Treating Breast Cancer After Menopause
Most women go through menopause in their 40’s or 50’s. It officially starts 12 months after your last menstrual period and signals the end of your ability to get pregnant. As a result of your body’s decreased production of the hormones estrogen and progesterone during this time, you may experience a variety of symptoms, such as hot flashes and a slowed metabolism.
Women of menopausal age are at an increased risk for breast cancer. Though menopause itself does not cause breast cancer, the chance of developing breast cancer increases the older you get. It also appears the longer your breast tissue is exposed to estrogen, the greater your breast cancer risk. For this reason, women who go through menopause later than the age of 55 and those who take hormone replacement therapy (HRT) to ease menopause symptoms may be at an increased risk of breast cancer.
If you are diagnosed with breast cancer after menopause, this can also affect your doctor’s treatment decisions. Some types of treatment are appropriate for women both before and after menopause. Others, however, are only used to treat postmenopausal women, because women who are still menstruating produce too much estrogen in their ovaries for certain treatments to be effective.
After receiving a breast cancer diagnosis, you’ll undergo several tests to learn more about your specific type of cancer. In addition to your menopausal status, these are some factors your doctor will consider:
- Stage of breast cancer: Your cancer will be given a stage from I to IV. This is based on the size of the tumor and whether the cancer has spread to the lymph nodes or other organs.
- Hormone receptor status: Your cancer cells are studied to determine if they have special proteins, called hormone receptors, which indicate if the cells need estrogen or progesterone, the female reproductive hormones, to grow. Your cancer may be referred to as ER-positive if it has receptors that attach to estrogen and PR-positive if it has receptors that attach to progesterone.
- Human epidermal growth factor type 2 receptor (HER2) status: Your cells will be checked for the HER2 protein. This protein is involved in cell growth and is found on some breast cancer cells.
- How aggressive the cancer appears: Your doctor will look at how rapidly the cancer is growing and if it appears likely to spread.
- Whether the cancer is new or recurring: Newly diagnosed cancer may be treated differently than cancer that has returned after remission.
You will likely receive multiple forms of treatment for your breast cancer. These are the most commonly used for all women, regardless of if they are pre- or post-menopausal.
- Surgery: Most breast cancer patients will have some type of surgery to try to remove the cancer. This may involve removing the tumor itself and any affected lymph nodes, or it may require a mastectomy—removal of one or both breasts.
- Chemotherapy: Chemotherapy uses powerful medication to destroy cancer cells, but it can also destroy normal cells in the process. It can be injected directly into your veins or given as a pill that you take by mouth. It may be given prior to surgery to help shrink the tumor or afterward in an attempt to kill the remaining cancer cells.
- Radiation: This is often recommended for women after they undergo a lumpectomy to remove the tumor. High-energy x-rays are directed at the tissue to destroy cancer cells and keep them from returning.
If you have hormone receptor-positive (HR-positive or HR+) breast cancer, you may also receive hormone therapy. The goal is to decrease the amount of estrogen or block it from attaching to the hormone receptors, so the cancer cells cannot grow. Hormone therapy may also prevent cancer from returning. Specific types of hormone therapy are approved for women after menopause.
A drug called tamoxifen (Soltamox, Nolvadex) is commonly used for its ability to block estrogen receptors in cancer cells. Toremifene (Fareston) and fulvestrant (Faslodex) are two other estrogen-blockers used in women with metastatic breast cancer that has spread throughout their bodies.
Aromatase inhibitors (AIs) work in a different way. After menopause, the amount of estrogen made by the ovaries decreases, but a small amount is still produced by an enzyme called aromatase. AIs stop aromatase from making estrogen. Three common AIs include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). Research suggests AIs may actually be more effective at reducing breast cancer recurrence and increasing survival in postmenopausal women.
Postmenopausal women are generally treated with hormone therapy for at least five years, though some studies recommend up to 10. You may receive both tamoxifen and an AI during that time.
Another emerging treatment known as targeted therapy attacks the cancer cells specifically, while leaving normal cells unharmed. Postmenopausal women who have hormone receptor-positive breast cancer are sometimes treated with targeted therapy in addition to hormone therapy. Palbociclib (Ibrance), everolimus (Afinitor), and ribociclib (Kisqali) are three examples. They block specific proteins that cause cancer cells to multiply.
A different type of targeted therapy has been developed to target the HER2 receptors, including drugs such as trastuzumab (Herceptin) and pertuzumab (Perjeta). They are used to destroy cancer cells in women with HER2-positive breast cancer.
Many options exist for treating breast cancer after menopause, but it may take some time to find what works best for your particular cancer. Researchers are continuing to study post-menopausal breast cancer and develop new ways to treat it, so consider talking to your doctor about participating in a clinical trial. Not only will your participation help the research process, it may provide you with access to cutting-edge treatments as well.