Breast changes in older women

As you get older, it’s natural for your breasts to lose their firmness, change shape, shrink in size and become more prone to certain abnormal lumps.

In most cases, breast lumps are harmless but, whatever your age, it’s important that you report any new lumps to your doctor.

From around the age of 40, you can expect your breasts to change in size and shape. It’s normal for breast tissue to become less glandular and more fatty as you get older, which makes them feel less firm and full.

With age, there’s also an increasing risk of abnormal growths in the breast. These are often harmless breast lumps, like cysts, but they can also be a sign of serious conditions like breast cancer.

As the years go by, you might also notice a wider space between your breasts and that your breasts shrink in size, sometimes by a cup size or more (unless you put on weight, in which case your breasts may get bigger). The area around the nipple (the areola) tends to become smaller and may nearly disappear, and the nipple may turn in slightly.

Many of the breast changes that happen as you get older are caused by hormonal changes.

Declining oestrogen levels at the menopause make breast tissue dehydrated and less elastic, so that your breasts lose their once rounded shape and begin to sag.

On the plus side, you may stop having any of the premenstrual lumps, pain or nipple discharge that you used to have.

Breast cancer screening

Screening for breast cancer is currently offered on the NHS to women aged 50-70 in England. However, it’s in the process of being extended as a trial to some women aged 47-73.

Breast screening uses an X-ray test called a mammogram that can spot cancers when they are too small to see or feel.

This short video explains what happens when you have a mammogram.

It’s your choice whether to have breast screening, but bear in mind that most experts believe it’s beneficial in picking up breast cancer early.

If you’re over 70, you’ll stop receiving screening invitations through the post, but you can still carry on with screening if you want to. To arrange an appointment, contact your local breast screening unit.

Find breast screening units in your area.

Read more about breast cancer screening.

Dense breasts

Young women who have not yet gone through the menopause often have what’s known as dense breasts.

Dense breasts contain more glandular and less fat tissue than usual. It’s not the same as having firm breasts and it has nothing to do with how big or what shape your breasts are.

Having dense breasts isn’t abnormal and it’s not something that you can change, but a potential drawback is that dense breasts can make breast cancer screening more difficult, because the dense tissue can mask potential tumours on a mammogram.

Breast tissue tends to become less dense as you get older, especially after the menopause, so it becomes easier to detect breast cancers on a mammogram.

Breast lumps

Breast lumps are common around the menopause. They’re usually cysts, which are harmless lumps filled with fluid. But if you notice a lump, don’t wait to be offered screening – see your GP, to rule out breast cancer.

Breast cancer is most common in women over 50. Other warning signs of breast cancer include:

• puckering of the skin
• nipple changes (like scaling or discharge)
• a swollen, red or "inflamed" breast

Read more about breast lumps.

Women over 70

Women over 70 are particularly at risk of breast cancer, because a woman’s risk of getting breast cancer increases with age. Don’t assume that because you’re in your 70s or older that you’re in the clear. Always report any unusual breast symptoms to your doctor.

Find out how to spot breast lumps.

Hot flushes: how to cope

Hot flushes are the most common symptom of the menopause but there are a range of medical treatments and self-help techniques to beat the heat.

Not all women experience hot flushes going through the menopause, but most do. Three out of every four menopausal women have hot flushes. They’re characterised by a sudden feeling of heat which seems to come from nowhere and spreads through your body. They can include sweating, palpitations, and a red flush (blushing), and vary in severity from woman to woman.

Some women only have occasional hot flushes which don’t really bother them at all, while others report 20 hot flushes a day, that are uncomfortable, disruptive and embarrassing.

Hot flushes usually continue for several years after your last period. But they can carry on for many, many years – even into your 70s or 80s. They’re probably caused by hormone changes affecting the body’s temperature control.

Causes of hot flushes

Most women going through a natural menopause experience hot flushes. But there are other causes of hot flushes, including:

• Breast cancer treatment – according to Cancer Research UK, seven out of 10 women who’ve had breast cancer treatment have hot flushes, and they tend to be more severe and frequent than those of women going through a natural menopause. This is because chemotherapy and tamoxifen tablets reduce oestrogen levels.
• Prostate cancer treatment – men having treatment for prostate cancer can also have hot flushes, sometimes for years. Hormone treatment causes hot flushes in men by lowering the amount of testosterone in their body. Read advice for men with prostate cancer on how to tackle hot flushes.

What does a hot flush feel like?

Women often describe a hot flush as a creeping feeling of intense warmth that quickly spreads across your whole body and face ‘right up to your brow’ and which lasts for several minutes. Others say the warmth is similar to the sensation of being under a sun bed, feeling hot ‘like a furnace’ or as if someone had 'opened a little trap door in my stomach and put a hot coal in’.

Watch these videos where women describe what a hot flush feels like.

Hot flush triggers

Hot flushes can happen without warning throughout the day and night, but there are well-known triggers, including woolly jumpers, especially polo necks; feeling stressed; drinking alcohol or coffee; or eating spicy foods.

Treatments for hot flushes

Many women learn to live with menopause-related hot flushes, but if they’re really bothering you and interfering with your day-to-day life, talk to your doctor about treatments that may help.

The most effective is HRT which usually completely gets rid of hot flushes. But other medicines have been shown to help, including vitamin E supplements, some antidepressants, and a drug called gabapentin, which is usually used to treat seizures.

Note that doctors recommend that you don’t take HRT if you've had a hormone dependent cancer such as breast or prostate cancer.

Here’s more information on help for hot flushes from your GP.

Complementary therapies for hot flushes

Women often turn to complementary therapies as a ‘natural’ way to treat their hot flushes.

There have been small studies indicating that acupuncture, soy, black cohosh, red clover, pine bark supplement, folic acid, and evening primrose oil may help reduce hot flushes.

However, the research is patchy, the quality of the products can vary considerably, and the long-term safety of these therapies isn't yet known.

It’s important to let your doctor know before you take a complementary therapy because it may have side effects (for example liver damage has been reported with black cohosh) or mix badly with prescription medicines (red clover is unsuitable for women taking anticoagulants).

Be aware, too, that soy and red clover contain plant oestrogens so may be unsafe for women who have had breast cancer.

Read more about complementary therapies and whether they work.

Self help remedies for hot flushes

Try these everyday tips to ease the overheating:

• cut out coffee, tea, and stop smoking
• keep the room cool, use a fan – electric or handheld – if necessary
• if you feel a flush coming on, spray your face with a cool water atomiser or use a cold gel pack (available from pharmacies)
• wear loose layers of light cotton or silk clothes so you can easily take some clothes off if you overheat
• have layers of sheets on the bed rather than a duvet so you can remove them as you need to and keep the bedroom cool
• cut down on alcohol
• sip cold or iced drinks
• have a lukewarm shower or bath instead of a hot one
• change the timing of your medicine. If tamoxifen is causing your hot flushes, Cancer Research UK suggests taking half your dose in the morning and half in the evening

Is a hot flush anything to worry about?

Hot flushes are generally a harmless symptom of the menopause. But very occasionally they may be a sign of a blood cancer or carcinoid (a type of neuroendocrine tumour).

See your doctor if, in addition to hot flushes, you've been unwell with, for example, fatigue, weakness, weight loss or diarrhoea.

Now read about the best foods to eat during the menopause.

Read other articles about the menopause.

Breast reconstruction after mastectomy

Watch a video about coping with cancer

If your breast cancer treatment plan includes mastectomy (an operation to remove the breast), you'll have a choice about what you do about your missing breast.

Some women choose to live with a flat chest on one side or use a prosthesis (false breast) inside their bra. Others choose to have a reconstruction.

If you have a mastectomy, there is still a chance that the cancer will come back. Having a reconstruction doesn't mean the cancer is more likely to come back.

When is breast reconstruction done?

Reconstruction surgery can be carried out at the same time as your mastectomy (immediate reconstruction), but this isn't always possible. If you need radiotherapy after your mastectomy, you may be advised to wait until after it's finished.

The benefits of immediate reconstruction include having just one anaesthetic, one hospital stay and one recovery period. However, the anaesthetic and recovery period will be longer than if you just have a mastectomy.

Reconstruction surgery may also be carried out some time after mastectomy surgery. This is called delayed reconstruction.

It's important to remember that reconstruction nearly always involves several operations. This is whether it's started at the same time as your mastectomy or later on.

How is reconstruction done?

There are two main types of breast reconstruction: implant and flap.

Implant reconstruction

The surgery for implant reconstruction is shorter than for flap reconstruction.

Your surgeon may suggest using a temporary expandable implant to begin with. This is so the skin on your chest can stretch gradually. The expander will be inflated over several clinic visits and then left to settle for three to six months.

Once the expandable implant is the right size, the surgeon will replace it with a permanent silicone one.

Sometimes it's possible to use a permanent silicone implant at the first operation.

Implant reconstructions sometimes need more surgery after a few years to maintain their appearance.

Flap reconstruction

With a flap reconstruction, tissue is moved from your back, tummy, thighs or buttocks to your chest. It’s shaped under the skin to make a new breast. The tissue is alive and natural, so it gives a natural shape and feel to the reconstructed breast.

Flap reconstruction is more complicated surgery, and you have to stay in hospital for longer.

You'll have scars where the tissue is removed from your body.

The new breast is likely to change shape and size in the first few months. Once it has settled the results are likely to be more long-lasting than an implant reconstruction.

Some women need to have a flap procedure with an implant to create a large enough breast.

Whether you have a flap or implant reconstruction your new breast won’t have any sensation.

Can my nipple be reconstructed?

Yes. Once the breast has settled into its final shape and size, your surgeon can perform a nipple reconstruction. If you are having immediate reconstruction this can sometimes be done during the first operation.

Nipple reconstruction sometimes involves taking part of the nipple from your remaining breast and attaching it to the new breast (nipple-sharing graft).

More often your surgeon will fold the skin on your new breast into a nipple shape (nipple flap).

Colour can then be tattooed on to the new nipple and the skin around it to give a natural appearance. This is usually done in hospital.

Will the new breast match my other one?

Your surgeon will match your new breast as closely as possible to your existing breast. Some women have surgery on both of their breasts to get a good match.

This can involve lifting the existing breast, or making it larger or smaller.

Some women with a high risk of breast cancer choose to have both breasts removed (double mastectomy), and two reconstructed breasts made, to reduce their risk of getting cancer again.

Who can help me make up my mind?

If you're considering reconstruction, you can talk to your GP, breast care nurse and breast surgeon, and have a consultation with a reconstructive plastic surgeon.

More advice on breast reconstruction

Macmillan Cancer Support has information on breast reconstruction, including:

• reconstruction using an implant
• reconstruction using your own tissue
• what to expect after reconstruction

Breast cancer genes

A fault (mutation) in certain genes can increase your risk of breast cancer. Women at risk of having a faulty gene are offered tests and screening.

Genes

We inherit genes from our parents. Genes determine many body characteristics, including hair and eye colour. We can also inherit conditions and diseases, or a higher risk of them, including breast cancer.

Genes called BRCA1, BRCA2, TP53, PALB2 or PTEN are the main ones linked to a high risk of breast cancer. Everyone has these genes. If there's a fault in one of them, the risk of breast cancer is higher.

Faulty BRCA1 and BRCA2 genes also increase the risk of ovarian cancer. A blood test can identify whether you have a fault in one of these high-risk genes.

Having a faulty high-risk gene linked to breast cancer isn't common, says Professor Gareth Evans, consultant medical geneticist at St Mary's Hospital in Manchester. "Mutations in the high-risk genes affect 1 in 400 people or less," he says.

What is the normal risk of breast cancer?

In the UK, a woman's lifetime risk of developing breast cancer is 10-12%. Out of every 100 women, around 10-11 will develop breast cancer by the time they are 80 years old. It can affect anyone. You can get it even if you don't have a faulty gene.

If more than one person in a family has breast cancer, this doesn't mean the faulty genes are present. It could be chance, as breast cancer is common.

What's the risk if you have a faulty gene?

If you have a faulty gene, it doesn't mean you'll definitely develop breast cancer, but you are at higher risk.

Having a fault in one of the high-risk breast cancer genes raises the risk of developing breast cancer to between 40% and 85%.

Out of every 100 women with a faulty gene, between 40 and 85 of them will develop breast cancer in their lifetime.

Who is tested for faulty genes?

If you are diagnosed with breast cancer and have a strong family history of breast and/or ovarian cancer, you will usually be offered a blood test to see whether you have a faulty gene.

If the test is positive, this means you have a higher risk of developing cancer in your other breast and, with BRCA1 and BRCA2, developing ovarian cancer.

"Women who have a mother or sister who has tested positive can opt for a simple genetic test to find out whether they've got the faulty gene," says Professor Evans.

If you don't have a relative who has tested positive for a faulty gene, family history needs to be strong to justify testing.

"Looking at family history means looking at the combinations of breast and ovarian cancer, and young-onset [younger than 50] breast cancer in the family," says Professor Evans.

"For example, a family history of three women in their 30s or four women in their 40s having cancer would easily qualify someone for genetic testing."

What if a woman without cancer has a faulty gene?

If you have a faulty gene, you have a high lifetime risk of breast and ovarian cancer.

Depending on your age and estimated risk, you'll be offered mammograms or magnetic resonance imaging (MRI) scans, or both.

You can still follow general health advice, too. "Women can reduce their risk by not putting on weight, by eating a good diet and by taking regular exercise," says Professor Evans.

"The problem is that they probably can't reduce their risk to much below 50%. That's why a high proportion of those women opt for risk-reducing surgery."

This involves surgical removal of the breasts (mastectomy) and sometimes removal of the ovaries (oophorectomy) to reduce the risk of cancer developing.

These are major operations, and you and your medical team need to discuss the risks and implications before any decisions are made.

"If a woman has a double mastectomy [removal of both breasts], her risk of developing breast cancer is reduced by 90-95%," says Professor Evans.

Where can I get help if I'm worried about my risk?

If two or three women in your family have had breast cancer and you're worried about your risk, see your GP.

If your GP thinks you have an increased risk, you can be referred to a local breast clinic. If there's already been a positive gene test in the family, they can refer you to a genetic clinic.

Read more about genetic tests for cancer risk genes.

Breast cancer awareness

Detecting breast cancer early can mean that treatment is more effective.

Knowing what your breasts normally feel like will help you to be aware of any abnormal changes.

However, not all changes are a sign of breast cancer. Some women have cysts or thickening of the breast tissue, which is normal.

According to Cancer Research UK, 9 out of 10 breast lumps are not cancer.

Read more about causes of breast lumps.

Get to know your breasts

Learn what your breasts look and feel like. Their appearance and feel can change at different times of the menstrual cycle.

The milk-producing tissue in the breast becomes active in the days before a period starts.

Some women find that their breasts feel tender and lumpy at this time, especially near the armpits.

After a hysterectomy (removal of the womb), the breasts usually show the same monthly changes until the time your periods would have stopped naturally.

After the menopause, activity in the milk-producing tissue stops. Normal breasts can feel soft, less firm and not lumpy.

The National Institute for Health and Care Excellence (NICE) says that being breast aware means:

• knowing what's normal for you
• looking at your breasts and feeling them
• knowing what changes to look for
• reporting any changes to your doctor without delay
• attending routine breast screening if you're 50 or over

Signs of breast cancer

Be aware of the following changes in your breasts that could signal breast cancer:

• changes in the outline or shape of the breast, especially those caused by arm movements or by lifting the breast
• changes in the look or feel of the skin, such as puckering or dimpling
• any new lumps, thickening or bumpy areas in one breast or armpit, with or without pain, that differs from the same part of the other breast and armpit
• discharge from the nipple (may be bloodstained)
• moist, red areas on the nipple that don't heal easily
• any change in nipple position, such as being pulled in or pointing differently
• a rash on or around the nipple

If you notice any of these changes, see your GP.

Watch videos of women talking about their breast cancer symptoms.

Watch videos of men talking about their breast cancer symptoms.

Breast pain

Many women worry that breast pain may be a sign of a serious condition. However, breast pain by itself is not a symptom of breast cancer, and breast pain does not increase your risk of developing breast cancer.

More on breast cancer

• Read about breast cancer diagnosis and the treatment of breast cancer
• Find cancer support services near you

Watch a video on breast cancer screening