Tag: Premenopausal

Pre- and Postmenopausal Breast Cancer — Hey, Talk About the Difference, Would’ya?

This follows on the heels of my last post, which discussed a couple of things that doctors say to cancer patients that I wish could be handled differently. Today’s post is specific to breast cancer and deals with menopausal status.

Okay, okay, the last time I wrote about this I concluded that healthful living was important regardless of whether you were staring down breast cancer before or after menopause. But I need to back up a bit, because there’s more that needs to be said.

It is a fact that the risk factors we hear about the ones associated with postmenopausal breast cancer, as are the recommendations for decreasing your risks. It took literally months for me to fully comprehend this.

Wish I’d known that earlier! Following my diagnosis, I beat myself up trying to understand what I did “wrong”, when in fact, I was doing everything “right”. I hadn’t worried about breast cancer because according to the informational breast self-exam card hanging in my shower, my risk was super-low.

Well, yeah, it was. For postmenopausal breast cancer.

It was only later, talking to my clinical counselor, that she described younger women at informational sessions for new breast cancer patients, looking dazed and not understanding why they were there. Vegetarians, non-drinkers, non-smokers, active exercisers, lean and fit. Isn’t that the lifestyle that we’re supposed to live in order to reduce our cancer risk? You mean it might not work?

The reality is that all bets are off for premenopausal breast cancer. The average age at diagnosis is 63, which means that there are a lot more postmenopausal women with cancer who have been studied, and so there’s more that we know about them. And that’s why everyone talks about them. For them, higher bodyweight is positively correlated with development of cancer, but higher weight in premenopausal women has a mildly protective effect. What’s up with that?!

I was already a full year into this blog, which I started a year after finishing my chemo, and I was STILL ranting about those stupid risk factors that mean nothing. But the truth was that I hadn’t yet connected the dots about menopausal status and cancer risk. My medical team kept saying things like “you’re still young”, and I didn’t understand what they meant by that, until my clinical counselor mentioned that things didn’t go as anticipated for younger (read: premenopausal) women.

So my anxiety about what I did to bring cancer upon myself could have been brought down a few notches (and my early posts on this blog would have been less acrimonious) had I known that the preventative information is aimed at women in a different stage of life.

Instead, I was frantically asking, “What should I do now? What should I change?” and was perplexed by the response: “Just keep doing everything that you’re doing!” “But that’s what gave me cancer!” (Obviously, it wasn’t, but in my mind, there was some preventative measure I hadn’t taken that left a crack open for cancer to squirm through.)

So, okay, no one knows exactly what causes breast cancer in an individual, and this is not the post to attempt tackling that question. But truly, it would help if doctors would admit that the view is *even* fuzzier if you haven’t yet gone through menopause. Psychologically, I would have been able to cut myself some slack, and perhaps it would have, just a teensy bit, eased that frustrating sense of helplessness.

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This is probably a good place to remind everyone that, even with everything we know about cancer and how it develops, there’s still so much we don’t know. Genes, environment, the alignment of the planets…who knows where the blame really lies?

Pre- vs. Postmenopausal Breast Cancer Risk: There’s a Difference, But Does It Matter?

You’ve probably seen those plastic breast self-exam cards you hang on your showerhead as a reminder to feel for lumps on a monthly basis. I have one myself, and would read it over and over when I was trying to decide whether my lump was worrisome, reviewing the “reduce your risk” tips the card offered.

However, there are two points that I wasn’t aware of at the time that I was diagnosed: (1) we know little about causal factors, as most studies that examine risk are only correlational; and (2) there’s a difference between being premenopausal vs. postmenopausal when talking about breast cancer.

Okay, there’s a third one too: (3) risk factors don’t mean squat when I’m talking about my personal diagnosis.

First, a well-known fact: postmenopausal women make up the majority (approximately 2/3) of these cancer cases, so it’s not surprising that the focus is on them.

I, however, was premenopausal when I felt the lump in my left breast.

Imagine my surprise, then, when I learned that while being overweight or obese is a significant risk factor for postmenopausal women, being overweight as a premenopausal woman seems to offer protection against the disease. Whereas I thought I didn’t have any risk factors for breast cancer, as suggested by that plastic card in my shower, perhaps I did.

There’s not much talk about that protective element of weight for premenopausal women. You would be hard-pressed to find a popular website that mentions it. And no doctor would encourage a premenopausal woman to carry extra weight on the off chance that it might lower her risk of breast cancer; it’s too much of a liability for other health issues, including other cancers.

This explains why, if you’ve gone to a gathering of newly-diagnosed breast cancer patients, you’ll see some younger, remarkably fit women looking a little dazed and wondering what they’re doing there.

The weight risk factor is often posed in the following way (from the Mayo Clinic site): “Overweight and obese women have a higher risk of being diagnosed with breast cancer compared to women who maintain a healthy weight, especially after menopause.” Well, that’s not wrong, but it doesn’t tell the entire story.

Harvard Health Online puts it differently, with a caveat: “Being overweight or obese has been linked to breast cancer risk, especially for women after menopause, but the relationship is complicated. It may be that risk is increased in women who gain weight in adulthood but not in those who’ve been overweight since childhood.” That seems even more confusing and less reassuring.

It’s true that everything about cancer is complicated. If it were straightforward, we would have found a cure by now. Furthermore, when it comes to guidelines to follow, people don’t want details, they want sound bites. But simplification cuts out information. For example, this CDC webpage about what you can do to lower your breast cancer risk posts recommendations geared for older women, including maintaining a “healthy weight”, but the photo that’s shown is clearly of two younger women.

Even a cursory glance at the research reveals what a difference menopausal status makes. In addition to extra weight seeming to have a protective effect in premenopausal women (Cold et al., 1998, Eur J Cancer; Lahmann et al., 2004, Int J Cancer), it’s also been determined that greater red meat consumption in adolescence is significantly associated with increased risk of breast cancer in premenopausal women (Farvid et al., 2015, Int J Cancer). Interestingly, higher quality diets have a more beneficial effect on the risk of postmenopausal women and seemingly no effect on premenopausal ones (Haridass et al., 2018, J Nutr). I would expect that a more exhaustive search would yield even greater differences.

Live as if your life depends on it.

So what does this tell us? This is less about the specific differences between pre- and postmenopausal breast cancer risk, and more that there simply is a difference. At this point in our knowledge, we are still putting together pieces of the cancer puzzle.

Additionally, many studies that offer preventative guidelines are based on other studies–they may be meta-analyses of previously collected data from a broad range of subjects. The data may be self-reported, which may result in recall error. And when you have a sample size of ~30,000 women, you’re talking about general risks for populations, not a specific risk for a specific, and very unique, individual: you.

All this sounds exasperating, but one concept holds true: no matter what your risks, the healthier you are before you’re diagnosed with cancer, the better your outcome compared to someone with less healthful habits, should you get the disease. Instead of obsessing about possible risk factors, give yourself the respect you deserve–put the effort into improving lifestyle habits to grant yourself the best chance for survival. In the end, that’s what matters.