Death In American Women Research Articles

Coronary Health Issues for Lesbians

Since coronary heart disease (CHD) is the leading cause of death in American women it is therefore likely the leading cause of death among lesbians. Prevention of CHD is a major health issue for lesbians. Efforts must continue to empower all lesbians to take personal preventative action to prevent CHD. Women in general do not believe they are at risk for CHD. A common misperception is that CHD is a man's disease and the most likely threat to a woman's life is breast cancer. This misperception probably exists among lesbians as well. Over a lifetime, a woman is 10 times more likely to develop CHD than she is breast cancer. Breast cancer remains an important health concern for woman, but CHD risk must be addressed with potent educational and advocacy programs for the health of our communities. Prevention of the clinical manifestations of CHD hinges upon the prevention of plaque formation. It is an obligation of primary care providers to give advice regarding the prevention of plaque formation and therefore the prevention of subsequent CHD events and to collaborate with patients to address these issues in an individually tailored manner. This review addresses risk factors for CHD in lesbians to assist providers in achievement of that goal.

Endocrine therapy in metastatic breast cancer.

Endocrine therapy represents a mainstay of effective, minimally toxic, palliative treatment for metastatic breast cancer. Research focusing on the mechanism of action of endocrine agents will provide new insights leading to new hormonal approaches in breast cancer treatment. Development of new agents, especially the 'pure' antiestrogens, is of great interest. Combining endocrine therapy with biologic agents, especially antiproliferative compounds, may lead to more effective treatment in the adjuvant as well as the advanced setting. Tables 4 and 5 summarize response rates to the different groups of endocrine agents used in metastatic breast cancer and doses of commonly used agents, respectively. At present, tamoxifen is the drug of choice as first-line endocrine therapy for metastatic breast cancer with no or minimal symptoms in premenopausal or postmenopausal women. Second-line therapy usually consists of megace. Aromatase inhibitors may be used as second- or third-line therapy in postmenopausal women. In premenopausal women, LHRH analogues are a reasonable choice. The other hormonal agents may be beneficial as salvage therapy. More effective endocrine approaches are under development.

Changing trends in the diagnosis and treatment of early breast cancer.

Breast cancer is the most frequently diagnosed malignancy and the second leading cause of cancer-related deaths in American women today. It is estimated that 180,200 cases will be diagnosed and 43,900 women will die in 1997 alone [1]. Although the incidence rate for breast cancer has been steadily increasing at a rate of 1–2% per year since the 1960s, the mortality rates have remained stable. This is due in part to effective screening programs and the detection of an increasing proportion of early invasive breast cancers and ductal carcinoma in situ [2].

The epidemiology of coronary heart disease and estrogen replacement in postmenopausal women

Cardiovascular diseases remain the leading cause of death in American women. Evidence from epidemiological studies indicates that estrogen replacement therapy in postmenopausal women can reduce their risk of coronary heart disease. Current users, in particular, appear to enjoy the most substantial cardiac benefits. It remains possible that the protective effect of estrogen observed in these studies may be due, in part, to bias. Women who use estrogen see a physician regularly, and compliance with estrogen therapy may identify a low-risk group of women. Furthermore, women who choose to use estrogen may lead generally healthier lifestyles than those who do not take such medication. However, adjustment for known cardiac risk factors in many of the large studies had little impact on the results, implying an equivalent risk status for users and nonusers. In addition, both animal and human studies show that estrogen use lowers low-density lipoprotein cholesterol levels, increases high-density lipoprotein cholesterol levels, improves blood flow, and reduces atherosclerosis. The effect of progestin added to estrogen therapy has not been adequately assessed, but initial evidence suggests that it may somewhat attenuate, although not completely eliminate, the benefits of estrogen on cardiovascular disease. Finally, each individual woman differs in her particular risks and benefits, and careful consideration of each woman's unique situation is required; the fear of breast cancer should be considered, together with the knowledge that many interventions are available to reduce the risk of cardiovascular disease.

Stat Bite: Breast Cancer Deaths in American Women, Ages 40-44

Stat Bite: Breast Cancer Deaths in American Women, Ages 40-44

Prevention of Cardiovascular Risk in Women: A New Concern for the Obstetrician/Gynecologist

Cardiovascular disease is the leading cause of death in American women, accounting for nearly half a million deaths annually. While most of these women are postmenopausal, data from the Bogalusa Heart Study have shown that fatty streak formation begins early in life, perhaps even in childhood. Successful risk intervention is best initiated early in the process, before the clinical manifestations of disease become apparent. Several major risk factors for cardiovascular disease--elevated cholesterol, elevated blood pressure, and cigarette smoking--are amenable to intervention. The critical role of cholesterol in the pathogenesis of cardiovascular disease, and the impact of even small fluctuations of important subfractions on CV risk have been demonstrated in numerous epidemiologic and clinical studies. A sensitive predictor of cardiovascular risk appears to be the high-density lipoprotein (HDL) cholesterol fraction, which is considered cardioprotective if elevated and a significant independent risk factor if decreased. Reductions in HDL have been documented following the use of even low-dose oral contraceptives containing progestins of high androgenic activity. Elevated LDL cholesterol may be an independent risk factor for CV disease in women. Hence, changes in the LDL/HDL ratio may be more sensitive predictors of change in CV risk. Major risk factors for CV disease in women are outlined with specific reference to the effects of oral contraceptives on lipoproteins.

Lung cancer in women.

In 1983, lung cancer exceeded breast cancer as the leading cause of death in American women. Between 1950 and 1985 there was a 500% increase in lung cancer deaths in women, and this trend is not expected to improve in the next decade. There is no corresponding increase in the overall incidence of lung cancer in the general population of the United States. Cigarette smoking is clearly the primary risk factor in this group and the role of passive smoking remains controversial. Various other etiologic factors, including a shift in occupational exposure, may play a minor role in the development of lung cancer in years after smoking cessation. If the incidence of smoking in American women was reduced to pre-1950 levels, it is estimated that lung cancer in women would once again become a rare finding after the year 2000.

Cardiovascular disease in women

Cardiovascular disease is the leading cause of death in American women. Atherosclerotic diseases, primarily myocardial infarction and stroke, are important causes of morbidity and mortality among women. Contrary to popular belief, the actual number of myocardial infarctions in men and women is similar, although women develop cardiovascular disease an average of 10 years later than do men. Total serum cholesterol level is a major indicator of risk of coronary heart disease; for every 1% increase in the total serum cholesterol level, a 2% increase in incidence of coronary heart disease is found. A high level of low-density lipoproteins is an independent risk factor for coronary heart disease in both men and women, but high triglyceride level is an independent risk factor only in women. Conversely, the higher the level of high-density lipoprotein, the lower the risk of coronary heart disease. To reduce the risk of coronary heart disease, target levels of total serum cholesterol must be lowered from 300 to 200 mg/dl. If the total cholesterol/high-density lipoprotein ratio is ≥4.5 or if the low-density lipoprotein concentration is >150 mg/dl, the patient is at high risk for coronary heart disease. Clinical trials that use diet or drugs to lower serum cholesterol levels have consistently shown a 2% reduction in the incidence of coronary heart disease for every 1% reduction in total serum cholesterol level.

Estrogen receptor, a marker for human breast cancer differentiation and patient prognosis.

Breast cancer is the leading cause of cancer death in American women. Over the past 80 years this malignancy has been studied intensively not only because of its high incidence, but also because of interest generated by the original observation of Beatson demonstrating that some tumors are hormone dependent. Unfortunately, it has only been over the past decade that real advances have been made in the treatment of this disease, as well as in our understanding of breast tumor biology and natural history.KeywordsBreast CancerEstrogen ReceptorPrimary Breast CancerNuclear GradeEstrogen Receptor StatusThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.