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
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
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
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.
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
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.
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
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."