Cancer

• What are my risk factors for cancer with the onset of menopause?
• Are some kinds of cancer more common in menopausal women?
• What is the risk of breast cancer during menopause?
• Risk Factors for Breast Cancer
• Should I consider hormone therapy for my menopause symptoms if I have any of these risk factors?
• If I develop cancer while on hormone therapy should I stop that therapy immediately?
• Are my overall risks of cancer higher if I am on hormone therapy?
• Is my age a factor in breast cancer?
• When and where do I get screened for breast cancer?
• What is the Society of Obstetricians and Gynaecologists’ position on hormone therapy?

What are my risk factors for cancer with the onset of menopause?

While overall cancer risk specifically associated with the onset of menopause is minimal, the following factors need to be considered when assessing a women’s risk of cancer:

• Body weight (20% or more overweight)
• Age at puberty
• Age at first childbirth, especially if pregnancies were delayed
• Breastfeeding history
• Current age
• Alcohol consumption
• Dietary and environmental exposures
• Smoking
• Physical fitness
• Family history of cancer (presence of one or more affected first order relatives)
• Hormone therapy use

Are some kinds of cancer more common in menopausal women?

The most common cancers affecting women are breast, colon, endometrial, lung, cervical, skin, and ovarian cancers. There are screening tests for many of these cancers; menopause is a good time to make a plan with your doctor to screen for preventable cancers.

Health providers treating menopausal women have been particularly focused on the risks of endometrial and breast cancer, as these cancers are affected by the presence of hormones in the body. It has long been known that hormone therapy with estrogen alone increases the risk of endometrial cancer, so women with an intact uterus are prescribed both estrogen and progestin to mitigate this risk. Hormone therapy with estrogen and progestin for more than 5 years increases risk of breast cancer. Risk of colorectal and lung cancer is not affected by hormone therapy.

What is the risk of breast cancer during menopause?

There is an increased risk of breast cancer for women who have used combined hormone therapy for more than 5 years. This increase is of a similar magnitude to other common risk factors for breast cancer, such as your age of puberty, being older than age 30 when you had your first child, or being overweight. Hormone therapy increases the incidence of breast cancer by 1-2 women per 1000, after 5 years of usage. This risk is slightly greater than that caused by drinking 1 glass of wine per day, and slightly less than that caused by drinking 2 glasses of wine per day, being obese, or having low physical activity. The good news is that the absolute risk for any one person is small, and the risk returns to normal within five years after stopping hormone therapy.

Risk Factors for Breast Cancer

*Baseline or basic risk applies to all women and is due to factors that cannot be controlled (e.g., aging, gender)

And since all women face an increased risk of breast cancer as they age, it is important to participate in regular breast cancer screening programs to enhance your chances for early detection.

Women who smoke increase their risk of all types of cancer, including breast cancer. Quitting smoking is one of the best things you can do to reduce your risk of being diagnosed with cancer. Lung cancer is the biggest cause of cancer death in women. HT appears to be neutral on lung cancer incidence. 

Should I consider hormone therapy for my menopause symptoms if I have any of these risk factors?

Since every woman is different, your risk factors need to balance against your particular menopause symptoms and concerns. Sitting down with your doctor to review your medical history and assess your treatment options is the first step to deciding if hormone therapy is going to be right for you.

If I develop cancer while on hormone therapy should I stop that therapy immediately?

With the exception of meningioma (a brain tumour), breast cancer, and endometrial cancer, there is no biological evidence that hormone therapy may increase the risk of recurrence. Some cancers are known to increase the risk of blood clots in the veins and your doctor should advise you about this concern.

Are my overall risks of cancer higher if I am on hormone therapy?

A number of recent studies that followed women through their menopause years have shed new light on the topic of cancer risk and hormone therapy (HT). These studies provide new evidence that the risk of cancer for HT users is of no greater magnitude than for other predictors such as age at puberty or age at childbirth, or family history.

There is an increased risk of breast cancer for women who have used combined HT for more than five years. This increase is of a similar magnitude to other common risk factors for breast cancer, such as your age of puberty, being older than age 30 when you have your first child, or being overweight. The good news is that the absolute risk for any one person is small, and the risk returns to normal within five years after stopping HT.

Is my age a factor in breast cancer?

All women face an increased risk of breast cancer as they age, and as a result you should participate in regular breast cancer screening programs. If a woman lives to age 85, she will have a one in nine chance of developing breast cancer. Most breast cancers occur after age 60.

When and where do I get screened for breast cancer?

Screening programs for breast cancer are different in each province and territory in Canada. A mammogram is an important screening tool for the early detection of breast cancer.

Mammography is less accurate in picking up small cancers in women with “dense” breasts, and women who have naturally dense breasts do appear to have an increased risk of breast cancer. If you have dense breasts your doctor may recommend more frequent screening, or suggest additional ways of screening for breast cancer, such as ultrasound, or in some cases MRI.

Some women on hormone therapy (HT) may also have an increase in breast density that makes it harder to detect a small breast lump. For these women as well, breast ultrasound may be useful to help get a better “look” at the health of your breasts.

The Canadian Cancer Society recommends the following for mammogram screening:

If you are 40 to 49: Talk to your doctor about your risk of breast cancer, along with the risk and benefits of mammography

If you are 50 to 69: Have a mammogram every 2 years

If you are 70 or older: Talk to your doctor about how often you should have a mammogram

Be proactive: Ask your doctor about what is available in your area and how you can participate. You should also have regular Pap smears to screen for cervical cancer. Colorectal exams screen for cancers of the colon and rectum and are recommended for everyone over the age of 50.

What is the Society of Obstetricians and Gynaecologists’ position on hormone therapy?

After carefully reviewing scientific research on hormone therapy from Canada and around the world, Canadian obstetricians and gynaecologists recommend hormone therapy (HT) as a safe option for most women who are experiencing disruptive symptoms of menopause.

The Society of Obstetricians and Gynaecologists of Canada (SOCG) published a relevant report in 2014 called Managing Menopause and concluded that health care providers should offer hormone therapy as the most effective therapy for the medical management of menopausal symptoms. The Society recommends that health care providers regularly review the risks and benefits of hormone therapy with their patients. Hormone therapy is a safe and reasonable option for women under the age 60.