For women, it’s so easy to put everyone else’s needs ahead of their own, but personal health shouldn’t be cast aside. When it comes to breast cancer, joint health and heart health, oversight can be grave.
It’s all too common: Women take care of everyone else while putting their own needs secondary, especially their personal health. The time and energy required to meet the obligations of work, family and friendship often leave them too exhausted to take care of themselves. This pattern can prove to be a serious mistake.
For decades, heart disease has been the No. 1 cause of death for men, but more recently it’s become a top concern for women, as well. Dr. Shobashalini Chokkalingam, a cardiologist with Mercyhealth, says she’s concerned about this turn in statistics because data show the disease is 80 percent preventable. Of even further concern is an alarming rise of heart disease among younger women.
“We used to see women develop heart disease mostly after menopause when the estrogen levels that protected them diminished,” Chokkalingam says. “Now, we are treating an increasing number of women in their 20s, 30s and 40s. While one in 31 women will be diagnosed with breast cancer, one in three will develop some form of heart disease. That averages out to one woman being diagnosed every 18 seconds.”
Risk factors such as smoking, high blood pressure, high cholesterol and diabetes lead to heart disease in women of all ages.
“I believe there are two things that women need to do now, while they are young, to prevent heart disease,” she adds. “They cannot afford to wait until they are in their 50s. That is too late.”
The first essential step is to know your family history. Chokkalingam says that heart disease in close family members such as parents and siblings – and to a lesser extent grandparents, aunts and uncles – may point to the same vulnerability in a younger woman.
“The other important item is to know their numbers,” Chokkalingam says. “By that, I mean they should know their weight, blood pressure, cholesterol count and blood glucose through regular physical exams with their primary doctors.”
Further, women need to understand that, because they are built smaller than men, on average, they are more susceptible to the adverse effects of smoking and alcohol consumption.
“Just 1.4 cigarettes a day triples a woman’s risk of developing heart disease as well as suffering strokes,” Chokkalingam says. “Half a drink per day decreases heart function and can lead to congestive heart failure.”
Today’s women are busy. With the obligations of family, work and other activities, they tend to ignore or put off personal health care and concerns.
“They often cannot seem to focus on their own needs, even to the point of not calling 911 when they might be having a heart attack,” Chokkalingam says. “Women experience different symptoms of an impending heart attack than men, who primarily suffer pain and crushing weight in their chests. About 40 percent of women have no chest pain at all. But they do experience heaviness, shortness of breath, joint aches, nausea, fatigue, low energy levels and other, seemingly unrelated symptoms.”
Despite a substantial effort to educate women on the dangers of heart disease, the statistics are still alarming. Chokkalingam says she has treated women as young as their mid-20s.
“One patient has been diagnosed with heart disease at 26,” she adds. “Her mother died of heart disease at age 29. It’s impossible to ignore the role family history plays in situations such as this. And yet, so many women fail to understand the gravity of the risk. Women need to step up their game, especially African-American women. But regardless of race, heart disease is concerning for women of every age.”
Chokkalingam is concerned about African-American women for good reason. According to the Mayo Clinic, one in every two black women over the age of 20 in America has some form of heart disease, and less than half are aware that heart disease is their demographic’s No. 1 cause of death. Each year, more black women die from heart disease than from breast cancer, lung cancer and stroke combined.
Regardless of your ethnicity, the role of a healthy diet in prevention can’t be understated.
“Something as simple as reducing the amount of sodium in your diet can make a huge difference,” Chokkalingam says. “Just a handful of blueberries or blackberries three times a week can reduce the risk of developing heart disease by as much as 34 percent, according to a Harvard study. Unsalted almonds are also a benefit to prevent heart disease.”
As serious as heart disease is, it’s not the only health risk women should watch. Breast cancer is a serious concern for many, but as well-recognized as this disease is, it’s also important to recognize other cancers in the reproductive system, including ovarian, uterine and cervical cancers. Each is distinctive and affects not only different age groups but also unique symptoms.
Cervical cancer is especially concerning to younger women.
“Cervical cancers skew younger than other reproductive system cancer,” says Dr. Eric Xanthopoulos, a radiation oncologist with Beloit-University of Wisconsin Cancer Center. “About 78 percent of cervical cancers are diagnosed in women 30 to 39 years old.”
Xanthopoulos explains that, with cervical cancer, women with more than four sexual partners, or with first intercourse before 16 years of age, are associated with a 60 percent greater incidence of developing cervical cancer.
“Smoking and heavy drinking also are associated with a 200- to 300-percent greater incidence of cervical cancer,” Xanthopoulos adds. “But keep perspective with this talk of risk: the baseline risk for any woman to get cervical cancer is less than 1 percent in their lifetime, so even a smoker has a less than 3 percent incidence of cervical cancer.
The best way to check against cervical cancer is to get regular Pap smears, he stresses.
“During a Pap smear, a gynecologist will insert a speculum into the vagina and use a small brush to collect cells from the cervix,” Xanthopoulos says. “Current guidelines recommend that Pap smears start three years after first intercourse or by age 21, whichever comes first. Women should get annual Pap smears until age 30. After that, they can get a Pap smear every two to three years if all their prior Pap smears were normal. Women typically stop getting Pap smears in their 60s.”
Xanthopoulos says one way in which women can prevent cervical cancer is to get the human papilloma virus (HPV) vaccine between the ages of 9 and 26.
“HPV comes in more than 50 varieties, but the ones associated with cervical cancer are Nos. 16 and 18. These are responsible for 70 percent of cervical cancers,” Xanthopoulos says. “Getting the vaccine greatly reduces the odds of developing cervical cancer in women, and other cancers in men,” he adds. “Because it is a virus-based cause, it can be passed on from one sexual partner to another.”
Curing cervical cancer involves surgery for small, early Stage I cancers (sometimes with a little radiation after), or chemoradiation for later cancers in Stage II and beyond, he continues. The treatments for cervical cancers may prevent women from having children later, which can be challenging because many patients with cervical cancer are in their younger, child-bearing years.
Ovarian cancer is more difficult to recognize. “Symptoms of ovarian cancer are fairly generic,” Xanthopoulos adds. “Pain in the back, stomach or after sexual intercourse can signal ovarian cancer, but they are also associated with many other ailments. This is when family history is vital in determining whether or not the woman may have ovarian cancer.”
These non-specific symptoms often mean ovarian cancer is diagnosed at a late stage when there are few good treatment options.
Uterine cancer has distinct symptoms, including vaginal bleeding, Xanthopoulos says.
“This is especially true after menopause,” he adds. “We always suspect uterine cancer when a post-menopausal woman comes in with spotting or bleeding. In that situation, we will do a vaginal ultrasound to look at the lining of the uterus. If it is thicker than normal, we will do a biopsy to rule out cancer.”
One out of every eight American women will be diagnosed with breast cancer, warns Dr. Alyssa Ceilesh, DO, an oncologist at the Patricia D. Pepe Center for Cancer Care at OSF Saint Anthony Medical Center in Rockford. But, she adds, it is possible to prevent this disease.
“In general, it is possible to lower the risk by staying active, maintaining a healthy weight, not smoking and limiting alcohol intake,” she says. “Smoking and alcohol consumption have direct links to breast cancer development.”
Family history also plays a vital role in the odds that a woman will have breast cancer, Ceilesh says. “The risk is higher in women whose close family members have been diagnosed with breast cancer.”
Genetic screening may be recommended if breast cancer has been found in a parent, sibling or other close relative, she adds. This may qualify a woman for advanced tests and screening at an early age to determine if she harbors a breast cancer-associated genetic mutation, such as the BRCA mutations.
“Women in this category should begin breast cancer screening at a younger age,” she adds. “With women who do not have these genetic markers, annual mammograms should start at age 40 until approximately age 75. Different agencies have differing timetables but, as a rule, this is the standard suggestion.”
Along those lines, women should also be aware of the density of their breast tissue, Ceilesh adds. Breast tissue density is measured on four levels, from tissue that’s low-density to tissue that’s high density. Increased breast density is associated with an increased risk of breast cancer and qualifies women for additional screening options such as breast MRI or ultrasound.
Early diagnosis or pre- or existing breast cancer increases the rate of survival significantly, Ceilesh says.
“Once that cancer moves beyond the lymph nodes and metastasizes, the more difficult it is to cure,” Ceilesh stresses. “In terms of survival, early detection can lead to a five-year survival rate of 90 percent. If the cancer has spread, the five-year survival rate drops to 20 percent. We have a wonderful range of excellent therapies, but if we can prevent the cancer or catch it early, we have a much better chance of saving more lives.”
With that in mind, Ceilesh says women should be aware of several possible symptoms for breast cancer that they can detect on their own.
“If a woman has a palpable lump in the breast, no matter how small, or a lump in an armpit, she should have an exam and mammogram immediately,” Ceilesh says. “Also, if the texture or surface of any part of the breast skin changes, or if she finds inflamed skin, as well as if the breast nipple abruptly inverts, she should see a physician immediately.”
The more women know about cancer’s symptoms and prevention, the better. That’s why Jessica Ward, nursing operations leader for FHN’s Women’s Service Line, says it’s vital that women have annual mammograms and pelvic exams to help provide early detection.
“Women’s Service Line is made up of obstetrics and gynecology specialists who provide not only routine testing but also respond to patients’ concerns about abnormal symptoms such as irregular vaginal bleeding,” Ward says. “We work with women to provide birth control, do pre-cancer screening and treat various gynecological-related diseases.”
Annual screening for breast and cervical cancer can help detect pre- and early stage disease, which makes treatment more successful, she adds. Ward says they often find early-stage cancers before women actually feel any symptoms.
“We use ultrasound as one diagnostic test to determine why bleeding or pain is occurring,” she adds. “It is important for women to not only have annual screenings but also to be familiar with their family histories. We run a specialized genetic test for women whose family history includes colon, breast, uterine, ovarian and cervical cancers.”
Ward explains that they first work with the patient’s gynecologist to establish the diagnosis and then find the most appropriate oncologist to treat the cancer. Once a woman is diagnosed with any type of cancer, Ward says it’s her team’s job to coordinate care through the entire treatment process, which can last from six months to a year or more.
“Depending on the various types of cancer and the stages in which they were diagnosed, they work with her treatment team to schedule radiation, chemotherapy and/or surgery,” Ward says. “We are involved with each patient through every step of her journey until the process is completed.”
Ward stresses that, while annual screening is essential to preventing cancer, a woman should not hesitate to contact her gynecologist with concerns.
“Don’t hesitate; contact us immediately,” she says. “Don’t wait until it’s too late.”
Not every symptom women develop leads to a serious diagnosis. The important thing is that women not only are consistent about annual screening appointments but also that they contact their gynecologist at the first signal that something is different. Early diagnosis and treatment translate to a longer, healthier life.