What Women Should Know About Their Health

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 seems only natural: Women take care of everyone else while putting their own needs secondary, especially when it comes to their personal health. For today’s woman, who is busier than ever before, the demands of work, family, friendships and social interaction have distracted too many from taking care of themselves.

And this oversight can prove to be grave.

For decades, heart disease has remained the No. 1 cause of death for men. More recently, the same can be said for women. This concerns Dr. Shobashalini Chokkalingam, a cardiologist with Mercyhealth. She points out that the disease is 80 percent preventable. Of even further concern is the alarming rise of heart disease among younger women.

“We mostly used to see women develop heart disease 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.”

Chokkalingam explains that factors like smoking, high blood pressure, high cholesterol and diabetes create the conditions that lead to heart disease in women of all age brackets.

“I believe there are two things that women need to do 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 is to know your family’s health history. Chokkalingam stresses 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. Knowing that history can help a woman to take preventive steps and recognize signals in her body.

“The other important knowledge is to know your numbers,” Chokkalingam adds. “By that, I mean she should know her weight, blood pressure, cholesterol count and blood glucose through regular physical exams with her primary doctor.”

Further, women need to understand that, because they are built smaller than men, on average, they are more susceptable 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 busier than ever. 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 extent that they don’t call 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 with public campaigns like Red Dress Fridays, 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 affects women of every age.”

Chokkalingam is rightfully concerned about African-American women and heart disease. According to the Mayo Clinic, one in every two black women over the age of 20 in the United States have some form of heart disease, and less than half are aware that heart disease is their No. 1 cause of death. Each year, more black women die from heart disease than from breast cancer, lung cancer and stroke combined.

Prevention is essential in fighting heart disease. Diet and nutrition can’t be ignored.

“Something as simple as reducing the amount of sodium in your diet can make a huge difference,” Chokkalingam adds. “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.”

Despite the rising prevalence of heart disease in women, breast cancer remains a major concern for women of all ages. Dr. Barry Rosen, a breast cancer surgeon and oncologist for AMITA Health Alexian Brothers Medical Center in Elk Grove Village, says that, while cure rates have improved tremendously in the past 25 years, prevention has not kept pace.

“There are a lot of misconceptions about breast cancer,” Rosen says. “Studies indicate that, for women who have annual mammograms from age 40 to 75 and are diagnosed early, the chance of a cure is about 90 percent.”

The sticking point is that too many women don’t understand the role that breast tissue density plays in accurately diagnosing cancer.

“It’s more complex than patients realize,” says Rosen. “About 50 percent of women have moderate to extreme density, and that directly affects our ability to see cancerous growths with mammograms alone. They need to know the A-B-C-Ds of breast density along with the other signs and symptoms.”

Breast tissue is composed of dense supportive tissue and lighter fatty tissues. According to the Mayo Clinic, an “A” density means the breast tissue is almost all fatty and has less of the dense supportive tissue; a “B” density indicates scattered areas of dense tissue; a “C” density indicates the tissue is generally dense; and a “D” density is considered entirely dense tissue.

Rosen explains that, for women with A and B density ratings, finding a cancerous growth too small to be felt is still feasible with a simple mammogram. However, when her density falls into the C and D range, mammograms can miss small, cancerous growths about 25 percent of the time.

“For women with C and D density, we now back up mammograms with supplementary imaging including ultrasound or MRI screening,” Rosen says. “We consider women with C and D density – roughly 50 percent of patients – as high risk and we scan them appropriately. Insurance companies were reluctant to pay for these extra tests in the past, but now they approve them routinely as both preventative and diagnostic procedures.”

Rosen adds that genetic testing is another advance in catching breast cancer. A simple blood test can determine whether or not a patient has hereditary factors that might predispose them to developing breast cancer in the future.

“A surprising three-fourths of diagnosed cases are environmentally based,” Rosen says. “But we don’t overlook the potential for heredity as a cause. And sadly, most women who are diagnosed were not screened or identified for hereditary causes.”

Screening for the BRCA1 and BRCA2 genes can help identify patients who are potentially vulnerable to breast cancer. These two genes are important in fighting the disease, according to the Centers for Disease Control and Prevention (CDC); a positive test indicating the presence of these mutated genes may help to foresee breast cancer.
“These tests used to be expensive,” Rosen explains. “But a 2013 anti-monopoly decision, plus lower costs, brought them down to $250, with most insurance companies covering the cost.”

Patients who test positive for BRCA1 and BRCA2 may have mammograms once a year, plus breast MRI screening once a year, offset every six months.
“We have also discovered many other mutations other than BRCA associated with cancer risk. If one was tested for BRCA in the past and was negative, it may be appropriate to re-test,” Rosen adds.

Should some of these indicators appear, one way to minimize the risk of breast cancer is with a preventative mastectomy.

“It’s not for everyone. The decision to perform this surgery takes into account a woman’s age, hereditary risk, and other family members’ experiences,” Rosen says. “But it’s not an easy decision because of the emotional impact this creates. However, we have come a long way with reconstructive options.”

The odds of surviving breast cancer have come a long way through regular screening and innovative treatment that maximizes effectiveness while minimizing side effects.

“I hope that through public awareness and education, consistent screening and advanced medical treatment, breast cancer survival rates will continue to improve,” Rosen says.

For all of the attention heart disease and breast cancer receive, a woman’s physical health is also affected by joint and muscle injuries. Increased interest in high-risk or even moderately vigorous physical activity can result in pain, stiffness, loss of flexibility and long-term concerns such as arthritis.

Regardless of how active they are, women of all ages need to guard against painful and sometimes long-term injuries to their shoulders, hips, knees and other joints. Dr. Savan Patel, an orthopedic surgeon with Northwestern Medicine, says that, while women are more prone to joint injury as they age, they are not immune to the same injuries when younger.

“It’s true that during the aging process, women can lose flexibility and strength,” Patel says. “They can also become more vulnerable to stresses because their bodies don’t respond as rapidly as they did in youth. Even with the benefit of regular exercise and sports activities, women can still suffer injuries that can carry over into middle and old age.”

For women in their late teens to 30, one of the most debilitating injuries is a sprain or tear in their anterior cruciate ligament (ACL), says Patel. This injury occurs when the patient comes down on the leg while it’s misaligned, thus causing tremendous stress on the ligament. While a sprain can be treated with rest and pain management, a torn ACL is almost always surgically repaired.

“An ACL tear is a matter of mechanics,” Patel says. “Women are more inclined to have ACL injuries because their musculature is different from men. Preventing ACL tears or sprains requires conditioning and training to ensure they land properly and in balance, reducing the potential for misalignment of the leg and hip.”

Women who have been highly active in sports from an early age are less prone to injury in their 20s and 30s. But for those women who want to take up more active pastimes such as tennis, for example, Patel adds it is vital they go into the increased activity in a stepped manner.

“Before going full-tilt at a sport, even tennis or golf, women should spend a few weeks to a month or more getting into better physical condition,” Patel says. “I recommend they work with a professional trainer or physical therapist to strengthen their muscles and become more flexible.”

With sports such as tennis and golf, the shoulder joints are especially vulnerable to stress, strain and damage.
“Swinging a racquet or golf club in a full-out sport outing requires additional flexibility from the shoulder joint, which is the most unstable joint in the body,” Patel says. “Because shoulder joints move in more directions than those in the rest of the body, they are proportionately more prone to injury including rotator cuff tears and other muscular damage.”

As with other concerns, the role of good nutrition in bone and joint health can’t be overlooked.

“Younger women athletes can suffer from lack of sufficient caloric intake, which can lead to injury as well as eating disorders,” Patel says. “Younger women need to be aware of their menstrual cycles slowing or stopping, severe lack of energy, fatigue and other symptoms that point to not eating enough calories to sustain their hyperactive lifestyles.”

As women move into their 40s and 50s, Patel stresses that preconditioning and stepped training become even more important to maintaining the body’s stability and avoiding injury.

“As women age, they need to understand that other concerns should be addressed, including their cardiovascular health, diet and nutrition,” Patel says. “And, equally important, women of all ages should seek medical evaluation and treatment as early as possible for even the most minor injury. Any woman who has joint pain after exercising or playing a sport should never ‘tough it out.’ Early treatment prevents muscle scarring, stiffness and loss of flexibility, and it can also forestall the onset of arthritis.”

With careful preparation and early treatment, Patel believes all women can enjoy the fun and benefits of an active, pain-free lifestyle, regardless of age.

Among area physicians, the overwhelming message to women is to take care of yourself because it’s the only way to enjoy your active lifestyle without losing a moment to illness.