Breast cancer risks as you age

While we will all jump for joy the day a cure for breast cancer is announced, that is still a way off, though organisations such as the National Breast Cancer Foundation has a goal of zero deaths from the disease by 2030.

And while this is heartening news, until then, breast cancer statistics continue to be sobering. One in eight Australian women will be diagnosed by age 85. In 2018, more than 18,000 Australians will be told they have breast cancer, including about 150 men.

While these figures are a stark reminder that it is still the leading cause of cancer for women, experts say they don’t tell the whole story. Being told you have breast cancer is no longer a “death sentence” — something that might not have been thought possible 15 years ago.

It is true, though, that your risk of developing the disease increases as you age.

Dr Vivienne Milch, Director of Cancer Care at Cancer Australia, says the two main risk factors to getting breast cancer are being a woman and getting older.

She says three-quarters of all breast cancers diagnosed in Australia are women aged 50 or over. Reproductive risk factors include at what age your periods began and menopause begins, and if you haven’t had children.

While there are some other risk factors women can’t do much about — including a strong family history, and whether you carry the BRCA1 and BRCA2 gene fault — there are lifestyle factors you can control.

The most important lifestyle choices include staying a healthy weight, limiting your daily alcohol consumption, and not being sedentary. This ought to be an established goal before and during menopause, but the need to keep this in check is even greater once you’re postmenopausal.

Dr Milch says Cancer Australia recommends women maintain a healthy weight as being overweight or obese is a risk factor. “It’s thought that fat tissue increases the level of oestrogen in your body, and we know that as weight increases, so does the risk,” she says.

“We know that alcohol consumption is associated with an increased risk of breast cancer,” says Dr Milch. “If you’re drinking more than one standard glass of alcohol [10 grams] each day — whether that’s wine, beer, or spirits — that can increase your risk. Your risk increases with each additional drink so we recommend limiting your alcohol intake.”

Dr Milch says exercise has been found to be a “protective factor” against breast cancer, especially for postmenopausal women. Cancer Australia recommends that women undertake 30 minutes or more of preferably vigorous physical activity daily. But even moderate-intensity exercise every day helps.

“Women aged 55 or older who start menopause can have an increased risk compared with women who start menopause anywhere from 45,” says Dr Milch.

“We’d also suggest limiting the amount of sedentary behaviour such as watching TV to reduce your risk,” she says. Tobacco smoking or passive smoking may also be a risk factor.

Dr Fiona Simpson, lead breast cancer researcher at the PA Research Foundation, agrees that women need to be mindful of their lifestyle choices. “Weight loss and exercise are incredibly important and along with [reducing] alcohol consumption, they are the strongest modifiable risk factors for breast cancer,” she says.

But while trying to reduce risk factors can be beneficial, sometimes being diagnosed with breast cancer comes down to bad luck. “It can be easy to focus on the risk factors for breast cancer, but many women who don’t have any risk factors will still develop breast cancer,” says Dr Milch.

There are medical interventions possible, too.

“Women who are at high risk of breast cancer because of a very strong family history may benefit from hormones such as Tamoxifen, usually administered over five years. A bilateral prophylactic mastectomy can be considered in women at high risk of breast cancer due to gene mutations,” says Dr Simpson.

She says the good news is that women who are diagnosed with breast cancer today have a high survival rate, and that is only going to increase as treatments improve.

The latest five-year breast cancer survival rates show the percentages for each cancer stage, one being the least invasive. They are:

  • Stage 1: 98 per cent
  • Stage 2: 93 per cent
  • Stage 3: 72 per cent
  • Stage 4: 22 per cent

“Every month there are reports in the scientific literature of new breast cancer therapy success,” says Dr Simpson. “There are new therapies called 'checkpoint' inhibitors which bring your immune system in to kill the tumor cells. These types of new cancer immunotherapy and combinations of these with other treatments are increasing success rates.”

More than anything, Dr Milch says the message she wants to get across is that women can feel empowered to know there is a lot they can do to help themselves. Central to this is breast awareness.

She says women should get to know their breasts and regularly look for any changes. Early detection of breast cancer is central to better treatment options and greater chances of survival. She suggests doing a self-examination monthly, say on the first day of each month.

“Women don’t need to be experts,” says Dr Milch. “They don’t need any particular technique. But whether they’re showering, dressing, or looking at their breasts in the mirror, they need to learn what is normal for them.”

Women need to look for any changes they might notice during a self-examination. They include:

  •  A new lump or lumpiness, especially if it’s only in one breast
  •  A change in the size or shape of the breast
  •  A change to the nipple, such as crusting, ulcer, redness or inversion
  •  A nipple discharge that occurs without squeezing
  •  A change in the skin over your breast, such as redness or dimpling
  •  An unusual pain that doesn’t go away

If you notice a change, there is no need to panic. According to Dr Milch, most changes to your breasts are not due to breast cancer, but you should always get checked out by your doctor to find out what those changes might be.

Dr Milch says half of breast cancers are found through symptoms either picked up by individuals themselves or their GP.

Suzanne Dempsey*, a 60-year-old mother-of-two from Sydney, has a recent experience of this.

“I’d had a mammogram fairly recently, but I just happened to notice what seemed like a lump in my breast one day when I was at home, which I went and had checked out straight away,” she says.

After undergoing numerous tests, including a biopsy, she was told she has breast cancer. “The lump wasn’t picked up in the mammogram,” she says.

Some experts believe there has been too much focus on having free mammogram screenings every two years, with not enough emphasis on encouraging women to check their breasts regularly.

While specialists have given Suzanne a more than 90 per cent chance of recovery because the lump was found early, is small in size, and has not spread, she is currently undergoing weeks of chemotherapy, followed by radiotherapy. “I’ve been told that they are hoping that after three rounds of chemo, they’ll be able to see whether the treatment is working,” she says.

Dr Milch strongly recommends women aged between 50 and 74 have a free screening mammogram every two years. “That is the age group who would most benefit from this,” she says.

*Not her real name.

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To make an appointment for a free screening mammogram, call BreastScreen Australia on 13 20 50 for the cost of a local call anywhere in Australia.

For more information on breast cancer, visit Cancer Australia.

Dr Simpson supports Project Pink to raise funds for breast cancer research.