Hormones, Menopause and Cancer: A Call to Consider Breast Cancer Risk

Menopause isn’t just about hot flushes and brain fog. It’s also a time when hormonal changes can influence breast cancer risk.

In the run-up to global Breast Cancer Awareness Month in October, the Cancer Association of South Africa (CANSA) is calling on women to take charge of their health and understand the connection.  

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Early detection

“Breast cancer remains one of the most significant health challenges for South African women, particularly during and after menopause,” says Lorraine Govender, National Manager: Health Programmes at CANSA.  

Globally, October campaigns highlight early detection, symptom awareness, and access to screening and treatment.

“Every year CANSA aligns its campaigns to these themes,” says Govender. “However, this year we are pivoting to the relationship between menopause and breast cancer.”  

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The menopause link

Menopause is a natural biological process, usually occurring in women in their 40s and 50s. As oestrogen levels decline, women may experience hot flushes, night sweats, mood shifts, vaginal dryness, sleep disturbances, and reduced bone density. 

Menopause does not cause cancer, but a woman’s risk of developing cancer increases with age.  

Hormone replacement therapy (HRT) is sometimes prescribed to ease these symptoms. Some breast cancers are hormone-sensitive, and long-term use of combined oestrogen-progesterone therapy (beyond three to five years) can increase breast cancer risk.

The good news is that risk levels usually fall back toward baseline within three to five years of stopping treatment.

Short-term or oestrogen-only therapy carries different risk profiles but may have other health implications if not carefully managed. Beyond cancer, oestrogen decline also affects bone and heart health, increasing risks of osteoporosis, fractures, and cardiovascular disease.  

Govender advises women to be fully informed before choosing whether to use HRT. “One way to get reliable information is to talk to a healthcare provider,” she says.

“The conversation needs to take into account personal and family cancer history, cardiovascular and liver health, and lifestyle factors such as weight, diet, exercise, alcohol consumption, and using tobacco.”  

Screening essential

Screening remains essential, she adds. “As with any form of cancer, early detection vastly improves outcomes.”  

That was true for 43-year-old Gwen Thabane, who discovered a lump during a self-exam. “I have a family history of cancer and am always on the lookout for symptoms and signs,” she says.  

Her story shows that hormone-sensitive conditions don’t wait for menopause. Diagnosed with endometriosis and fibroids in her late 30s, Gwen had a hysterectomy that left her ovaries intact to delay early menopause.

A few years later, she was diagnosed with hormone receptor-positive breast cancer. This is a type of cancer that uses oestrogen and progesterone as fuel. “All three diagnoses were oestrogen-driven,” she explains.  

Says Govender: “Gwen’s story is a reminder that while menopause is a key turning point in women’s hormonal health, hormone-sensitive conditions can emerge long before. This underscores the importance of awareness and informed healthcare decisions at every stage of a woman’s life.” 

Prevention tips

CANSA advocates that some of the most effective ways to lower risk include maintaining a healthy body weight; engaging in regular physical activity; avoiding alcohol and tobacco use and keeping up with mammograms and other screening.   

CANSA encourages women to raise these questions with their healthcare providers: 

• What type and duration of HRT, if any, is appropriate for me? 
• What are my personal risks (family history, hormone exposure, lifestyle)? 
• What screening tests should I prioritise, especially during and after menopause? 
• What lifestyle changes can I realistically adopt to reduce my risk?

Govender concludes, “Breast cancer doesn’t wait and neither should you. Our call to action this October is simple: understand the role of hormones and menopause, talk to your healthcare provider, and take charge of your health today.”  

CANSA urges women to prioritise breast self-examinations and screenings for breast cancer. It provides affordable Clinical Breast Examinations at its Care Centres to identify any lumps or irregularities.

Patients with medical aid can claim the cost from their medical aids after payment. Additionally, government health clinics offer free clinical breast examinations.  

Women can access mammograms at public hospital breast clinics with a referral letter from a medical professional or a CANSA nurse. Alternatively, contact the Radiological Society of SA (RSSA) at www.rssa.co.za to arrange a mammogram. Women over 40 are advised to undergo annual screenings.