No matter how much we complain about our breasts—“they bounce when I run, they are six inches lower that they used to be, the left one is bigger than the right”—we don’t want anything worse than “natural sag” to ever happen to them. They have fed our children, filled our shirts, and, let’s face it, are quite sexy.

But as the number of candles on our birthday cakes increases, so does our risk of developing breast cancer. While a 30-year-old woman’s risk of developing breast cancer in the next 10 years is one in 227, that of a 60-year-old woman is one in 28, according to the National Cancer Institute. Hit 70 and the risk increases to one in 26.

“Age, or getting older, is the single greatest risk for getting diagnosed with breast cancer,” says women’s health expert Dr. Ricki Pollycove, M.D. “There are many likely reasons for this, and many are related to unhealthy lifestyles about which we can become educated and actively change our behaviors to lower individual risks as we get older.”

So if you want to keep your breast cancer risk from mounting into menopause (show of hands, please?), you first need to understand the connection between your age, reproductive health, menopause, and breast cancer.

Here are some detailed answers to women’s most common questions about menopause and breast cancer:

How Does Hormone Replacement Therapy Affect the Risk of Breast Cancer?

“Estrogen use over the long term lowers a woman’s risk for breast cancer! It decreased rates of breast cancer by 23 percent in the largest clinical trial out of the U.S., which was re-analyzed after 11 years of estrogen use and published in 2011,” Dr. Pollycove says. “In fact, a 33 percent lowered rate of breast cancer was seen in women who took more than 80 percent of their study pills!” However, headlines often read differently and scare women out of the HRT they need. For example, a recent study in the Journal of the National Cancer Institute found that HRT’s effect on breast cancer risk varies somewhat by ethnicity, body mass index, and breast density. The HRT progestin (not natural progesterone!) used in the study however, was Provera, a fact that is often not mentioned in news reports. And not all forms of HRT are created equal, says menopause specialist Dr. Josh Trutt, MD, a healthy aging expert from PhysioAge Medical Group in New York City. Bioidentical hormones are associated with a lower breast cancer risk—and can actually up your lifespan. “The pervasive fear of breast cancer is causing women to avoid estrogen therapy—and avoiding estrogen therapy is killing women by the tens of thousands. Each year, heart disease kills eight times as many women as breast cancer,” Dr. Trutt says. In fact, according to the Kronos Early Estrogen Prevention Study, the average woman believes that breast cancer is the number one killer of women, leading to 39 percent of all deaths among women. However, heart disease is the true leading killer, contributing to 45 percent of all deaths among women. Breast cancer only leads to 4 percent. The bottom line: Don’t let a fear of breast cancer stand between you and the HRT you need.

How Does Hysterectomy Affect the Risk of Breast Cancer?
Ready for your silver lining? “Surgical menopause actually slightly lowers a woman’s risk for breast cancer. The basis for this lowered risk is not well understood, but it is one of the good-news aspects of the upsetting situation many women feel when they have to give up their uterus due to pain, diseases like severe endometriosis, or abnormal precancerous or cancerous growths,” Dr. Pollycove says. What’s more, one 2011 study from the University of Southern California, Los Angeles shows that removal of one or both ovaries is also associated with a decreased risk of breast cancer.

What Is the Breast Cancer Survival Rate Among Menopausal Women?

“The reassuring news is that the older a woman is when diagnosed, the less likely she is to have a life-threatening cell type of breast cancer,” Dr. Pollycove says. Women with non-invasive cancers of the breast (which are the most common in women who undergo regular screenings) have a survival rate of 93 percent, according to the American Cancer Society. Women with non-invasive breast cancer often have a lumpectomy in which the cancerous tumor is removed while leaving the rest of the healthy breast tissue intact, says Dr. Pollycove. The key here, however, is early detection. (More on that next!)

How Often Should I Be Screened for Breast Cancer?

It depends on whom you ask. “The most important thing women can do to lower their chance of having their quality of life or lifespan affected by breast cancer is to get regular mammograms and at least an annual clinical breast exam by a provider,” says Dr. Pollycove. The American Society of Breast Diseases (ASBD), internationally respected as the premier multidisciplinary breast-care society, recommends annual screening for women 40 and older. To confuse things, however, in 2009, the U.S. Preventive Services Task Force issued new guidelines stating that women younger than 50 didn’t need routine annual mammograms and those ages 50 to 74 should only get screened every two years. Before that, the recommendation was that all women aged 40 and older get mammograms every one to two years—a recommendation the American Cancer Society, ASBD, ASPRS, many physicians, and, according to a new study, about half of women, still follow. In fact, a new analysis published in Cancer shows that half of all breast cancer deaths occur in women under the age of 50—most of whom have never had a mammogram prior to diagnosis. Their death rates are higher because their cancers are found later when they are larger and may have spread to the lymph nodes. While the U.S. Preventative Task Force recommends not performing breast self-exams and, statistically, they are less important than mammograms, up to 25 percent of invasive breast cancers are found during self-exams. These cancers have much higher cure rates when detected as small, new lumps. So the general consensus among physicians is to still perform self-checks on a regular basis. Try feeling yourself up every national holiday or, if you are still menstruating, a few days after each period.

Are All Mammography Machines the Same?

As far as my girls’ yearly photo shoots are concerned, I use the Rolls-Royce of mammography machines: the Hologic Selenia Dimensions Breast Tomosynthesis machine. Nothing but the best for the ladies! While conventional 2D mammography produces a single, flattened image of the breast, breast tomosynthesis minimizes the impact of overlapping breast tissue during imaging since the camera moves over the breast, taking images from multiple angles. These images are combined to create a 3D rendering of the entire breast to produce fewer false positives. Its levels of radiation are slightly higher than those of conventional mammography machines, but the quantities are still under regulation and deemed safe by the FDA. Next year, Hologic plans to introduce a lower-radiation addition to the machine. Many health insurance plans do not cover this new technology, so be reassured: annual, digital 2D imaging is still a great bet and much more sensitive than even the most skilled of hands.

What Breast Cancer Risk Factors Are Out of My Control?

“Divide the risk factors for breast cancer into two buckets: the risks about which you can do something and those that are out of your control as you enter menopause,” Dr. Pollycove says. While it’s frustrating if you have a family history of breast cancer or mutated BRCA1 and BRCA2 genes, knowing—and communicating to your doctor—your inherited, “not-going-anywhere,” risk factors is important in determining the right prevention plan for you. Some other risk factors include dense breast tissues and previous benign breast conditions such as hyperplasia of ductal or lobular tissue, cysts, and papillomas. What’s more, if you’ve never been pregnant or had your first pregnancy after age 30, your risk for breast cancer increases slightly, according to the American Cancer Society. Pregnancy and breastfeeding reduce breast cancer risk likely because they help mature breast tissue and reduce the total number of menstrual cycles that a woman has throughout the course of her life; this may influence cancer risk by altering hormone exposure to the breast tissues.

What Lifestyle Factors In Menopause Increase the Risk of Breast Cancer?

Basically, anything that’s bad for your overall health is bad for your breasts. Some examples: smoking, being overweight or gaining weight at mid-life, living a sedentary or stressful lifestyle, eating a diet high in saturated fat, drinking more than seven to 10 alcoholic drinks per week, and eating few fruits and vegetables, says Dr. Pollycove, who “beats the lifestyle drum” every day with her patients. Her prevention prescription: Perform aerobic exercise for at least 20 minutes a day. That alone can cut your risk of breast cancer in half, Dr. Pollycove says. While you’re at it, check out these five ways to fight menopausal weight gain.

What Kinds of HRT Options Are Available for a Breast Cancer Survivor?

As if breast cancer wasn’t bad enough, for many women, the fear of going off of hormone replacement therapy is downright crippling. Don’t worry! “All sorts of well-tolerated and easy-to-use therapies are available in the U.S. for breast cancer survivors. Unfortunately, once again, a lot of ignorance, confusion, and fear surround these choices. In a nutshell, local-only vaginal therapies are appropriate for virtually every woman who has bothersome symptoms and can be safely prescribed,” says Dr. Pollycove, who notes that it’s always best to have an oncologist or a perimenopause and menopause specialist review the particulars of your breast disease diagnosis before you fill any scripts. Being detail-oriented serves us well when it comes to enjoying optimal health.

Sisters, it’s time to show our breasts the care they deserve. Let’s celebrate with both hormone and breast happiness!

 Suffering in silence is OUT! Reaching out is IN!