Breast Cancer in Women Over 50

Breast cancer is the second most common cancer among women in the United States, after some kinds of skin cancer. It is also the leading cause of cancer death among women of all races and Hispanic origin populations. Breast cancer is most common in women over 50 who have been through menopause. About 8 out of 10 cases of breast cancer happen in women over 50 .

Statistics

According to the National Cancer Institute, an estimated 297,790 new cases of female breast cancer and 43,170 deaths from the disease are expected to occur in the US in 2023. The incidence rate of breast cancer has been decreasing since 2000, mainly due to lower use of hormone replacement therapy and increased mammography screening. The death rate of breast cancer has also been declining since 1989, mainly due to improvements in early detection and treatment.

The risk of developing breast cancer increases with age. The median age at diagnosis for female breast cancer is 63 years, and the median age at death is 70 years. The five-year relative survival rate for female breast cancer is 90.8%, but it varies by stage at diagnosis and race/ethnicity. For example, the five-year relative survival rate for localized breast cancer (cancer that has not spread beyond the breast) is 99.5%, while for distant breast cancer (cancer that has spread to other organs) it is 29.1%. The five-year relative survival rate for White women is 92.1%, while for Black women it is 83.7%.

Causes

The exact causes of breast cancer are not fully understood, but some factors may increase the risk of developing the disease. These include:

- Genetic mutations: Some inherited genes, such as BRCA1 and BRCA2, can increase the risk of breast cancer by up to 80%. Women who have a family history of breast or ovarian cancer should talk to their doctor about genetic testing and counseling .

- Hormonal factors: Exposure to estrogen and progesterone, either naturally or through hormone replacement therapy, can stimulate the growth of breast cells and increase the risk of breast cancer. Factors that increase hormonal exposure include early menstruation, late menopause, having no children or having them later in life, and using hormone replacement therapy for more than five years after menopause .

- Lifestyle factors: Some behaviors and habits can affect the risk of breast cancer, such as being overweight or obese after menopause, drinking alcohol, smoking, being physically inactive, and eating an unhealthy diet .

- Environmental factors: Some chemicals and radiation may increase the risk of breast cancer, such as exposure to pesticides, industrial solvents, plastics, and ionizing radiation (such as from medical tests or treatments) .

Prognosis

The prognosis of breast cancer depends on many factors, such as the stage at diagnosis, the type and grade of the tumor, the hormone receptor status, the HER2 status, the presence of genetic mutations, and the response to treatment. Generally, the earlier the breast cancer is detected and treated, the better the outcome.

The prognosis of breast cancer can be estimated by using prognostic tools, such as nomograms or calculators, that take into account various factors and predict the likelihood of survival or recurrence. However, these tools are not perfect and cannot account for individual variations or new treatments. Therefore, they should be used with caution and in consultation with a doctor.

Treatment

The treatment of breast cancer depends on many factors, such as the stage at diagnosis, the type and grade of the tumor, the hormone receptor status, the HER2 status, the presence of genetic mutations, and the patient's preferences and overall health. The main types of treatment for breast cancer are:

- Surgery: This involves removing part or all of the affected breast (lumpectomy or mastectomy) and sometimes nearby lymph nodes (axillary dissection or sentinel node biopsy). Surgery may be followed by radiation therapy to kill any remaining cancer cells in the breast area.

- Radiation therapy: This involves using high-energy rays or particles to destroy cancer cells. Radiation therapy may be given after surgery to reduce the risk of recurrence, or before surgery to shrink the tumor and make it easier to remove. Radiation therapy may also be given to other parts of the body where the cancer has spread, such as the bones or the brain.

- Chemotherapy: This involves using drugs to kill cancer cells or stop them from growing. Chemotherapy may be given before surgery to shrink the tumor and make it easier to remove, or after surgery to reduce the risk of recurrence. Chemotherapy may also be given to other parts of the body where the cancer has spread, such as the liver or the lungs.

- Hormone therapy: This involves using drugs to block or lower the effects of estrogen and progesterone, which can stimulate the growth of breast cancer cells. Hormone therapy may be given after surgery to reduce the risk of recurrence, or to treat advanced breast cancer that has spread to other parts of the body. Hormone therapy may also be given before surgery to shrink the tumor and make it easier to remove.

- Targeted therapy: This involves using drugs that target specific features of cancer cells, such as proteins or genes, that make them different from normal cells. Targeted therapy may be given alone or in combination with other treatments, such as chemotherapy or hormone therapy. Targeted therapy may be used to treat advanced breast cancer that has spread to other parts of the body, or breast cancer that has a high risk of recurrence.

- Immunotherapy: This involves using drugs that stimulate the immune system to recognize and attack cancer cells. Immunotherapy may be given alone or in combination with other treatments, such as chemotherapy or targeted therapy. Immunotherapy may be used to treat advanced breast cancer that has spread to other parts of the body, or breast cancer that has a high risk of recurrence.

The treatment of breast cancer may cause side effects, such as pain, fatigue, nausea, hair loss, infection, lymphedema, infertility, menopausal symptoms, and emotional distress. These side effects can be managed with supportive care, such as pain relief, anti-nausea drugs, antibiotics, compression garments, fertility preservation, hormone replacement therapy, and counseling.

It is important to be aware of the signs and symptoms of breast cancer, such as a lump in the breast, nipple discharge, skin changes, or pain. It is also important to have regular mammograms and clinical breast exams to detect breast cancer early and improve the chances of survival. The treatment of breast cancer depends on many factors and may involve surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, immunotherapy, or a combination of these. The treatment of breast cancer may cause side effects that can be managed with supportive care.