To mark National Women’s Health Week (May 8-14), Lifescript reveals some of the top medical advances affecting women. Learn about better breast-cancer screenings, safer hormone-replacement therapy, a new bone-building drug, why we’re finally getting our own EKG heart tests, fertility hope for cancer patients, and a simple way to protect your heart (and possibly even live longer)…
We've been blessed with Kindle II’s, all-in-one washer/dryer sheets (by Purex) and even spray-on clothes, but the past year has also been an important one for women’s health research. Life-saving medical advances have been made in areas from bone and heart health to better ways to detect breast cancer.
“Some results were quite surprising,” says Jacques Rossouw, M.D., chief of the Women’s Health Initiative branch in the National Heart, Lung and Blood Institute’s Division of Cardiovascular Sciences. “For example, we now know for sure that certain women who use hormone replacement therapy have dramatically lowered their risk of breast cancer.”
Researchers also are gaining a better understanding of how women’s bodies differ from men’s – and how that affects their care. Read on for important breakthroughs in women’s health.
Better Breast-Cancer Detection
Women have another weapon in the arsenal against breast cancer. Molecular breast imaging (MBI) finds three times as many breast tumors as mammography, reports the Mayo Clinic’s online research magazine Discovery’s Edge. And it’s especially helpful for women with dense breasts (which contain more connective tissue and less fat, and are harder to view in mammograms).
If you have dense breast tissue – as many women under 50 do – standard mammograms may not detect early-stage breast cancer. In fact, they fail to catch it in 1 out of 4 women ages 40-49. Women with dense breast tissue are 4-6 times more likely to develop cancer than other women, Mayo researchers say.
“It’s a completely different way of looking at breast tissue,” says Deborah Rhodes, M.D., a Mayo Clinic preventive-medicine specialist who helped develop the new technology. “It could revolutionize breast imaging.”
Patients are injected in the arm with a radioactive dye that’s absorbed by any breast tumor cells. This can be viewed with a gamma radiation-detecting camera. Tumors appear as bright spots on MBI film.
Two images are taken of each breast in a procedure that lasts about 40 minutes. Unfortunately, breasts still need to be compressed, but MBI requires two-thirds less pressure than a mammogram.
Because MBI is so sensitive, it can detect a mass two-fifths of an inch in diameter, even in dense breast tissue.
MBI has been approved by the Food and Drug Administration (FDA) but isn’t widely available yet. It doesn’t replace mammography but will be an additional tool for women with dense breasts or at higher risk of breast cancer. They can have both procedures done. MBI is more expensive, costing about $500; standard mammograms cost $100-$400.
Another option for women at high risk for breast cancer is magnetic resonance imaging (MRI), which uses a magnetic field, radio frequency pulses and a computer to produce very clear breast images. But it provides many false alarms and is expensive (about $1,100 per screening).
Safer Hormone-Replacement Therapy
Few health issues confound women and their doctors as much as hormone replacement therapy (HRT) to relieve menopause symptoms. Now there’s some good news: After being treated with supplemental estrogen alone, some women had a reduced risk of breast cancer and heart attack, a long-term study published in April 2011 has shown.
The findings confirmed earlier results from the landmark Women’s Health Initiative (WHI). Among about 11,000 women who’d had a hysterectomy (the surgical removal of the uterus), those who took supplemental estrogen for six years had a 23% lower risk of breast cancer over 11 years compared with participants who took a placebo.
“This is statistically significant – it’s not just a trend,” Rossouw says. “The benefit is [important] for all women of all ages.”
HRT commonly combines estrogen with progestin (a synthetic hormone meant to protect the uterus), but research has found that it increases cancer risk in women. The combination therapy was tested in this study too, but that part was stopped when participants turned out to face double the risk of breast cancer.
But single-hormone therapy had a variety of benefits.
“Women taking only estrogen also have a reduced risk of fractures and aren’t at increased risk of blood clots, stroke or colon cancer,” Rossouw says. “With combination drugs, the reverse is true.”
Also, women who started taking estrogen in their 50s had up to 50% fewer heart attacks than those who didn’t take it. (However, heart attack rates rose – by 16 cases per 10,000 women – among those who took it in their 70s.)
“The news is reassuring for younger women who use estrogen only,” Rossouw says. “It’s riskier if you’re older.”
A New Drug to Prevent Bone Fractures
Women with osteoporosis have more and easier treatment options for the bone disorder with the introduction of Prolia (denosumab), an injectable drug approved by the FDA in June 2010. It’s available now for postmenopausal women with multiple risk factors for fracture, or those who haven’t responded to other osteoporosis therapy.
The drug reduced fractures by 20%-68%, depending on where the bone was located, and increased density by 5%-8%, according to a three-year study of more than 7,800 women with osteoporosis, ages 60-91. Follow-up data found slightly greater increases in density over the following two years. The results were released by the drug’s manufacturer, Amgen.
Prolia is administered by injection once every six months in a doctor’s office. Side effects can include skin rashes and infections.
It works by deactivating a protein that stimulates cells to dissolve bones. But unlike other osteoporosis drugs, which slow normal bone loss, Prolia isn’t incorporated into bone tissue.
“The advantage is that it’s rapidly reversible, unlike the bisphosphonates [such as Fosomax or Boniva], which stay in your body a long time,” says Felicia Cosman, M.D., a professor of clinical medicine at Columbia University in New York, who studies causes of and treatments for osteoporosis (but wasn’t associated with this study). “This is a great new tool for us.”
A Better Test for Women’s Heart Health
Medical tests are often geared toward men, but that’s no longer true of the cardiac stress test, one of the ways doctors gauge heart attack risk.
The test works like this: As you run on a treadmill at an increasing speed and slope, an electrocardiogram (EKG) machine measures how much stress your heart can manage before developing an abnormal rhythm or reduced blood flow.
The important readings come when you reach 85% of your maximum heart rate – a standard number for your age group. But until recently, those numbers were based on men’s statistics, according to Martha Gulati, M.D., an associate professor of medicine in the Division of Cardiology at Ohio State University. Using a formula tailored to men often led to a worse prognosis in women, Gulati says.
Along with her team at the Center for Women’s Cardiovascular Health at Northwestern University (where she previously was associate director), Gulati analyzed the tests of more than 10,000 women to determine normal fitness levels. The old formula for maximum heart rate, based on studies of men, was 220 beats per minute minus the patient’s age. The new, more accurate formula for women is 206 minus 88% of age.
Not all doctors are aware of this new standard, so women should ask them, Gulati says.
“We’re advising physicians to use the new formula, but we need to increase both physicians’ and women’s awareness,” she says.
Stand Up and Live Longer
Can’t fit in that daily workout? You don’t have to. Just getting off your duff and moving around throughout the day may help reduce your risk of heart disease – even more than 30 minutes of exercise at a gym, according to a 2010 American Cancer Society (ACS) study published in American Journal of Epidemiology.
On the other hand, the longer you sit, the greater likelihood you’ll die earlier, according to ongoing research by physiologist Marc Hamilton, Ph.D., a professor at Pennington Biomedical Research Center in Baton Rouge, La.
In the ACS study, when researchers followed 123,000 adults for 14 years, those who remained glued to their chairs more than six hours a day were 18% more likely to die than those who sat fewer than three hours per day. It didn’t matter if they were fat or thin, or if they worked out daily.
“People who don’t formally exercise at all can take heart,” Hamilton says. “You can feel better and improve your health just by getting up and moving around.”
Just going to the gym once a day isn’t enough, he adds.
“It’s like a person who eats a healthy breakfast, then during the day eats fatty, sugary snacks and bad meals,” Hamilton says. “One good activity doesn’t cancel out the rest of the bad.”
So what’s an office worker to do?
“Every chance you get, bend over to pick something up, walk or stand instead of sitting down when you’re on the phone, walk up and down the stairs – just move,” Hamilton advises.
Hope for Cancer Patients
Cancer treatments such as radiation and chemotherapy may lead to sterility and threaten a woman’s ability to have children (unless she acts quickly beforehand to freeze embryos with in-vitro fertilization, or IVF). But the field of onco-fertility – a discipline combining oncology (cancer medicine) and reproductive medicine – is allowing some women to have families.
Patients who are too young or whose cancer is too advanced for IVF may be able to remove and freeze an entire healthy ovary before treatment.
So far, 12 live births have resulted from the procedure, in which an ovary is removed, frozen and put back later, says Teresa Woodruff, Ph.D., Watkins professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine in Evanston, Ill.
“Fertility management is one of the biggest breakthroughs in women’s health,” Woodruff says. “It allows health professionals to make sure cancer patients can have the family they want.”
At Northwestern University, more than 50% of patients now get onco-fertility counseling, which wasn’t even available five years ago.
“It helps patients return to a normal life after they’ve looked at their mortality,” Woodruff says.
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