Many individuals still believe that the most deadly disease among women is breast cancer, not cardiovascular disease. This article discusses how this myth developed. In addition it discusses which women are at greater risk for breast cancer, and for cardiovascular disease and why? It also discusses In the case of cardiovascular disease why women have poorer health outcomes than men. The primary, secondary, and tertiary preventions implemented for breast cancer and cardiovascular disease and their effectiveness are also discussed.
Women are at a greater risk of dying from heart disease as compared to other disease, including breast cancer. Still, many view heart disease as a middle age man's disease. This myth developed because heart disease has been seen as a man's disease and breast cancer as a women's. There was insufficient research in the area of heart disease to find out that women express heart disease differently than men (Condon, 2004). Initially, research was conducted on men due to their greater accessibility. For example, heart disease has different symptoms in men and women. Men experience an aching pain, whereas women may experience a dull pain, dizziness, sickness, shortness of breath, or sweatiness, which resembles anxiety or stress (Kornstein & Clayton, 2002). Women's symptoms were not reported, and often heart disease went undiagnosed in women. The public has been made aware of the threat of breast cancer to a greater extent than with heart disease. Awareness of heart disease in women is slowly increasing.
Any person that partakes in behaviors and circumstances that cause injury to the inner lining of the bloods vessels that supply the heart and brain with oxygen and nutrition is at an increased risk for heart disease (Condone, 2004). Women who smoke, eat a poor diet, are overweight, have a sedentary lifestyle, or are of a low socioeconomic level are more at risk for heart disease and breast cancer. Other risk factors include, increasing age, menopause, male sex, family history and heredity, diabetes, high blood pressure, or cholesterol (Condone, 2004; Kornstein & Clayton, 2002). African American women have a greater risk of heart disease, stroke, and more severe blood pressure than Europeans. Incidence of heart disease is higher among Mexican Americans, American Indians, and Native Hawaiians (Condon, 2004).
Women who are increasing in age have an increased risk for heart disease and breast cancer. Women who have reached menopause are at a greater risk because estrogen can protect against heart disease as it maintains cholesterol. With menopause is a lowering of estrogen and women are left more vulnerable. Estrogen replacement can reduce most of the risk factors (Condon, 2004). Breast cancer increases with age, as women age 30, 1 out of 5900 will have breast cancer whereas women age 70, 1 in 330 will have it (Condon, 2004). This may be due to an increase in age, being associated with an increased exposure to ovarian hormones, external estrogens, and environmental toxins. External estrogen increases the risk of heart disease and decreases health (Condon, 2004).
In people under 50, obesity poses a greater risk for coronary artery disease as it increases strain on the heart and increases the risk of diabetes (Condone, 2004). Diabetes is more serious for women than in men. Women diabetics are three to seven times more likely to develop heart disease than a non-diabetic, whereas men are only two to three times more likely. This may be due to the strong negative effect diabetes has on lipid levels and blood pressure in women (Condone, 2004).
Smokers are more at risk for heart disease. Nicotine constricts blood vessels and increases abnormal plaque formation on the walls of the vessels (Condon, 2004).
Smoking also increases the release of catecholamines into the blood and lowers estrogen levels. This causes levels of undesirable low density lipoprotein to increase and the levels of heart protective high density lipoprotein to decrease. In addition, nicotine masks chest pain and increases platelet aggregation. It also lowers oxygen levels (Condone, 2004). There is a clear risk associated with cigarette smoking, high estrogen contraceptives, and risk of heart disease in women over age 35 (Kornstein & Clayton, 2002).
A lack of social support, depression, anxiety, hostility, social isolation, and low or no religious involvement are associated with an increased risk of heart disease as these factors are associated with an increase in stress (Condon, 2004). This is especially true for those of a lower socioeconomic status. Stress increases the release of catecholamines and free radical damage to the coronary arteries (Condon, 2004).
African Americans, the elderly, and those with less education and from a lower socioeconomic group are at an increased risk of developing heart disease. The higher rate of heart disease in ethnicities is partially due to higher rates of obesity and diabetes within these cultures (Condon, 2004). Minorities in many circumstances have less contact with healthcare. Their healthcare is also of lesser quality. Illnesses are less likely to be detected early and early detection increases survival. Both breast cancer and heart disease need to be diagnosed and treated as soon as possible (Condon, 2004).
African Americans have double the rate of cardiovascular disease. African Americans have an additional 22-40 percent chance of dying after a myocardial infraction (Condon, 2004). They are also more than twice as likely to suffer death and disability from stroke. Heart disease is the leading cause of death ages 30-39 years (Kornstein & Clayton, 2002).
African American women experience breast cancer less than white women, but die from it more frequently then white women. African Americans are less likely to get tested early for heart disease and breast cancer. They are unlikely to devote attention to a problem that "might" exist (Condone, 2004). Many of these women carry heavy social burdens that prevent them from getting preventative healthcare and early treatment for health problems. In regards to breast cancer, by the time a lump is found, the cancer has already been growing. This is why breast cancer needs to be detected as soon as possible, before it spreads to other areas of the body (Condon, 2004). Breast cancer death rates are decreasing, but not for African Americans, which suggests these women do not have the access to the healthcare that white women do and are not receiving the much needed clinical breast examinations and mammography screenings (Condone, 2004).
In regards to cancer, a woman's risk is linked to amount of ovarian hormones to which she has been exposed. Incidence of breast cancer in rural Africa is lower due to women's higher frequency of pregnancy and nursing (Condon, 2004). Cancer is more common in American society due to an increase in exposure due to chemicals found in insecticides, fungicides, and chlorine based solutions.
Puerto Rican women suffer a 15 percent higher chance of coronary heart disease and experience more deaths from heart disease and cancer due to a lack of preventative care. Native American women have an increased risk for heart disease due to their bodies being unable to handle relatively large amounts of sugar in a traditional diet (Condon, 2004).
China and Japanese's ethnicities experience lower incidences of heart disease and breast cancer. Rural Asians low body weight is protective, because fat cells produce small amounts of estrogen. In addition, Asian Americans eat diets heavy in vegetables and soy products and low in fat (Condon, 2004).
Occupations that have high psychological demands and low freedom to make job decisions have been found to relate to depression, exhaustion, and job dissatisfaction. Depression is a risk factor for the developing coronary heart disease and for increased morbidity and morality. Not only are depressed individuals less likely to seek treatments and to take care of themselves, but Serotonin plays a role in amplifying the platelet response to thrombosis (Kornstein & Clayton, 2002).
There has been a reduction in the death rate in heart disease; but this has occurred primarily in men (Condon, 2004). In regards to heart disease, women have a poorer prognosis than men. This may be due to onset of heart disease occurring at a later age, the misdiagnosis of symptoms, the failure of detection methods, and lifestyle factors.
Women tend to develop heart disease on average, 10 years later then men, due to the protection of estrogen when younger (Condon, 2004). An increased age is the most significant factor in increased cardiac morality, a decreased effectiveness of thrombosis and aspirin therapy, and a tendency for the under use of these medications in women (Kornstein & Clayton, 2002). In addition, women who have heart attacks tend to have diabetes and high blood pressure and, as such, develop more complications.
Women experience different symptoms of heart disease than men. CAD has been seen a man's disease for so long, that physicians often look for the male pattern symptoms of the disease. Women's chest pain is sometimes dismissed as related to anxiety or gastrointestinal problems (Condon, 2004). This is related to the societal view that women are more prone than men to anxiety and other emotional problems. Where men experience the unmistakable crushing pain, women's pain may be felt in the arm, jaw or chest. The mild pain is often a feeling of pressure or burning and is often mistaken by many women for heartburn. Patients with cardiac disease may complain of neuro-vegetative symptoms that mimic depression, including loss of energy, appetite, concentration, sleep and nausea (Kornstein & Clayton, 2002). In addition, symptoms of arthritis or osteoporosis may obscure the diagnosis and are more common in women (Kornstein & Clayton, 2002).
Due to differences in male and female physiology, some testing procedures are more effective for men than women. For example, the exercise stress test is often more accurate for men. For women it can lead to false positives, but even more dangerous, it can miss the disease. The stress tests are more likely to pick up triple vessel disease, which is more common in men, than single vessel disease which is more common in women. In addition, some older women are unable to exercise at a high enough level to stress the heart sufficiently (Condone, 2004).
Women who seek care from primary doctors, due to lack of knowledge regarding symptoms, may not be referred to treatment on a timely basis (Kornstein & Clayton, 2002). Women do not often receive as aggressive therapies as men. This may be due to a man's fix it attitude and a women being more readily accepting of the illness. Women may be more likely to refuse cardiac transplants (Kornstein & Clayton, 2002). Women fail to seek prompt treatment when first experiencing symptoms. They may wait longer due to less painful heart attacks. This delay in treatment further damages the heart. Women may feel that their families needs take precedence over their own (Condone, 2004). Having experienced pain or cardiac procedures, women may feel more obligated to return to household responsibilities; therefore, they may not enroll in cardiac rehabilitation (Kornstein & Clayton, 2002).
Women are three times more likely than men to die or suffer complications during an angioplasty. This may be due to women having smaller arteries, age and co-morbidities (Condone, 2004). The left ventricle is smaller in women but contracts at a higher velocity. This extra work, plus the loss of estrogen, puts women at a higher risk (Condone, 2004). These factors plus misdiagnosis and delayed treatment decrease the prognosis rate for women. Activity promoting cardiovascular wellness may compensate for any genetic factors that predispose the individual (Condon, 2004). Women tend to get less exercise than men and have more sedentary lifestyles (Condon, 2004).
There are three levels of prevention in healthcare: primary secondary, and tertiary. The primary prevention includes or aims at reducing the risk factors that could lead to the development of heart disease or breast cancer (Condon, 2004). Avoidable risk factors include smoking, obesity, stress, and sedentarily lifestyles (Condon, 2004). Women who exercise for thirty minutes, three times a week, reduce their cardiovascular risk by 50 percent (Condon, 2004). Self breast examinations increase the chance of detecting a lump early. Adopting a healthy lifestyle, that includes exercising, eating a diet high in vegetables, fruits, whole grains, and maintaining ideal body weight, will reduce the risk of disease (Condon, 2004).
Secondary prevention involves detecting and managing cardiovascular disease and breast cancer at an early stage (Condon, 2004). Women are encouraged and recommended to perform self breast examinations, to have routine clinical examinations, and annual mammograms. Mammograms can detect lumps when they are too small to be felt (Condon, 2004). In the case of finding a lump, a lumpectomy will conserve the breast and will remove only the cancer. Although the threat of future cancer still exists. Stress testing and EKGs can detect heart disease; however, for women, these methods are not as accurate.
Tertiary prevention involves maximizing health by taking measures to prevent an existing condition from worsening and complications from developing in persons who have established cardiovascular disease or breast cancer (Condon, 2004). In regards to breast cancer, this prevention includes a mastectomy, which reduces the risk of breast cancer in 90 percent of women (Condone, 2004). However, a mastectomy can be damaging to a women's self image and sense of femininity especially in our appearance driven society. The use of tamoxifen is used to reduce risk of developing cancer by 50 percent.
Preventions for heart disease include the various forms of heart surgery such as valve and artery replacements, and angioplasties. Angioplasty is not as effective in women (Condone, 2004). The prevention methods will increase in effectiveness as research on heart disease in women increases.
Awareness, a greater use of screening procedures, and early detection help to decrease rates of breast cancer and deaths related to breast cancer. The prevention methods are effective to an extent. Annual mammograms are the best prevention besides a healthy lifestyle, as it is the earliest detection possible at this time (Condone, 2004).
The methods of prevention of heart disease are not as effective. Many women are still unaware of the serious threat of heart disease. For example, my mother who is a diabetic, was told by her doctor, that her heart is in the condition of having had a previous heart attack. The doctor told her she needs to exercise everyday. If this method of prevention were entirely effective, my mother would be exercising everyday, but she does not. She does not exercise everyday, despite the doctors "advice" and despite my persistent nagging. The doctor needs to do more than just tell patients what they need to do. They need to hit home with the seriousness of the situation, even if it means scaring the patients into action. After all, it is scary, people die even though preventive measures can be taken. The doctor needs to be aggressive in his or her approach. I notice my mother will exercise if I will walk with her. It would be beneficial to almost have a community buddy exercise program. Support groups that pair people up. Low cost gyms are also beneficial. In one area, where gyms are high priced, the addition of the low cost Curves enticed people that were not previously exercising to join the gym.
There need to be more efforts to increase awareness in the public, to increase public involvement in the assessment of research in the prevention and treatment of heart disease, and to increase federal support for research on women (Kornstein & Clayton, 2002).
