Your health isn’t something to ignore. Learn about some key threats to women’s health and how to prevent problematic conditions.
Many of today’s leading threats to women’s health can be successfully treated, once diagnosed, or prevented all together. The key is awareness and understanding risks for women of all ages.
According to the U.S. Centers for Disease Control and Prevention (CDC), the top causes of death among adult women in America are heart disease, stroke, cancer, chronic lower respiratory disease, Alzheimer’s disease and unintentional injuries. A closer look at the top three underscores the need for paying close attention so that these diseases can be detected, treated and cured.
Reproductive System Cancers
Cancer in a woman’s reproductive system poses treatment challenges that are being addressed by a relatively new sub-specialty. Dr. Ali Mahdavi, a board certified gynecological oncologist at Mercyhealth, says he chose this specialty because it allows him to focus on cancers that occur in the cervix, uterus, ovaries and Fallopian tubes.
“Each of these cancers is a separate disease, and must be treated differently,” Mahdavi explains. “It is recommended that women begin cervical cancer screening, through PAP smears, at age 21. While the average age for diagnoses of cervical cancer, for instance, is in the late 40s, it can occur earlier because of changes in a woman’s reproductive organs as the result of dysplasia and other conditions.”
While cervical dysplasia is not itself cancer, a positive test indicates that abnormal cells are found on the surface of the cervix that can develop into cancer. What differentiates cervical cancer from the other reproductive cancers is that it’s nearly always caused by the human papillomavirus (HPV), which has been sexually transmitted.
“Unfortunately, there are not many symptoms to indicate cervical cancers,” Mahdavi says. “The most common way it is discovered is with PAP tests. But in later stages, patients may experience bleeding or spotting, or have pain in their lower pelvis region.”
While uterine and ovarian cancers may be anticipated due to a woman’s family history and other biological factors, cervical cancer stands alone as having a viral cause. Mahdavi says the U.S. Food and Drug Administration (FDA) approved the HPV vaccine to help prevent the spread of this virus.
“I strongly recommend that young women between the ages of 9 and 26 be vaccinated,” he says. “More recently, the FDA also recommended that young boys also be vaccinated. Doing so breaks the cycle of transmission.”
Early stage cervical cancer is first treated with surgery, Mahdavi explains. However, if the cancer is found in later stages and has spread locally or to distant sites, chemotherapy and radiation are the first line of treatment.
“Early stage diagnosis and surgery adds years to a woman’s survival chances,” Mahdavi says. “At Mercyhealth, we offer minimally invasive surgery for the treatment of gynecologic cancers. Minimally invasive surgery results in faster recovery, less pain, shorter hospital stay and improved quality of life compared to traditional open surgery.”
Asked about the risks posed by hormone therapy, in post-menopausal women, Mahdavi says a patient and her physician should discuss the risks and benefits. Although there is some evidence that prolonged hormone replacement therapy could increase the risk of breast and endometrial cancers, it significantly helps with menopausal symptoms and may safely be used over a limited period of time.
Survival rates for women with reproductive cancers that have been diagnosed in the earliest stages are encouraging. Mahdavi says women with stage one cervical cancer have a cure rate of about 90 percent.
“In more advanced stages, say stage three or four, the survival rate drops significantly,” he adds. “By stage four, the patient has less than a 50 percent chance of survival.”
The number of deaths resulting from cervical cancer has decreased significantly in the past 20 to 30 years.
“This is because of public awareness and education as well as consistent screening to detect the cancers earlier,” Mahdavi says.
Once considered a “man’s disease,” lung cancer is now an equal-opportunity killer and remains the leading cause of cancer deaths in women, with smoking being the main cause in up to 80 percent of these patients. Dr. Ajaz M. Khan, a hematologist and oncologist who chairs the cancer committee in the Patricia D. Pepe Center for Cancer Care at OSF Saint Anthony Medical Center, says women must be as vigilant as men are about the onset of lung cancer.
“Of the estimated 224,000 cases of lung cancer diagnosed in the United States last year, women and men were equally affected, close to a one-on-one ratio,” Khan says. “Unfortunately for women, based upon on the Surveillance, Epidemiology, and End Results Program (SEER) database, the rate of new lung cancer cases in males has decreased by 28 percent over 37 years, but women’s cases increased 98 percent in the same period of time.”
Khan describes this explosion in women’s lung cancer diagnoses as a serious health epidemic. Lung cancer has been the leading cause of cancer deaths in women since 1987, and claims more lives than breast, ovarian, uterine and cervical cancers. One in five women who develop lung cancer have never smoked, but women suffered 21,000 deaths from this disease, this year alone. In fact, women who never smoked are three times more likely to develop lung cancer than men who never smoked.
“When lung cancer is diagnosed in stage one, the woman has about a 45 to 65 percent chance of five-year survival if surgical resection can be offered,” Khan explains. “But when it reaches stage four and has metastasized, which occurs in greater than 50 percent of cases at diagnosis, the five-year survival rate is about 4 percent. Our best initial treatment may help the patient live 10 to 12 months longer. But over all, the five-year survival rate for lung cancer remains around 17 percent, which is significantly lower than other more common cancers, such as breast and colon cancer.”
Khan explains that lung cancer cells fall into two categories: small cell and non-small cell, with non-small cell occurring more often.
Peggy Malone, a nurse navigator at OSF, says about 75 percent of lung cancer patients begin treatment in the later stages of the disease. In the majority of cases, smoking is the No. 1 culprit.
“Now, thanks to the Affordable Care Act, smoking patients can receive lung cancer screening subsidized by insurance,” Malone says.
Khan explains that the screening program targets smokers between the ages of 55 and 75 who have a 30-pack habit, averaging one pack a day for 30 years, and who have not quit in the past 15 years. This is based upon the National Lung Trial Screening Program (NLST), which has demonstrated a mortality reduction from lung cancer of 20 percent.
But for women who do not smoke, there is no screening program. Khan says standard chest x-rays and sputum tests are not sensitive enough to detect lung cancer in its earliest stages.
Patients who are referred to OSF’s cancer center first encounter Malone, who takes them step by step through each procedure.
“My primary role is to educate the patient,” Malone says. “I learn what type of lung cancer she has, and supply materials for her to review. I also sit in on all appointments with our oncologists and fill out a form. After the appointment, I go over the information with the patient and answer any questions she may have.”
As a nurse navigator, Malone also works with patients on social issues, such as finding transportation to and from treatments, tests and appointments.
“I have a dedicated telephone number and voice mail which helps me be available to patients whenever they need me,” Malone adds.
Once the patient is introduced to the treatment team, the team evaluates the patient for stage and overall health condition, says Khan.
“If the lung cancer is diagnosed at an early stage, we recommend surgery to remove the tumor, which provides the best chance for cure,” Khan says. “We may also schedule preoperative chemotherapy and/or radiation treatment to shrink the tumor. After surgery, a program of chemotherapy and/or radiation is developed to meet each patient’s pathological and clinically specific needs. This is a collaborative effort with Peggy as the key element.”
In patients whose lung cancer has progressed to advanced disease, the cancer is biopsied to test for predictive biomarkers including ALK gene rearrangements, EGFR mutations, BRAF, ROS and RET gene arrangements. These tests can be used to predict therapeutic efficacy of treatment.
Tests are performed to determine if markers may influence the response to therapy and patient outcome.
“An oral medication can be prescribed to treat these kinds of lung cancers in about 20 percent of patients,” Khan adds. “It’s sort of an oral chemo in which the patient takes one pill a day. We have one patient who has been on this regime for two years, is working and doing well.”
However, when surgery is not an option because of advanced stages or high-risk conditions such as heart disease, diabetes or other lung conditions, such as chronic obstructive pulmonary disease, a course of chemo and radiation is designed to target the patient’s individual disease.
“Both are more effective together than given alone,” says Dr. George Bryan, a board-certified radiation oncologist at OSF. “We consult together to devise the specific plan needed. In patients with stage two or three lung cancer, we generally do treatments daily on Monday through Friday for six-and-a-half to seven weeks. In patients with stage one lung cancer who have pulmonary risks, we prefer a closely targeted radiation treatment using high dosages for one week.”
These protocols are so new, there’s not yet a clear survival rate.
“However, we haven’t seen a great improvement in survival rates in the past 20 years, despite development of new therapeutic compounds, lab tests, and aggressive strategies to add to our treatment and care armamentarium,” Khan says. “The No. 1 message we want to send is to stop smoking. That alone will reduce the number of cases and deaths across the board.”
Not so long ago, heart attacks and congestive heart failure were also considered to be diseases that impacted men more than women. But Lisa Larson, a nurse practitioner in Swedish American’s Heart Center, says this has not been the case for a few decades now.
“When it came to heart attacks, women were the forgotten sex,” Larson says. “About 12 years ago, the American Heart Association (AMA) launched its ‘Go Red’ campaign dedicated to educating the public on the very real dangers of women’s heart health issues that were going under-diagnosed.”
Heart disease is the No. 1 killer of women, and women who suffer a heart attack are more likely to die than men, says Larson. Why? For one thing, women have atypical symptoms. And, they tend to shrug off symptoms for as long as a month, before seeking medical help.
“Actress Elizabeth Banks, famous and relatively young, in her early 40s, had a heart attack,” Larson says. “She made an informational film titled ‘Just a Little Heart Attack’ that focuses on the problems and dangers of not being aware of those unusual symptoms and not going to the doctor immediately.”
Larson points out that crushing chest pain, radiating pain in the shoulders and arms, and other well-known symptoms of heart attack are not always experienced by women. Instead, they may have back pain or believe they have heartburn, gas or acid indigestion. They may dismiss symptoms of fatigue as being the result of working full time, juggling family and other obligations. Plus, everyday and excessive stress combined with factors such as untreated high blood pressure, diabetes, too much body weight, insufficient exercise or a smoking habit, contribute to the possibility that a woman may be developing congestive heart disease or an impending heart attack.
“The AMA’s highly successful Red Dress Campaign has brought a sharpened focus on the need for vigilance and awareness in order to prevent and adequately treat heart disease in women,” Larson adds.
She emphasizes the need to watch for fatigue and a feeling of being out of breath, as well as vague pain in the shoulders and back. Unexplained weight gain may indicate a fluid build-up around the heart that signals congestive heart failure.
“Women don’t have heart health issues as early as men can,” Larson says. “Hormones, especially estrogen, protect them for up to 10 years later than the average age that men can develop heart disease. Hormone replacement during menopause to relieve those uncomfortable hot flashes and other symptoms also protects a woman against heart attack.
But, after a year has past since a woman’s final menstruation, estrogen therapy becomes more of a detriment than a benefit, because it can enhance the possibility of reproductive and breast cancers as well as strokes and heart disease.”
Up until 10 years ago, estrogen therapy was commonly prescribed to prevent osteoporosis.
“At that time, estrogen was a lot less expensive than it is now,” she explains. “Today, we have safer and more cost-effective ways to help women avoid bone mass loss.”
Asked what women can do to help themselves prevent heart disease, Larson says factors such as age, family history and genetics cannot be changed.
“What can be addressed is controlled blood pressure, well-managed diabetes, weight loss, an appropriate exercise program and good health habits,” Larson says. “Smoking cessation is probably the most important thing a woman can do to stay healthy on pretty much every level. And those electronic cigarettes are not a viable option. They still have the nicotine and other irritants. Far better to cut down smoking until the woman can quit completely.”