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214 Current Topics in Menopause Victor G. Vogel
whether these observed differences are explained by the accumulation of a
number of events that occur throughout a woman’s lifetime or by a single event
triggered with greater frequency in older than in younger women [1-3].
Figure 1: Age-specific invasive breast cancer incidence rates on a log scale from the National
Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER 13, 1998-2002)
for all women [4].
In the general population, breast cancer risk is related to several reproductive factors.
The association with age at menopause is explicable in terms of the marked
reduction in steroid hormones leading up to the menopause, which also results in a
marked decline in the slope of the age-incidence curve for breast cancer at
menopause. The age-related association between menopause and breast cancer risk
seems to be similar for natural menopause and surgical oophorectomy, strongly
suggesting that the association is a direct result of a change in ovarian function.
Hormonally-linked adult reproductive and anthropometric risk factors have been
well established in the etiology of postmenopausal breast cancer, though early life
exposures have been evaluated only more recently [5]. The in utero experience of