The idea of breast cancer haunts many women. Harboring memories of young family members or friends lost to its deadliest manifestations, they often assume a diagnosis of breast cancer means they'll also be fighting the same destructive disease. But a distorted fear of developing breast cancer can keep older women from taking positive steps to protect their health.
"The fear of breast cancer can be more disabling to the female population than it need be," notes Dr. Lesley Degner, professor of nursing at the University of Manitoba in Winnipeg. In fact, she muses, "it's ironic that women are terrified of breast cancer yet they're eight times more likely to have a heart attack.
Many women are afraid of taking hormone replacement for fear of causing breast cancer, yet we know in terms of longevity and quality of life that hormone replacement benefits virtually all women, except those with a very high family risk of developing the disease."
Breast cancer statistics
Statistically, a woman has a one in nine chance of developing breast cancer in her lifetime, based on her living to be at least 85. The risk of breast cancer is not constant throughout her life, however, but occurs with greater frequency as women age.
In older women it's more often a slower growing form, more responsive to treatment than in someone younger.
"Before menopause, it's likely to be genetically linked," explains Degner. (Women in families where several close relatives have had breast cancer at a young age and in both breasts, may have a genetic predisposition to developing the disease.) "Some [younger] women do well, but there's a lot who have a very aggressive disease, whereas with older women, it's part of aging."
The National Council on Aging reported that a survey of 1,000 women aged 45 to 64 indicated 61 per cent feared dying of cancer (especially breast cancer).
Only a quarter recognized that lung cancer, which is largely preventable, was actually the leading cause of cancer deaths in women. And less than 10 per cent of the 1,000 surveyed realized that heart disease was by far the greatest threat to their lives.
Ironically, in spite of this fear of breast cancer, postmenopausal women don't seem to recognize that aging is a risk factor for breast cancer and a compelling reason to continue to monitor their breasts. They also need to take responsibility for discussing breast health with their physician if the subject isn't raised during an office visit.
Learning to do breast self-examination properly is critical. Results of the Canadian National Breast Screening Study revealed that women who used a correct palpating technique were twice as likely to be free of lymph node involvement when diagnosed.
Those who included a visual inspection of their breasts were twice as likely to have tumors smaller than 2 cm in size than women who left out this step. (Both are positive factors in surviving breast cancer.)
The Canadian Cancer Society recommends that even after menopause women should examine their breasts at the same time each month and have their breasts examined by a health professional at least every other year. The society also advises women 50 to 69 to have a mammogram every two years.
There's no guarantee that screening will detect cancer, even if it is there. But an increasing incidence of breast cancer and a slight decline in mortality rates from the disease are indicators that screening programs and better treatments are having a positive effect.
"Breast cancer in women over 70 is very different than breast cancer in young women," says Dr. Steven Narod, chair of breast cancer research, at Sunnybrook and Women's College Health Sciences Centre in Toronto, Ont.
He points out that breast cancers in the elderly tend to be more readily treatable by surgery and tamoxifen (a hormone-blocking drug) than in younger women and if detected and treated early, they can be cured. Although women 70 or 75 do die from breast cancer, it's more likely they will die from other causes.
"If you're 50, what puts you at increased risk of having breast cancer is having few kids and a strong family history (of breast cancer). At 70, it's all related to your postmenopausal estrogen exposure, which means hormone replacement therapy."
Because of estrogen's effect on maintaining bone density in older women, Narod says "the strongest predictor of breast cancer in elderly women is strong bones.
"I think women should have a bone density at menopause to evaluate the risk for osteoporosis and have an evaluation of the risk for heart disease, based on lipid profile, cholesterol and family history," he says. "Everyone should have an evaluation of their risk for breast cancer, based on their family history and risk factor profile."
Nevertheless, he suggests postmenopausal women should be on one of four regimens: estrogen, estrogen plus progesterone, tamoxifen or roloxaphene (used to prevent osteoporosis).
The key lies in deciding which drug is appropriate. "In the best of all worlds," he says, "the choice of drug would take into consideration the woman's particular risk factor and her preference."
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