses. Examine your breasts once a month, and if it helps you to stay in the habit, you can do it on the same day each month. Or do it a few days or a week after each period, when breasts are less sensitive and tender. It’s wise to continue periodic exams and mammograms after menopause.

1. Breast health factors we cannot always influence:

*Gender.
*Age.
*Genetic history.
*Personal health history.
*Race.
*Inadvertent exposure to environmental oestrogens.
*Past pregnancies and breastfeeding history.
*Past use of BCP’s or HRT, and DES exposure.

2. Breast health factors we can influence:

*Performing regular self-exams.
*Finding our healthy body mass.
*Raising vitamin D and calcium intake — while studies of the nutritional benefits of vitamin D and calcium are not crystal clear, research links higher intakes with lower risk of developing breast cancer.
*Eating soy and leafy greens from the Brassica family — a good nutritional start for many women.
*Getting plenty of sleep in a dark room.
*Getting regular exercise and body movement.
*Lessening or (even better) eliminating alcohol and tobacco use.
*Managing oestrogen exposure, current oral contraceptive or HRT use.
*Healing negative emotional patterns that create stress and anxiety.

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