World Menopause Day 18 October, 2013:
The International Menopause Society is marking World Menopause Day with the publishing of a major review of cancer during and after the menopause and asking women and their doctors to take appropriate precautions to minimise cancer risk. The report Oncology in midlife and beyond is published in the October issue of peer-reviewed journal Climacteric (1).
Cancer is a major cause of death and disability worldwide. It affects women increasingly as they get older, with the majority of cancers striking women after the menopause.
Early diagnosis vital
According to Professor Anne Gompel (Paris, France), principal author and IMS Board Member:
"This document aims to help women to understand and minimise their potential risks. It is important for a woman to consult her doctor if any abnormal symptoms occur; this could help with early diagnosis and treatment, which is often vital with cancer. It is important to take part in screening where it is available, to help identify cancers earlier".
While highlighting the real risks from cancer, the IMS stresses the need to keep the cancer risk in perspective. Between 35 and 40 women in every hundred in developed countries die of cardio/circulatory diseases, whereas around 20 to 25 in every hundred die of cancer. "Cancer is important, but circulatory diseases kill more women than does cancer. We need to be aware of cancer, not to fear it," said Professor Gompel.
She continued, "It is important to understand that the increase in cancer incidence is related at least partially to increasing life expectancy - the older a woman becomes, the more time there is for a cancer to develop. Increasing use of cancer screening also mean that more cancers are being picked up than in previous years. Women need to ensure that they play an active role in their own health care, especially as they pass the menopause".
Regional difference in cancer rates
As one would expect, the report highlights that different cancers are more common in different regions of the world, for example:
- Lung cancer is the leading cause of cancer mortality in some countries such as the USA, UK, China, Norway, Sweden, etc.
- Whereas in the Western world breast cancer is mostly a postmenopausal disease, in Asia the peak incidence occurs at 45-55 years of age. In Singapore, breast cancer incidence peaks at age 50 years and levels off after that. In India, Pakistan, North Africa, and western Africa (Niger), breast cancer occurs predominantly in young women and is more aggressive.
- The incidence and mortality from cervical cancer have declined over the last 30 years in countries where the screening is available. It remains high in Africa, some Asian countries, and some Latino American countries. Generally, where there is easy access to good health care, the incidence and mortality have declined.
What women can do
IMS President, Dr Tobie de Villiers (Cape Town) reinforced the need for women to take responsibility for ensuring that their cancer risks are minimised:
"The IMS recommends that women and their doctors should plan an annual health review, both as they approach the menopause and afterwards. Especially with cancer, catching it early can often make a difference to a woman's life. Many of us check our cars every year; our bodies should be no less important".
As part of the Oncology in midlife and beyond review, the IMS is making some specific recommendations.
When should women consult a doctor?
Women and their doctors should plan a systematic follow-up at least once a year, for each woman in midlife and beyond. In addition, if a woman experiences any abnormal symptoms, she should see her doctor immediately. These symptoms may include:
- Abnormal vaginal bleeding, pelvic/abdominal pain
- Unusual digestive symptoms, blood in the faeces, urine
- Breast abnormalities
- Unusual cough
- Unusual pain in the lower leg, which may be suggestive of a blood clot.
Pharmaceuticals and cancer
Some drugs need to be treated with caution if women have an increased risk of cancer (for example, if a woman has a family history of breast cancer). Some types of Hormone Replacement therapy (HRT), for example, are associated with a slightly increased risk of some cancers, whereas the same HRT may reduce other cancers. Women should discuss their individual risk factors with their doctors before embarking on any course of treatment.
The best way to avoid an increased risk of cancer is to lead a healthy lifestyle and to avoid contact with possible cancer-causing chemicals.
Tips for a healthy menopause
1. Do not smoke
2. Maintain a regular exercise routine
3. Maintain a normal weight
4. Restrict intake of sugar, salt and alcohol
5. Maintain a low-fat, well-balanced diet
6. Eat foods containing adequate amounts of calcium and vitamin D
7. Maintain a regular and sufficient sleep schedule
8. Take hormone therapy if needed
9. Proactively manage menopause and use it as an opportunity to prevent disease and improve long-term health and quality of life.
More information is available on the IMS website, http://www.imsociety.org/
Australasian Menopause Society
The Australasian Menopause Society welcomes and endorses the position of the International Menopause Society in highlighting cancer risk among women. Dr Anna Fenton, President of the AMS, emphasizes how important it is for women approaching menopause to assess their risks of both cardiovascular disease and cancer. Educating and encouraging women to make pro-active choices with their health should reduce risk and improve outcomes. Simple changes in diet, alcohol consumption and lifestyle can have significant effects on the risk of cancer.
“The AMS has a goal of improving quality of life for women at mid-life by ensuring good quality information is available to women and their doctors. This thorough review from the International Menopause Society encourages women to take charge of their health and seek advice if there are any abnormal symptoms.”
1. Gompel A, Baber RJ, de Villiers TJ, Huang KE, Santen RJ, Shah D, Villaseca P, Shapiro S. Oncology in midlife and beyond. Climacteric. 2013 Oct;16(5):522-35. doi: 10.3109/13697137.2013.823539. Epub 2013 Aug 9.