Open Veterinary Journal, (2025), Vol. 15(2): 204-210

10.5455/NJPPP.2025.v15.i2.15

A prospective comparative study of breast cancer in pre- and postmenopausal women

Nirav Patel¹, Sneh Shah¹* and Shaunak Chacha²

¹Assistant Professor, Department of Surgery, GCS Medical College, Hospital and Research Center, Ahmedabad, India²3rd Year PG Resident, Department of Surgery, GCS Medical College, Hospital and Research Center, Ahmedabad, India

*Corresponding Author: Sneh Shah. Assistant Professor, Department of Surgery, GCS Medical College, Hospital and Research Center, Ahmedabad, India. Email: snehshah133.ss [at] gmail.com

Submitted: 21/11/202 Accepted: 12/01/2025 Published: 28/02/2025

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Abstract

Background: Breast cancer is a significant cause of female morbidity and mortality. Indian womenThe incidence of breast cancer is rising in India (22.9%) and it is now the second most commonly diagnosed cancer in women here.

Aims: To evaluate the difference between pre- and post-menopausal breast cancer women regarding risk factor, nature of disease presentation, tumor characteristic, and management. To determine and compare breast cancer in premenopausal and postmenopausal women. To determine the most prevalent high-risk group for carcinoma breast. To determine the difference in clinical presentation, risk factor, most common type of cancer and pathological type, characteristic, and management of cancer in premenopausal and postmenopausal women.

Materials and Methods: This was an observational, prospective comparative study designed to evaluate and compare various clinical, demographic, and pathological factors associated with breast cancer in pre-menopausal and post-menopausal women. 100 women with breast cancer (50 each in premenopausal and postmenopausal) presenting at GCS Medical College, Hospital & Research Centre from July 2022 to July 2024 were included in the study. Data on demographics, clinical features, histopathological findings, treatment, and follow up were collected and analyzed statistically thereafter.

Results: Age at first pregnancy is significantly different between the two groups, with post-menopausal women tending to have their first pregnancy earlier than pre-menopausal women. The duration of breastfeeding is significantly associated with menopausal status with postmenopausal women breastfeeding for longer duration. Family history of breast cancer and age at menarche are associated with menopausal status, with pre-menopausal women more likely to have a family history and earlier menarche. No statistical significance is found regarding parity, clinical presentation, histopathological findings (Histopathological examination grading, receptor status), tumor staging, postoperative radiotherapy, and recurrence rates between premenopausal and postmenopausal women.

Conclusions: The comparative study between pre-menopausal and post-menopausal women shows the significance of certain risk factors and their implications in further chemo or radiotherapy influence. The complexity of pre and post menopausal should be further evaluated and classified in order to predict, screen, and prevent advanced breast cancer cases as well as their management, post detection, or screening.

Keywords: Breast cancer, Premenopausal, Postmenopausal.

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Introduction

Breast cancer remains a significant public health challenge, leading to considerable morbidity and mortality in women worldwide. It is the most commonly diagnosed cancer in women, accounting for a substantial proportion of cancer cases and deaths annually. The global burden of breast cancer is expected to rise due to factors such as aging populations, lifestyle changes, and advancements in detection and diagnostic technologies. Understanding the epidemiology, risk factors, and biological behavior of breast cancer is crucial for developing effective prevention, diagnosis, and treatment strategies (Wilkinson and Gathani, 2022).

The incidence of breast cancer varies widely across regions and populations, and it is influenced by a complex interplay of genetic, environmental, and lifestyle factors. Notably, breast cancer affects women across all age groups, but its manifestation and clinical outcomes can differ significantly between premenopausal and postmenopausal women (Francies et al., 2020).

The biological behavior of breast cancer varies according to the menopausal status. Premenopausal breast cancer is often associated with more aggressive tumor characteristics, such as higher histological grade and hormone receptor negativity. These cancers tend to have a faster growth rate and differ in their response to systemic therapies compared with postmenopausal breast cancers. In contrast, postmenopausal breast cancer is more frequently characterized by hormone receptor positivity, particularly estrogen receptor (ER) positivity, which typically indicates a better prognosis and responsiveness to hormonal therapy. These biological differences require distinct clinical management approaches tailored to the needs of premenopausal and postmenopausal women (Rajarajan et al., 2021).

The etiology of breast cancer is multifactorial and involves a combination of genetic predispositions, hormonal influences, and environmental exposures. Premenopausal women also presented with risk factors including early menarche, nulliparity, late age at first childbirth, and family history of breast cancer. Hormonal factors, particularly those related to endogenous estrogen exposure, play a critical role. In postmenopausal women, risk factors include age, prolonged hormone replacement therapy, obesity, and cumulative lifetime exposure to estrogen. Lifestyle factors, including diet, physical activity, and alcohol consumption, also significantly contribute to the risk profile in both groups (Admoun and Mayrovitz, 2022).

This research is significant for several reasons. First, this study addresses a critical gap in the literature regarding the comparative analysis of breast cancer according to menopausal status. Second, these findings may influence clinical practice by providing evidence-based insights into the optimal management of premenopausal and postmenopausal breast cancer patients. Finally, by highlighting the unique needs of these distinct patient groups, the study contributes to the broader goal of personalized medicine in oncology, ultimately aiming to improve patient outcomes and quality of life.

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Results

Age: The average age of premenopausal participants was 43.30 years, whereas postmenopausal participants had a significantly higher average age of 61.82 years. The overall mean age of all participants was 52.56 years, with a p-value of less than 0.001 indicating a highly significant difference between the two groups.

Duration of complaints

The mean duration of active complaints was 8.86 weeks for premenopausal participants and 10.62 weeks for postmenopausal participants, resulting in an overall mean duration of 9.74 weeks. The p-value of 0.062 suggests that the difference in complaint duration between the two groups was not statistically significant.

Age at first pregnancy

Premenopausal participants had an average age of 27.36 years at their first pregnancy, while postmenopausal participants reported their first pregnancy at an average age of 23.40 years. The overall mean age at first pregnancy was 25.31 years, with a p-value of 0.001, indicating a significant difference between the two groups.

Complaints

All participants, regardless of menopausal status, reported the presence of lumps (50 individuals per group). Other symptoms, such as pain, skin changes, nipple retraction, and nipple discharge, were less common and did not show significant differences between the groups, as indicated by their respective p-values (see Table 1).

Family history

Most of the participants (97 of 100) reported no family history of breast cancer. Among those with a family history, three were premenopausal, and no postmenopausal participants reported a family history. The p-value of 0.079 suggests no significant association between family history and menopausal status.

Age at menarche

A notable number of postmenopausal participants (23) reported an unknown age at menarche, whereas the majority of premenopausal participants (44 out of 50) experienced menarche before the age of 12. A p-value less than 0.001 indicates a significant association between age at menarche and menopausal status. However, because of the uncertainty regarding menarche in the 23 postmenopausal women, we cannot draw definitive conclusions about the overall significance of age at menarche.

Parity and menopausal status

The majority of participants were multiparous, with 45 premenopausal and 48 postmenopausal women classified as such, while a smaller number were nulliparous. The p-value of 0.240 indicates no significant difference in parity between the two groups.

Duration of breastfeeding and menopausal status

Most premenopausal participants (38) breastfed for less than 12 months, while postmenopausal participants exhibited a wider range of breastfeeding durations, with many (28) breastfeeding for 12–24 months. The p-value of 0.005 indicates a significant difference in breastfeeding duration between premenopausal and postmenopausal women.

Tumor size and menopausal status

The distribution of tumor sizes among study participants was evenly divided between premenopausal and postmenopausal women, with each group consisting of 50 participants. The largest number of patients presented with tumor sizes between 2 and 5 cm (see Table 2).

Palpable axillary lymph nodes and menopausal status

Both the premenopausal and postmenopausal groups included 38 women with palpable axillary lymph nodes. This result indicates no statistically significant difference in the prevalence of palpable lymph nodes between the two groups, suggesting that menopausal status does not influence the likelihood of lymph node involvement in this study population.

Table 1. Other symptoms including pain, skin changes, nipple retraction, and nipple discharge.

Table 2. Tumor sizes.

Table 3. Distribution of clinical stages between premenopausal and postmenopausal women.

Clinical staging and menopausal status

The distribution of clinical stages of breast cancer according to menopausal status revealed distinct patterns; however, these differences were not statistically significant. The total number of participants was evenly split, with 50 individuals in each group. The p-value of 0.138 indicates that although variations exist in the distribution of clinical stages between premenopausal and postmenopausal women, these differences are not statistically significant. This suggests that menopausal status does not have a strong impact on the clinical stage of breast cancer in this study cohort (see Table 3 and Fig. 1).

Histopathological examination (HPE) and menopausal status

The distribution of HPE findings according to menopausal status revealed various types of breast cancer, but there were no statistically significant differences between premenopausal and postmenopausal women (see Table 4). The sample is evenly divided, with 50 participants in each group. The p-value of 0.135 indicates that menopausal status did not significantly influence the histological subtype of breast cancer in this study cohort.

Receptor status and menopausal status

For ER, 18 premenopausal and 24 postmenopausal participants tested positive, with a total of 42 positive cases. For PR, 17 premenopausal and 24 postmenopausal participants were PR positive, resulting in 41 positive cases. For HER2 neu, 21 premenopausal and 12 postmenopausal participants were HER2 neu-positive, with a total of 33 positive cases. (Refer to Table 5 for specifics.)

Chemotherapy and menopausal status

Among premenopausal participants, 46 out of 50 underwent chemotherapy, whereas 4 did not. In contrast, 42 out of 50 postmenopausal participants received chemotherapy, and 8 did not. Overall, 88 participants received chemotherapy, whereas 12 did not. The p-value of 0.027 indicates a statistically significant difference in the likelihood of receiving chemotherapy between premenopausal and postmenopausal women, with premenopausal women showing a slightly higher rate of treatment.

Fig. 1. Distribution of clinical stages between premenopausal and postmenopausal women.

Table 4. Distribution of histopathological examination (HPE) findings according to menopausal status.

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Discussion

Age group and parity

Age difference

Premenopausal women had a mean age of 43.30 ± 3.77 years, whereas postmenopausal women were significantly older, with a mean age of 61.82 ± 8.23 years. In a study by Kocaöz et al. (2019), the average age at breast cancer diagnosis was reported as 56.16 ± 12.71 years. Specifically, premenopausal patients had a mean age of 46.84 ± 6.44 years (range, 19–55 years), whereas postmenopausal patients had a mean age of 66.02 ± 9.96 years (range, 44–96 years). The statistical significance of this age difference is indicated by a p-value of 0.001, indicating a strong correlation between age and menopausal status (Kocaöz et al., 2019).

Age at first pregnancy

Postmenopausal women had a significantly younger mean age at first pregnancy (23.40 ± 3.37 years) than premenopausal women (27.36 ± 4.54 years), with a p-value of 0.001. A study by Surakasula et al. (2014) highlighted that an earlier age at first full-term pregnancy is a well-established protective factor against breast cancer, particularly in postmenopausal women.

Age at menarche

All postmenopausal women had an unknown age at menarche. Among premenopausal women, 75.9% reported having menarche before age 12, whereas the majority of postmenopausal women (68.4%) had menarche at age 12 or older. This difference was statistically significant (p=0.001).

Table 5. Receptor status and menopausal status.

Parity

The majority of premenopausal (48.4%) and postmenopausal (51.6%) women in the study were multiparous. However, nulliparous women were more common among premenopausal participants (71.4%). The p-value for parity was 0.240, indicating no significant association between parity and menopausal status. Surakasula et al. (2014) reported a higher prevalence of breast cancer in women with lower parity, suggesting that multiparity may act as a protective factor against breast cancer, particularly in postmenopausal women.

Family history of breast cancer

Our study found no significant association between a family history of breast cancer and menopausal status. Similarly, Surakasula et al. (2014) identified family history as a risk factor for breast cancer, but they did not provide detailed statistical data to support this finding.

Duration of breastfeeding

Premenopausal women primarily breastfed for less than 12 months, whereas postmenopausal women exhibited a wider range of breastfeeding durations, often between 12 and 24 months. The observed difference in breastfeeding duration between the two groups was statistically significant (p=0.005). This finding is supported by a study by Stordal et al. (2013), which suggested that extended breastfeeding may have a protective effect against breast cancer, particularly in postmenopausal women.

Breast complaints

The occurrence of lumps was evenly distributed between pre- and postmenopausal women. However, breast pain was more prevalent among premenopausal women, although the difference was not statistically significant. Skin changes were more commonly reported in postmenopausal women and approached significance. There were no significant differences in nipple retraction or discharge between the groups. Surakasula et al. (2014) also reported a high prevalence of lumps in the central region of the breast, with 28.84% of postmenopausal women and 18.75% of premenopausal women presenting with lumps in this location.

Size and site of breast cancer

The relationship between breast cancer size and site and menopausal status was not statistically significant. Surakasula et al. (2014) noted that while specific details for this study’s findings were not provided, they highlighted the central and upper outer quadrants as notable locations for breast cancer in premenopausal women, with a preference for the upper outer quadrant in postmenopausal women (Surakasula et al., 2014).

Clinical stage

Stage IA was observed exclusively in premenopausal women, whereas the other stages exhibited varied distributions without any significant trend (p-value=0.138). This suggests that menopausal status does not have a strong impact on the clinical stage of breast cancer. The majority of patients were classified as Stage IIB. In the Kocaöz study, various characteristics of breast cancer were analyzed in premenopausal and postmenopausal women. The tumor size distribution revealed that 22.66% of all patients had tumors smaller than 2 cm, 60.05% had tumors between 2 and 5 cm, and 17.29% had tumors larger than 5 cm (Kocaöz et al., 2019).

Lymph node involvement

Our data showed no significant difference in lymph node involvement between premenopausal and postmenopausal women (p-value=0.506). Among the 24 participants without palpable axillary lymph nodes, the distribution was balanced, with 12 (50.0%) premenopausal and 12 (50.0%) postmenopausal. Similarly, of the 76 participants with palpable axillary lymph nodes, 38 (50.0%) were premenopausal and 38 (50.0%) were postmenopausal. The total sample consisted of 100 participants, which were evenly split between the two menopausal groups. In the Kocaöz study, a higher percentage of premenopausal women (76.60%) had axillary lymph node metastasis than postmenopausal women (57.51%), with lymph node involvement being significantly higher in the premenopausal group (p < 0.001) (Kocaöz et al., 2019).

Histopathological examination

Histopathological examination revealed that 47 postmenopausal women (50.5%) and 46 premenopausal women (49.5%) were diagnosed with invasive ductal cell carcinoma. The other subtypes included invasive ductal cell carcinoma with intraductal papillary features in 2 postmenopausal women (100%), along with various other subtypes in premenopausal women. The p-value of 0.135 indicates no significant difference in histopathological findings between the two groups.

Receptor status

ER status

ER-negative cases are more common among premenopausal women (55.2%), whereas ER-positive cases are more common in postmenopausal women (57.1%) (p-value=0.224).

Progesterone receptor (PR) status

PR-negative cases are also more frequent in premenopausal women (55.9%), whereas PR-positive cases are more prevalent in postmenopausal women (58.5%) (p-value=0.15).

In the study by Kocaöz et al. (2019) premenopausal patients exhibited a higher likelihood of positive ER expression than postmenopausal patients (55.8% vs. 44.2%, p=0.002). Similarly, positive PR expression was more common in premenopausal women (52.7% vs. 40.9%, p=0.014). The likelihood of both ER and PR being positive was significantly higher in the premenopausal group (53.61% vs. 30.05%, p < 0.0001). Conversely, the postmenopausal group showed a significantly higher proportion of ER-positive and PR-negative cases (15.32% vs. 24.87%, p=0.013), as well as ER-negative and PR-positive cases (4.25% vs. 12.95%, p=0.001) (Female Breast Cancer — Cancer Stat Facts, 2024).

HER2/neu status

HER2/neu-negative cases were more common in postmenopausal women (56.7%), whereas HER2/neu-positive cases were more common in premenopausal women (63.6%) (p-value=0.056). Partridge et al. (2015) also found that HER2-positive tumors were more frequently observed in younger, premenopausal women, which is consistent with our findings.

Triple negative

A total of 30 patients in our study (14 premenopausal and 16 post-menopausal) were classified as triple negative. Although African American women generally have a lower overall risk of developing breast cancer compared to white women, premenopausal African American women face a higher risk of developing triple receptor-negative cancer. This increased risk is a significant factor contributing to the poorer prognosis observed in young African American women with breast cancer (Carey et al., 2006).

Chemotherapy/Radiotherapy

Our study found no significant difference in the administration of chemotherapy or radiotherapy based on menopausal status. Chemotherapy was more frequently administered to premenopausal patients because of their higher risk of tumor recurrence. This is consistent with the findings of Early Breast Cancer Trialists’ Collaborative Group (2005), who reported that chemotherapy is a widely used adjuvant therapy for breast cancer, significantly reducing the risk of recurrence Additionally, the study by Kocaöz et al. (2019) indicated that premenopausal patients received chemotherapy more often than postmenopausal patients (83.83% vs. 73.06%, p=0.007). Radiotherapy was also more common in the premenopausal group than in the postmenopausal group (22.55% vs. 13.47%, p=0.008). Furthermore, premenopausal patients were more likely to receive endocrine therapy than their postmenopausal counterparts (Kocaöz et al., 2019).

Recurrence and menopausal status

Among the participants, 97 showed no recurrence, with a nearly even distribution (49.5% postmenopausal and 50.5% pre-menopausal). There were 3 cases of recurrence, 2 of which were postmenopausal. The p-value of 0.558 indicates no significant association between menopausal status and recurrence.

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Conclusions

Our study revealed a strong and statistically significant correlation between age and menopausal status, with postmenopausal women being significantly older than their premenopausal counterparts. Notably, the age at first pregnancy differed between the two groups, as postmenopausal women tended to have their first pregnancy earlier than premenopausal women. Additionally, the duration of breastfeeding was significantly associated with menopausal status, with postmenopausal women breastfeeding for a longer duration.

We also found that a family history of breast cancer and age at menarche were linked to menopausal status, with premenopausal women more likely to report a family history of breast cancer and to have experienced earlier menarche. Moreover, menopausal status significantly influences the choice of chemotherapy regimens, suggesting that it can guide treatment decisions.

Conversely, our study found no statistically significant differences in parity, clinical presentation, histopathological findings (including HPE grading and receptor status), tumor staging, postoperative radiotherapy, or recurrence rates between premenopausal and postmenopausal women.

This study underscores the complexity of the relationship between menopausal status and breast cancer characteristics. Given the limitations of our research, including restricted population size and time constraints, we found significant differences in age, age at first pregnancy, and duration of breastfeeding between premenopausal and postmenopausal women. Future studies should involve larger populations and extended timeframes to further evaluate and establish these findings.

Limitations

- Sample Size: The study was limited to 100 participants, which may have affected the generalizability of the findings.

- Single institution: The results may not be applicable to other settings or populations.

- Follow-Up Duration: A 2-year follow-up period may not adequately capture long-term outcomes and recurrence rates.

Conflict of interests

The authors declare that there are no conflicts of interest associated with this study or its findings.

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