Question
Is the prevalence for breast cancer higher in pre- or post-menopausal women, and why?
How does breast cancer prevalence change with age and estrogen levels?
All Answers (29)
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sex chromatin has some association -
How, can you explain further? -
Prevalence roughly increases with age. Hence it is much higher in post than in premenopausal women. Types of cancer do change somewhat, with slower growing tumors that are generally er positive at older ages. -
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The higher estrogen level, the higher prevalence. But this " estrogen level" dose not mean single time measurement. The age at menopause contribute morbidity of breast cancer, which mean lifetime estrogen level figures risk of breast cancer.
About age, nothing have to be put in Mr. Ritse Mann. -
As oestrogen dominance is linked to Breast Cancer, then post-menopausal women would have had an increased lifetime exposure of oestrogen. The oestrogen metabolism ratio is more likely to shift in favour of 16OH:2OH and this favours abnormal growth and increased risk of breast cancer. Poor oestrogen metabolism is also linked to obesity and weight gain is more common in menopause and post menopause. There is more lifetime exposure to xenoestrogens such as pesticides, bisphenol A, Phthalates, PCB's etc in the environment and as oestrogen is metabolized through the liver with phase 1- Hydroxylation and phase 11 methylation, glucuronidation and sulfation, the extra toxic burden on the liver shifts the ratio to increased levels of 16 alpha hydroxyoestrone. Many other lifestyle factors like increased stress, less exercise, ageing factors such as a decrease in muscle mass, inflammation, periodontal disease, less efficient digestion, exposure to radiation, change in sleep patterns etc can all have an impact on higher risk of breast cancer. Looking at all of these factors at a young age can influence epigenetics and future risk. -
Do you mean incidence or prevalence?
Incidence is how often breast cancer occurs. This is much higher in post menopausal women. The incidence increases with each year of age up to about age 85 when it starts to decrease slowly.
Prevalence is how many people are living with that condition.
As the incidence of breast cancer per year is lower age 35 to 50, and higher age 51 to 90, and there are many more women age 51 to 90 ( 30 to 40 years worth of women). Incidence and prevelence are much higher if post menopausal.
Plus women who developed premenopausal breast cancer will become post menopausal if they live long enough. Do you want to include them in the post menopausal prevalence or keep them in the premen cohort once they go thru menopause? -
It depends on the population studied. Generally, we noticed that the incidence is higher in pre-menopausal black women and in postmenopausal caucasian women. Many authors as Ly and al., and Hemminki and al., suggest that biological factors could influence that variability of age-related incidence. -
@Ritse Mann... so breast cancer is more in post menopausal women... as per @Akhiro Nomoto...total amount of estrogen throughout life contributes the breast cancer.... but I think, estrogen prevents freed radical generation ?? then how higher levels of estrogen plays important role in breast cancer... or can i say, fluctuation of estrogen level is more for Breast cancer ???
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@Kathlene... as u told alteration in metabolism of Estrogen may leads to breast cancer.... so Vitamin B6 plays any role here ???
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In the non Western world the incidence is higher in premenopausal women as it is in African American women in this country. In Western countries it is postmenopausal. Since the curves are the same for all women under fifty it is probably lifestyle issues over fifty ie HRT, later first pregnancy, mammographic screening, obesity, lack of exercise. While estrogen is indeed related, progesterone seems to be more important and the most agressive cancers are not sensitive to hormones! There is something else going on...
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Figure 2 of Lisa Newman's paper does not appear to agree with Dr. Love's assertion above that AA incidence is truly higher in premenopausal women. See: www.touchbriefings.com/pdf/2032/Rivers.pdf -
Dr Love is correct. The difference is small and is not visable on the graph shown by Dr Newman.
See:
J Natl Med Assoc. 2002 March; 94(3): 149–156.
PMCID: PMC2594112
Breast cancer racial differences before age 40--implications for screening.
Edwin T. Johnson
"The incidence of breast cancer (SEER Report 1994-1998) in the 30-39-age bracket for African-American and white women was 48.9 and 40.2 at the 95% confidence level, " -
@Prof Kevin.... thank you very much for the comments....
@All... thank you very much for sharing ur valuable comments.... im just a kid in research, doing PhD in Migraine Genetics. While reading I found that, Breast cancer is less in Migraine patients. After that I explored the literature... and I found that, after the cure of Breast Cancer more chances of getting migraine. I am more interested to know how estrogen is playing with these conditions... -
I never questioned that there was a higher incidence in African American women at younger ages. The question is: Where is the abundance of incidence? Are most Breast Cancers occurring in post-menopausal women in both blacks and whites? The answer appears to be YES. Ergo, Age is the number one risk factor for breast cancer in both blacks and whites.
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@Prof Bert... I agree with u after reading the literature.... But what is the reason to be more in post-menopausal women.... is it due to sudden fall of estrogen levels ???
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It is not the fall that is probably important, but the aggregate exposure period: Estrogen is a potent mammary tissue mitogen. Over long periods of exposure, it probably has some effect on the relevant pathways. Beyond that, everyone's best guess is that gene lesions at specific loci exacerbate the likelihood of disease. These loci were brilliantly characterized recently by Michael Stratton and his co-workers in this Nature article: http://www.nature.com/nature/journal/vaop/ncurrent/full/nature11017.html
Malignancies must also avoid immune response, avoid triggering the cell death apparatus (apoptosis), and divide faster than normal tissues. Estrogen probably plays a role in all this. -
@Prof Bert... is Homocysteine play any role in Breast Cancer??
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One carbon metabolism probably plays an important role in epigenetics of many cancers, but it's not clear how such epigenetics are regulated yet. Homoscysteine and Methionine (specifically S-adenosyl methionine) play important roles in one carbon metabolism. But, it is pretty clearly not a simple relationship. Many investigators are working this area: Peter Jones, Steve Baylin, Stanley Hamilton, Andrew Feinberg, others. Good luck.
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Thank you very much Prof.
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Breast cancer is not a short-time event but a long-lasting and developing procedure. Breast cancer occurence in younger women, to my opinion, depends on and is related to different pathopyysiological mechanisms and pathways as compared to older women. In younger females breast density may play a critical role via overexpression of several peptides or growth factors (IGF, CGRP, VEGF), which leads to specific subtypes independently of estrogen activity (ER-, PR-). On the contrary, breast cancer in older women seems to be the consequence of a prolonged exposure to estrogen rather than the result of a more complex mechanism via hypoxia-inducing carcinogenesis. -
thank you Prof Vassilios
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Young women with breast cancer are more likely to have aggressive tumors (grade3, ER-). Fortunately, breast cancer is less common in premenopausal women.
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I agree with Prof Vassilios. And the focus on estrogen is being questioned a bit. Certainly in postmenopausal women on hormones after menopause, the progesterone seems to be more important as E plus P increases the risk within 3 years and estrogen alone may decrease it. In addition women with tumors that are positive for estrogen receptors respond to drugs which block the receptor like Tamoxifen or block aromatase which is involved in estrogen synthesis but also respnd equally well to DES and premarin. It just isn't so simple as we would like it to be.
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Also thre is more breast cancer in postmenopausal whites but not blacks....probably related to HRT and mammography screening!
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Dear Dr. Love, Perhaps you are not constructing your sentences in the way that you intended. The majority of breast cancer in both African Americans and in Caucasians is POST-Menopausal (after menopause). There is some disparity in younger age cancers: African American incidence rates exceed Caucasian incidence rates in some younger age categories. But, the blanket statement above that '...there is more breast cancer in postmenopausal whites but not blacks..." certainly appears misleading to me. Sincerely, Bert Gold, Ph.D., FACMG
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Some Reflections on the Hydra-like Breast Cancer Matrix
I will suggest that the facts are more nuanced and complex than suggested above, and that ultimately the focus on menopausal status lacks sufficient explanatory power and becomes increasingly inconsequential under close inspection of etiological and epidemiological facts especially in the modulating light of molecular classes and genetic and epigenetic developments.
Recent data strongly supports that breast cancer is a complex matrix of diseases caused in part by the progressive accumulation of multiple genetic mutations coupled with epigenetic dysregulation of critical genes, both oncogenes and their contraries, the TSGs (tumor suppressor genes), and molecular pathways, with only some of these malignant transforms being estrogen-mediated as we learn increasingly of the contributions of insulin pathways and perturbations of the adipokines in breast carcinogenesis and tumorigenesis.
At first blush, in women, incidence rates of breast cancer rise sharply with age until ages 45 to 50, at which point the rise is muted and becomes less steep, and by ages 75 to 80, the curve actually flattens and then decreases. Dozens of epidemiological studies support this generalization extrapolated from the large Cancer Statistics reported by Ahmedin Jemal and Rebecca Siege with ACS and colleagues at IARC, along with data mining of the large SEERS, IARC CancerBase / GLOBOCAN databases along with national and regional registries. (And note of course that age is not the single most critical risk factor for breast cancer development, gender is; as to menopausal status, at least as to BC incidence, the ACS, IARC, OECD and other cancer-statistics organizations do not even reference it independent of age).
At second blush too this "general field theory" of breast cancer, of steadily increasing incidence with age until about age 45 - 50 when there is a slight plateau and even a brief slope down around the menopause age, called the Clemmensen's hook, after which the incidence begins to increase again, but at a more gradual rate, and with an apparent whole spectrum of biological differences, now well known, between breast cancers arising in premenopausal and postmenopausal women, including notably the differential impact of obesity. This is clinically expressed in the relatively high prevalence of hormone-independent, aggressive, tumors and poorer prognosis associated with premenopausal breast cancer in which the relationship of obesity to breast cancer risk is a positive association in postmenopausal women as we have all come to expect, but with obesity being actually protective in premenopausal women, although a caution is that much of these findings is based on European and North American studies almost exclusively white populations (see below).
But as we keep on blushing, the waters get rapidly more muddy. So for instance (1) there is an inverse association of current BMI with premenopausal breast cancer b... [more] -
This is a great summary. I also reference the work of William Anderson on this topic. The whole issue of heterogeneity is hugh since we make our whole characterization on a single core biopsy of a lesion which until very recently we rarely repeated on recurrences and mets....the chance of missing the heterogeneity is great!
Finally as to etiology I am increasingly distressed by the fact that we are getting better understanding of the molecular biology of the tumor but have very little understanding of the anatomy and physiology of the breast. We are still arguing as to how many holes are in the nipple, and have no idea of the pattern or distribution of the ductal systems or whether the disease occurs in one duct or the whole breast (our research suggests the former). Unfortunately research on anatomy and physiology is not sexy and not funded! -
Yes, good point re Anderson, Susan; I credit his contributions in the fuller versions (in progress) of my condensed discussion above, especially as to the distinct etiology of triple negative and phenotypic core basal cells.
You make a very shrewd observation re structural and morphological breast complexity. In that connection, I love how the great breast pathologist James Going at Glasgow University starts off his recent insightful chapter on the lobar anatomy of the breast by a quote:
"I have heard a good anatomist say "the breast is so complicated I can make nothing clear of it"
[from pioneer anatomist Astley Paston Cooper].
When I read papers on breast subgross morphology, the so-called "sick lobe hypothesis", and post-ductal-lavage fluid-yielding ducts, among others, I realize what astounding intricacies are involve and I have to hit the old breast anatomy/physiology books and literature all over, which only take you so far, and awake you to the fact that there are far too many mysteries as yet unexplored and too many questions unresolved. A shame that as you say, research dollars more follow high-visibility issues, rather than fundamental / core ones.
It is the same with prevention: I tabulated that there were 47 presentations at ASCO 2012 on cancer prevention (16 in the BC ER/HER2 Prevention topic, another 31 in Cancer Prevention/Epidemiology), out of almost 5000 (4671 to be precise) presentations total, a measly 1%, suggesting a distorted commitment to treating the disease rather than preventing it from developing, accounting for the abysmal current state of prevention after approximately forty years when we first declared war on cancer in the National Cancer Act of 1971, promising "a cure for cancer in our time." Time is running out.
Constantine Kaniklidis
Director, Medical Research, No Surrender Breast Cancer Foundation (NSBCF)
European Association for Cancer Research (EACR)
Popular Answers
Incidence is how often breast cancer occurs. This is much higher in post menopausal women. The incidence increases with each year of age up to about age 85 when it starts to decrease slowly.
Prevalence is how many people are living with that condition.
As the incidence of breast cancer per year is lower age 35 to 50, and higher age 51 to 90, and there are many more women age 51 to 90 ( 30 to 40 years worth of women). Incidence and prevelence are much higher if post menopausal.
Plus women who developed premenopausal breast cancer will become post menopausal if they live long enough. Do you want to include them in the post menopausal prevalence or keep them in the premen cohort once they go thru menopause?