Statistics from Cancer Research show that around 8 in 10 breast cancers are diagnosed in women aged 50 and over. The good news is that breast cancer survival rates are improving and women are now twice as likely to survive the disease for 10 years or more than those diagnosed 40 years ago. Although survival rates are improving, the emotions women who are diagnosed with the disease feel, and the difficult decisions they have to make, still have a massive impact on their lives. Mr Stephen McCulley MBChB, FCS(SA)Plast, FRCS(Plast), is a Consultant Plastic, Reconstructive and Aesthetic Surgeon based in Nottingham and a leading expert in breast cancer treatment and reconstruction. Below he shares his insight into why being diagnosed with breast cancer is such a life changing experience for women in their 50s and above.
How common is breast cancer in women over 50?
Firstly, it’s important to remember that breast cancer can affect women of any age but it is more common with age. 80% of breast cancer cases in the UK occur in women over fifty and the risk increases with age. Between the ages of 49 and 59, women have a 1 in 20 risk of contracting breast cancer, this risk increases to 1 in 13 up to the age of 69. Although breast cancer is seen as an ‘older women’s’ disease, many people don’t realise that the risk continues to increase with age which is why regular checks and screenings are so important.
What unique issues affect women in their 50s and above with breast cancer?
Breast cancer is a difficult journey at any age, and the decisions women have to make around treatment can be tough. Although issues around fertility are generally no longer a concern for women in this age group, (some breast cancer treatments can reduce fertility), women in their 50s still have to consider how their treatment will affect themselves and their families. The role of reconstruction as part of the breast cancer treatment is a very personal decision. Although it gets less common with age, most woman in their 50s would still consider themselves good candidates for breast reconstruction. It’s important to mention though that there is no age limit to reconstruction and I have performed it in ladies in their 70s.
For many woman reconstruction is often a more appealing option as it means the breasts can be restored using implants or by using tissue taken from other areas of the body such as the thighs, bottom or the tummy. Reconstruction does mean that a patient will undergo two operations, one to remove the breast or breasts and then the reconstruction procedure, which can mean a longer stay in hospital and longer recovery times. Many women in their fifties are, of course, still working, raising a family and living an active life so it’s important that they make a choice which is right for their lifestyle and their individual circumstances.
How is breast cancer in women in their 50s and above usually treated?
There are two stages of treatment for breast cancer: removing the cancerous tissue with surgery and then treating any remaining potential cancer with radiotherapy, chemotherapy and/or hormone treatment if required. Sometimes chemotherapy is done first. It is important to remember that not all patients require these other treatments.
Younger people are likely to have chemotherapy as part of a cancer treatment. The type of cancer older women suffer from tends to be less aggressive and can often be treated with surgery and hormone treatment or even sometimes hormone treatment alone. There will be circumstances where women over 50 will be advised to have radiotherapy, such as if the cancer has spread to the lymph glands, if it is a certain size or if the cancer is in separate areas throughout the breast. Radiotherapy can effect implant reconstruction so a surgeon will decide if a patient is likely to need radiotherapy before surgery to plan the entire operation and decide if it is better to schedule in reconstruction once the course of radiotherapy is complete. In each situation a surgeon will guide the individual through the options available from the outset, offering advice and support throughout her breast cancer journey.
What are the options available for women who choose to have reconstructive surgery?
Many women opt for reconstructive surgery, rather than a mastectomy, because this can help them to feel more feminine and can help them regain a sense of normality once their treatment is over. If you consider that a woman who is successfully treated for breast cancer in her 50s may go onto live for 30 years or so then it’s clear why reconstruction is such as popular choice.
There has been some major advances in implant surgery in recent years and, depending on her situation, a woman may be offered implants or the option to have her breasts reconstructed with her own body tissue from the tummy, bottom or thighs which can often provide a more natural look and feel to the breast. Taking tissue from these areas also means that women can experience a slimmer shape in the area where the tissue has been taken from, with results similar to a tummy tuck procedure, which can be an added benefit of this type of reconstruction. Generally it’s accepted that the look achieved by implants can become worse over time and require some revisions. However, this does avoid bigger surgery and scars on the body elsewhere. Using a patient’s own body tissue means the breast reconstruction can actually improve in appearance over time and are less likely to require revision over time.
Mr Stephen McCulley MBChB, FCS(SA)Plast, FRCS(Plast), is a Consultant Plastic, Reconstructive and Aesthetic Surgeon based in Nottingham. Stephen specialises in breast reconstruction and is one of the few Consultants in the country who can offer both cancer surgery and the full range of breast reconstruction options.