Breast cancer is one of the most common malignant tumors in women, and its incidence increases significantly in menopausal and perimenopausal women. This is closely related to the drastic changes in estrogen levels in the body during menopause—estrogen decline leads to metabolic disorders, weakened immune function, and increased risk of abnormal cell proliferation. The treatment of breast cancer during menopause should follow the principles of individualization and comprehensiveness, combining systemic therapy, local therapy, and minimally invasive treatment, with focused ultrasound ablation as a key added minimally invasive option. The specific treatment plan needs to comprehensively consider factors such as the patient’s age, tumor stage, molecular subtype, general health status, and whether there are other complications.
1. Hormone Therapy (Endocrine Therapy)
Hormone therapy is a core treatment for hormone receptor-positive breast cancer, which accounts for about 70% of postmenopausal breast cancer cases. Since postmenopausal women’s estrogen is mainly synthesized by the adrenal glands and converted into active estrogen in peripheral tissues, hormone therapy mainly achieves the purpose of inhibiting tumor growth by blocking estrogen receptors or reducing estrogen levels in the body. Commonly used drugs include aromatase inhibitors (AIs), such as letrozole, anastrozole, and exemestane, which can effectively inhibit the synthesis of estrogen in peripheral tissues and are the first-choice drugs for postmenopausal hormone receptor-positive breast cancer. For some patients who cannot tolerate aromatase inhibitors, selective estrogen receptor modulators (SERMs), such as tamoxifen, can be used, which can block the binding of estrogen to tumor cell receptors and inhibit tumor proliferation. Hormone therapy has a long course of treatment, usually 5-10 years, and needs to be taken under the guidance of a doctor, with regular monitoring of bone density and blood lipid levels to avoid side effects such as osteoporosis and hyperlipidemia.
2. Surgery Treatment
Surgery is the main local treatment method for early and middle-stage postmenopausal breast cancer, aiming to remove the tumor tissue and reduce the risk of local recurrence. The commonly used surgical methods include breast-conserving surgery and total mastectomy. Breast-conserving surgery is suitable for patients with small tumors (usually less than 3cm), single lesions, and no extensive lymph node metastasis. It only removes the tumor and surrounding normal breast tissue, while retaining most of the breast, which is more in line with the patient’s aesthetic needs. After breast-conserving surgery, radiotherapy is usually required to further eliminate residual tumor cells and reduce the local recurrence rate. Total mastectomy is suitable for patients with large tumors, multiple lesions, or extensive lymph node metastasis. It removes the entire breast tissue, including the nipple and areola. For patients with lymph node metastasis, axillary lymph node dissection or sentinel lymph node biopsy is also needed to clarify the extent of metastasis and guide subsequent treatment. Since postmenopausal women have no fertility needs, the focus of surgery is on radical treatment and reducing recurrence, while taking into account the patient’s quality of life.
3. Focused Ultrasound Ablation (High-Intensity Focused Ultrasound, HIFU) – Key Minimally Invasive Treatment
Focused Ultrasound Ablation (HIFU) is a safe, effective, and non-invasive minimally invasive treatment that has gradually become an important supplementary option for the treatment of postmenopausal breast cancer, especially suitable for elderly patients with poor physical condition, those who cannot tolerate surgery or radiotherapy, or those who refuse traditional invasive treatment. It uses high-intensity focused ultrasound energy to penetrate the skin and normal breast tissue, accurately focus on the breast tumor lesion, and generate high temperature (60-100℃) at the focal point to coagulate and necrose the tumor cells. After the tumor tissue is necrosed, it will be gradually absorbed and eliminated by the body’s immune system, thereby achieving the purpose of shrinking the tumor, controlling the disease, and relieving symptoms.
Compared with traditional surgical treatment, HIFU has significant advantages: First, it is non-invasive, with no incision, no bleeding, and no risk of infection, which greatly reduces the physical trauma to patients and shortens the recovery period. Elderly postmenopausal patients can recover quickly after treatment without affecting their daily life. Second, it can retain the breast shape to the greatest extent, avoiding the psychological impact caused by mastectomy and improving the patient’s quality of life. Third, the treatment process is painless and does not require general anesthesia, which reduces the risk of anesthesia-related complications, making it more suitable for patients with underlying diseases (such as hypertension, diabetes, and heart disease). Fourth, the treatment effect is accurate. For small and medium-sized tumors (less than 5cm), the ablation rate can reach more than 90%, and it can effectively control the growth of tumors and reduce the risk of local recurrence. Fifth, it has good compatibility with other treatments. HIFU can be used in combination with hormone therapy, radiotherapy, etc., to improve the overall treatment effect. It should be noted that HIFU is mainly suitable for early and middle-stage breast cancer with small tumors, no extensive lymph node metastasis, and no distant metastasis. For patients with large tumors, extensive metastasis, or malignant tumors with high invasiveness, HIFU is usually used as an auxiliary treatment to relieve symptoms and control the progression of the disease.
4. Radiotherapy and Chemotherapy
Radiotherapy is a local treatment method that uses ionizing radiation to kill residual tumor cells, mainly used as an adjuvant treatment after breast-conserving surgery, or for palliative treatment of advanced breast cancer to relieve pain and other symptoms. Postmenopausal patients have relatively weakened tolerance to radiotherapy, so the radiation dose and course of treatment need to be adjusted according to the patient’s physical condition to reduce side effects such as skin damage, fatigue, and myelosuppression. Chemotherapy is a systemic treatment method that uses cytotoxic drugs to kill tumor cells or inhibit their proliferation, suitable for patients with hormone receptor-negative breast cancer, advanced breast cancer, or patients with high-risk factors after surgery. The choice of chemotherapy drugs and regimens needs to be determined according to the patient’s tumor stage, molecular subtype, and physical condition. Due to the poor tolerance of postmenopausal patients, supportive treatment (such as antiemetic, protective gastrointestinal mucosa, and blood transfusion) should be strengthened during chemotherapy to reduce side effects and improve the patient’s treatment compliance.
5. Targeted Therapy and Immunotherapy
Targeted therapy is a precise treatment method that targets specific molecular targets of tumor cells, with high efficiency and low toxicity, and is suitable for patients with specific molecular subtypes of breast cancer. For example, trastuzumab is suitable for patients with HER2-positive breast cancer, which can specifically bind to HER2 receptors on tumor cells, inhibit tumor proliferation and angiogenesis, and improve the treatment effect. Immunotherapy uses the body’s own immune system to recognize and kill tumor cells, and is mainly used for advanced or metastatic breast cancer that is insensitive to traditional treatment. Postmenopausal patients can benefit from targeted therapy and immunotherapy, but before treatment, relevant molecular detection is needed to determine whether they are suitable for treatment.
In summary, the treatment of breast cancer during menopause is a comprehensive process that needs to combine the patient’s specific situation to formulate an individualized treatment plan. Hormone therapy, surgery, radiotherapy, and chemotherapy are the traditional core treatment methods, while focused ultrasound ablation, as a non-invasive, breast-preserving minimally invasive treatment, provides a new choice for postmenopausal patients, especially the elderly and those with poor physical condition. No matter which treatment method is chosen, regular follow-up after treatment is necessary to monitor the recovery of the condition, detect recurrence and metastasis in time, and improve the survival rate and quality of life of patients.