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Understanding and preventing Cardiovascular Disease and Cancer
- 2. Cardiovascular Disease and Cancer The greatest causes of death in the United States • Cardiovascular disease – Heart disease – Cerebrovascular disease (stroke) • Cancer – Can affect any area – In women, most likely to affect breasts, lung, reproductive system and skin
- 3. Cardiovascular Disease Figures: 2019 • 153,296 U.S. women died of coronary heart disease and 47,064 died of myocardial infarction—the leading causes of death in women. • 82,787 U.S. women died of stroke—the third leading cause of death in women. • More women than men die of stroke each year.
- 4. Economic Dimensions • Direct costs: health expenditures, hospital and nursing home services, medications, home health care • Indirect costs: lost productivity (both to people with CVD and their caretakers)
- 5. Cardiovascular System Figure 10.6 Illustration of the heart.
- 6. Coronary Heart Disease (CHD) • Occurs when the coronary arteries become blocked or narrowed with plaque • Clots forming in an artery can also lead to blockages. • Can lead to a heart attack (death of part of the heart) Figure 10.6 Illustration of the heart.
- 7. If Plaque Causes CHD, What Causes Plaque? Figure 10.8 Picture of clogged arteries. • CHD begins with plaque buildup inside the lining of the coronary arteries. • Plaque begins with LDL cholesterol moving inside the arteries; white blood cells can also get stuck inside the lining and die. • Plaque can grow until it takes up 95% of the space in an artery.
- 8. Other Forms of Heart Disease (1 of 2) Congestive heart failure (CHF) • Weak heart muscles that cannot perform the pumping function with proper vigor • Often a disease of older women who have suffered heart damage from other causes Arrhythmias • Problems with the heartbeat (fast, slow, or irregular)
- 9. Other Forms of Heart Disease (2 of 2) Rheumatic heart disease • Results from bacterial infection with Streptococcus, which can cause damage to heart valves; can usually be cured with antibiotics Angina pectoris • Chest pain resulting from insufficient supply of blood (oxygen) to heart muscle • Disease of the extremities (arms/legs) in which blood supply is diminished, resulting in lack of nutrients and oxygen
- 10. Metabolic Syndrome • Group of diseases that occur together and cause CVD • Risk factors – Elevated waist circumference – High blood lipid levels – Low HDL levels – High blood cholesterol levels – Elevated fasting blood glucose level • Metabolic syndrome is a greater risk for women than it is for men.
- 11. Cerebrovascular Disease (Stroke) • Blood vessels either within or leading to the brain becomes damaged, blocked, or burst. • This leads to portions of the brain being unable to receive oxygen, and thus dying. • Often survivors have a long, difficult recovery process—many thought processes and physical actions may have to be relearned.
- 12. Stroke Types of stroke – Ischemic stroke: the most common type, caused by a cerebral thrombus or embolism – Hemorrhagic stroke: caused by ruptured blood vessels such as an aneurysm • Possible warning signs: transient ischemic attacks (TIAs)—brief memory loss, garbled speech, or other symptoms Figure 10.9 Cerebrovascular accident.
- 13. Recovery from a Stroke Recovery statistics • 50 to 70% of survivors regain functional independence. • 15 to 30% are permanently disabled. • 20% require institutional care within 3 months of onset. • 25% die within a year (risk of death and future strokes increases with age). Rehabilitation • Depends on area affected—may require physicians, nurses, physical therapy, speech therapy, mental health professionals, or others
- 14. Risk Factors for CVD • Age • Genetics • Race • Obesity • Smoking • Hypertension • Elevated cholesterol • Sedentary lifestyle • Diabetes • Menopause
- 15. CVD Gender Differences • Before menopause, women’s hormones, in general, protect them from CVD; with menopause, the risk increases more sharply. • Symptoms and signs of a heart attack vary among genders; women tend to have somewhat different symptoms. – Fewer sharp, intense pains – Less shortness of breath – More cold sweats, nausea, dizziness • Women are more likely to die from heart attack
- 16. Cigarette Smoking and CVD • Smoking is a major risk factor for CVD (as well as lung and other cancers). • Carbon monoxide, nicotine, and other substances in cigarette smoke constrict and injure arteries. • Secondhand smoke is a CVD (and cancer) risk factor. • Health risks for smoking decline the earlier a woman quits.
- 17. Cancer • Cancer: disease caused by uncontrolled cellular growth or reproduction • Tumor: any abnormal cell growth – Benign (contained) – Malignant (growing/spreading) • Metastasis: the process of cancer spreading throughout the body • Carcinogen: a substance that can cause cancer
- 18. Cancer and Women • Cancer is the second-leading cause of death in the United States. • 75% of cancers are diagnosed in people aged 55 and older. • Breast cancer is the most common cancer in women. • Second most common = lung cancer, but causes the most deaths (lower survival rate) • Third most common cancer = colorectal • Fourth most common cancer = endometrial
- 19. Breast Conditions (1 of 2) • Most women will find a lump in their breast at some point in their lives. In 9 of 10 cases, this is not cancer. • Benign breast diseases – Fibrocystic breast disease (cystic mastitis) – Hyperplasia – Fibroadenoma
- 20. Breast Conditions (2 of 2) Breast cancer is a frightening, misunderstood issue in women’s health. It can usually be successfully treated if detected early. • Five levels – In situ: Too small to be felt; nearly 100% 5-year survival rate – Stage I: < 2 cm in size, localized – Stage II: 2–5 cm in size, localized – Stage III: > 5 cm in size, grown into chest wall, skin, or lymph nodes – Stage IV: Growth spread to other parts of body
- 21. Risk Factors for Breast Cancer • Gender • Age • Family history • Never had children or first child after 30 • Early menarche (before 12) or late menopause (after 55) • Consumption of high-fat diet or alcohol • Environmental factors • Obesity • Oral contraceptive use?
- 22. Breast Cancer Screening • Breast self-exam • Clinical breast exam • Mammography
- 23. Treatment • Lumpectomy • Partial or segmental mastectomy • Simple mastectomy • Radical mastectomy • Modified radical mastectomy • Chemotherapy, radiation therapy, and hormone therapy may be used alongside surgery to improve chances of recovery.
- 24. Lung Cancer • Cigarette smoking is responsible for almost every case of lung cancer, the deadliest form of cancer for men and women. • Lung cancer often spreads to other parts of the body before it can be detected. • Common symptoms are persistent cough, weight loss, bloody sputum, recurring bronchitis, pneumonia, and chest pain. • Treatment is very difficult but can include surgery, radiotherapy, and chemotherapy.
- 25. Cervical Cancer • Caused by “high risk” strains of HPV • Modern medicine has the potential to prevent almost all cases of cervical cancer. • Screening: Pap smear, HPV test (for women 30 and over) • Vaccination can prevent most, but not all, cases of cervical cancer (screening still needed). • Treatment: cyrosurgery, cone biopsy, laser cone biopsy
- 26. Gynecological Conditions Benign uterine conditions • Fibroids • Endometriosis—when it grows into wall of uterus, called adenomyosis • Endometrial hyperplasia • Treatments include: hormone therapy or surgery (myomectomy, laparoscopy, hysterectomy)
- 27. Malignant Uterine Tumors • Risk factors – Age (older than 50) – Obesity, diabetes, high blood pressure, smoking – Early menarche or late menopause – History of infertility – Family or personal history of other cancers – Long-term high-dose ERT – Use of Tamoxifen for breast cancer • Difficult to detect—too high up to be found on a pelvic examination • Treatment may involve surgery and/or radiotherapy.
- 28. Ovarian Growths Benign ovarian growths • Cysts—follicular, hemorrhagic, epithelial, dermoid • Polycystic ovarian syndrome Ovarian cancer • A deadly, stealthy, and largely misunderstood form of cancer. • Risk factors: no children, early menstruation, late menopause, pregnancy after age 30, previous cancer, long-term use of some fertility drugs • Early symptoms: pelvic pressure, abdominal swelling, gas pains, indigestion, vague abdominal discomfort • Treatment: surgery, radiotherapy, chemotherapy
- 29. Cervical Cancer • Caused by human papilloma virus (HPV), a common sexually transmitted virus • Only high-risk strains of HPV can cause cervical cancer • Most women with high-risk HPV will not develop cervical cancer • Easily treated if found early (Pap smear, HPV test) • A vaccine can protect against some high-risk strains of HPV
- 30. Colorectal Cancer • Risk factors: Increasing age and familial adenomatous polyposis (FAP) are major risk factors; high-fat, low-fiber diet is also a risk factor. • Warning signs: blood in stool, cramping in lower abdomen • Screening: digital rectal exam, sigmoidoscopy, fecal occult blood testing, colonoscopy • Treatment: surgery, radiotherapy, chemotherapy
- 31. Skin Cancer • Melanomas vs. nonmelanomas (basal cell and squamous cell carcinomas) • Risk factors: UV from sunlight, moles, family history, race • Screening and diagnosis: skin exam looking for ABCD – Asymmetry – Border irregularities – Color irregularities – Diameter • Treatment: surgery, radiation therapy, electrodessication, cryosurgery, laser therapy The American Cancer Society emphasizes four warnings of melanoma: asymmetry, border irregularities, color irregularities, and diameter. Courtesy of National Cancer Institute.
- 32. Reducing Your Risk of CVD and Cancer • Importance of preventive lifestyle habits • Knowledge of family history, genetic risks • Importance of screening for early detection What are you doing to reduce your risk of CVD and cancer?
Editor's Notes
- Chronic diseases are diseases or conditions that persist or progress over a long time. Chronic diseases develop slowly. Chronic illnesses are prolonged, do not resolve spontaneously, and are rarely cured completely. There are many different chronic diseases, but the two biggest killers are cardiovascular disease and cancer, by far the leading causes of death in the United States as well as the rest of the world. Cardiovascular disease (CVD) comprises a group of diseases that includes two major categories: diseases of the heart and cerebrovascular disease (primarily stroke). Cancer is a disease characterized by uncontrolled cellular growth and reproduction. Cancer can occur in any part of the body, but we’ll discuss a few that are of the greatest importance to women’s health: breast cancer, lung cancer, cancers of the reproductive system, and a few others.
- More lives are claimed by CVD than by the next five leading causes of death combined. Cardiovascular deaths usually occur in later years when women are beset with a variety of comorbid conditions, such as high blood pressure, high blood cholesterol, osteoporosis, and diabetes. The two major forms of CVD are heart disease and stroke; of these, coronary heart disease is the major killer. Strokes, however, also cause many deaths, and they disproportionately affect women—6 of 10 people who die from strokes are women.
- Cardiovascular disease imposes a heavy burden on the medical care system in the United States, particularly on emergency medical departments and hospitals. Clinical care of CVD patients is costly and often prolonged. Cardiovascular disease often affects individuals during their peak productive years at work, causing significant disruption to families who are dependent on the person’s income. The high rate of CVD also carries a burden for the countries that lose productive workers to disease. The emotional cost to women and their families and friends from such disease is incalculable.
- Cardiovascular disease cannot be understood without an appreciation of the heart as a vital organ. The cardiovascular system consists of the heart, arteries, veins, and capillaries (Figure 10.3). The heart has four major chambers: the right atrium and right ventricle and the left atrium and left ventricle. The oxygen-poor blood enters the right atrium of the heart from vena cava (major veins). From the right atrium, blood flows into the right ventricle, where it is pumped to the lungs via the pulmonary arteries. In the lungs, carbon dioxide and waste products are removed from the blood and exchanged for fresh oxygen. The newly oxygen-rich blood leaves the lungs via the pulmonary veins and flows into the left atrium. From the left atrium, it passes into the left ventricle. The left ventricle contracts and forces the oxygen-rich blood through the aortic valve into the aorta (the main artery) and from there throughout the major arteries, flowing gradually into smaller and smaller arteries, arterioles, and finally capillaries throughout the body. For this system to function properly, the pump—the heart—must remain strong and forceful. It must contract forcefully and quickly when a woman runs a marathon, yet it must slow for rest during sleep.
- The most common form of heart disease is coronary heart disease. This occurs when a hard sticky substance called plaque builds in the coronary arteries, limiting the heart’s blood supply and sometimes blocking it entirely. As you can see from this image, the coronary arteries are twisted and narrow, yet the supply the heart with the blood it needs to beat 24 hours a day, 7 days a week. If the arteries are blocked entirely, a heart attack can occur. A heart attack is the death of part of the heart. Coronary heart disease is often treated with balloon angioplasty or coronary artery bypass surgery. Coronary arteries can be blocked by plaque, or by a clot forming inside the artery.
- The main culprit behind CHD is plaque, which builds inside the lining of the coronary arteries. Normally, arteries have a smooth, slick lining, but if this lining is injured, low density (LDL) cholesterol, known as “bad” cholesterol, moves from the bloodstream into the artery wall. White blood cells can enter the lining in an attempt to absorb the LDL cholesterol, and then get stuck and die, adding to the plaque. The end result is like a growing pimple in your artery.
- There are other forms of heart disease in addition to CHD. Congestive heart failure (CHF) occurs when heart muscles are weak and flabby and cannot perform the pumping function with proper vigor. In such a case, the heart loses its ability to contract properly or sufficiently to meet the demands placed on it. Even if the arteries remain open, without a strong pumping action from the heart, the ability of the nutrient-rich and oxygen-rich blood to reach cells is hampered, and the cells may suffer damage or die. Arrhythmias occur when there are problems with the heartbeat. Heartbeats can be too fast, too slow, or at an irregular pace.
- Rheumatic heart disease results from a bacterial infection (Streptococcus) that has been inadequately treated and causes damage to the heart valves. Rheumatic heart disease is a downward progression from an inadequately treated strep throat, which progresses to rheumatic fever and affects the entire body in an inflammatory process. Modern antibiotic therapy has sharply reduced mortality from rheumatic heart disease. In 1950, approximately 15,000 Americans died of this disease; in 2014the number has dropped to almost zero. Angina pectoris (or just angina) is chest pain resulting from an insufficient supply of blood, and thus oxygen, to the heart muscle. Angina is also a symptom of CVD and may be a predictor of future myocardial infarction.
- Metabolic syndrome is the name for a group of diseases that can occur together and create a greater risk for CVD. The principal factors contributing to metabolic syndrome appear to be central obesity and insulin resistance—factors that are increasingly common among women. The National Heart, Lung and Blood Institute and American Heart Association recommend weight loss and control, healthy eating, and increased physical activity as ways to prevent metabolic syndrome. Metabolic syndrome appears to be a greater risk for heart attacks and adverse outcomes in women than it is for men.
- Cerebrovascular accident, commonly called stroke, is a condition in which blood vessels leading to and within the brain become damaged. The process of blood flow blockage that occurs in the coronary vessels of the heart is similar to that which occurs in the brain. The other major process involved in stroke is vessel rupture, often resulting from atherosclerotic vessels. When the blood vessel either is blocked or bursts, part of the brain cannot get blood and therefore oxygen, which it needs to survive. The most common type of stroke, ischemic stroke, is caused by blockage; the clot in such cases is called a cerebral thrombus or cerebral embolism. Hemorrhagic strokes are caused by ruptured blood vessels. After a stroke, rehabilitation is often necessary to help survivors relearn skills that are lost when part of the brain is damaged and learn new ways of performing tasks to compensate for any disabilities. Generally, stroke can cause five types of disabilities: (1) partial paralysis; (2) loss of the ability to feel pain, temperature, or position (some experience pain, numbness, or odd sensations of tingling or prickling in paralyzed or weakened limbs); (3) language impairments, involving the ability to speak, write, and understand spoken and written language; (4) damage to parts of the brain that are responsible for memory, learning, and awareness (stroke survivors may have dramatically shortened attention spans or may lose their ability to make plans, comprehend meaning, learn new tasks, or engage in other complex mental activities); and (5) fear, anxiety, frustration, anger, sadness, and a sense of grief for their physical and mental losses. The physical effects of brain damage are responsible for some of these emotional disturbances and personality changes, such as depression.
- The most common type of stroke, ischemic stroke, is caused by blockage; the clot in such cases is called a cerebral thrombus or cerebral embolism. Hemorrhagic strokes are caused by ruptured blood vessels. Warning signs may precede a stroke in the form of a transient ischemic attack (TIA). In a TIA, the artery may close momentarily in a spasm, and the woman may have a brief memory lapse or garbled speech. Such an event often occurs very quickly, and the woman may have little memory of it.
- Although a stroke can happen at any time to anyone, it is generally a condition that occurs in older individuals. The incidence of a stroke doubles each decade for people older than 55. Of those women with an initial stroke, 25% die within a year. Those who suffer a stroke at age 65 or older have an even greater chance of dying. After a stroke, rehabilitation is often necessary to help survivors relearn skills that are lost when part of the brain is damaged and to learn new ways of performing tasks to compensate for any disabilities. Therapy begins in the acute care hospital after the patient’s medical condition has been stabilized, often within 24 to 48 hours after the stroke. Post-stroke rehabilitation requires the services of physicians; rehabilitation nurses; physical, occupational, recreational, speech-language, and vocational therapists; and mental health professionals.
- Cardiovascular diseases result from a complex interaction of genetics, lifestyle, and environmental factors that lead to different pathological conditions of the cardiovascular system. The major risk factors (those that make a significant contribution to the development of a disease) for CHD that can be modified or controlled include cigarette smoking, high blood pressure, high blood cholesterol, diabetes, obesity, and sedentary lifestyle (see Self-Assessment 10.1). The major risk factors for stroke that can be modified or controlled are high blood pressure, cigarette smoking, and diabetes. Risk factors that cannot be changed or controlled include increasing age, family history of CVD, and being African American.
- Between the ages of 25 and 34, CVD is twice as prevalent in males than in females; between the ages 45 and 54, CVD is equal between genders; after the age of 65, women are at least as likely to get CVD and are more likely to die of a heart attack or stroke. Symptoms of a heart attack tend to be quieter in women, and are thus more easily missed by women themselves and by their healthcare providers. This makes providing women with good health care more difficult. For this and other reasons, women are more likely than men to die of a heart attack.
- Cigarette smoking is the greatest preventable cause of death in the United States. Not only does it increase the risk of several kinds of cancers, but it also sharply increases the risk of heart attack (especially sudden death from heart attack), stroke, and peripheral artery disease. Certain components in cigarette smoke, such as carbon monoxide and nicotine, act as vasoconstrictors, meaning they close down the blood vessels. By narrowing the blood vessels, vasoconstrictors increase the likelihood of a blood clot forming. Over time in a chronic smoker, vasoconstriction contributes to the increased fragility and brittleness of arteries, which in turn contributes to atherosclerosis. The good news is that when a woman stops smoking, her risk for heart disease begins to decline within months. One year after quitting, the risk of coronary heart disease decreases by 50%; within 15 years, the relative risk of an ex-smoker dying from CHD approaches that of a lifetime nonsmoker. Secondhand smoke, also known as environmental tobacco smoke (ETS), comes from nearby tobacco products that are burning. Secondhand smoke is associated with a number of potentially lethal conditions: lung cancer, sinus cancer, lung conditions (such as asthma, or impaired lung function, especially in young children), and heart disease, low birth weight in babies (especially when mothers smoke during pregnancy), and others.
- Cancer is a disease characterized by uncontrolled cellular growth and reproduction. A tumor, also referred to as a neoplasm, or “new growth,” is any abnormal growth of cells. A benign tumor is one that remains localized and confined in its original growth site; that is, it does not invade the surrounding tissue or spread to distant body sites. Usually benign tumors are not life threatening unless they are located in a surgically inaccessible location. In contrast to benign tumors, malignant tumors, also called malignant neoplasms, are capable of spreading to other tissues and organs and invading adjacent tissue, the definition of cancerous growth. The process of cancer cell invasion and spreading is known as metastasis. Cancer cells circulate through the blood or lymphatic system and can invade healthy cells in other parts of the body. A carcinogen is a cancer-causing substance, such as asbestos, or any number of compounds found in cigarette smoke.
- Cancer is the second leading cause of death for women in the United States, with an estimated 275,710 women dying from this disease in 2014. If all forms of cancer were eliminated, life expectancy would increase by 3 years. Although anyone can develop cancer, most cases affect adults beginning in middle age. More than 75% of cancers are diagnosed in people aged 55 and older. Although lung cancer is the leading cause of cancer deaths in women, breast cancer has the highest prevalence among new cancer cases among women in the United States. Although fewer new cases of lung cancer are diagnosed each year in women than are cases of breast cancer, annual lung cancer deaths surpass breast cancer deaths in women. The mortality rates for lung cancer are steadily increasing for women even as they decrease for men, largely because men’s smoking rates have declined faster than women’s. Colorectal and endometrial (uterine lining) cancers are respectively the third and fourth most common cancers for women.
- Most breast lumps are not cancer. Fibrocystic breast disease, also called cystic mastitis, is the most common breast disorder and the most frequent cause of a breast lump in women younger than age 25. Typical symptoms of this condition include lumpy, tender breasts, particularly during the week before menses. Only a small subgroup of women with fibrocystic breast disease is at increased risk for breast cancer. These women have an atypical cell condition known as hyperplasia, which can be diagnosed by a breast biopsy. Another nonmalignant form of breast tumor is fibroadenoma, which is common in women in their twenties and thirties. This type of tumor produces a firm, movable, nontender lump. Fibroadenomas are usually removed both to confirm the diagnosis and to prevent further damage to breast tissue.
- Breast cancer remains, however, the most common form of cancer among women. Breast cancer causes about 40,000 deaths per year. The vast majority of new cases and deaths are in women aged 40 and older. An understanding of breast cancer is important for all women, because this disease is one of the most treatable cancers if it is detected early. The classification system for breast cancer consists of the following five levels, in increasing order of severity.
- Several major risk factors have been identified for breast cancer. The greatest risk factor is simply being a woman (men can and do get breast cancer, just not nearly as often), and the second most important risk factor is age. Most breast cancer cases occur in women older than 50 years. Genetics are also important. Hormones, especially estrogen, also appear affect breast cancer risk, so women who have early menarche, late menopause, or no children or the first child after age 30 appear to be at an increased risk. Some studies have shown that oral contraceptives may slightly increase the risk for breast cancer for some women; however, the evidence for this is inconclusive (other studies have found no increased risk).
- Many of the identified risk factors for breast cancer cannot be modified by lifestyle behaviors. Early detection of breast cancer, however, can be lifesaving. Indeed, the prognosis for breast cancer strongly depends on the stage at which it is detected. Breast self-examination (BSE) consists of the systematic palpation of the breast tissue of each breast while lying on one’s back. The American Cancer Society recommends that women over the age of 20 years examine their breasts monthly after menses and at the same time each month. Clinical breast examinations (CBE) are conducted by a woman’s healthcare provider and should be performed every 3 years for women aged 20 to 39 and every year for women aged 40 and older. Mammography, a low-dose radiograph of the breast tissue, can detect smaller breast lesions that cannot be felt through BSE or CBE. This technology has the potential to detect breast cancer at its earliest stages of development.
- Surgery is the primary treatment for breast cancer, although it may be combined with radiation therapy or hormone therapy. Several different types of breast removal surgical procedures are used to treat breast cancer. A lumpectomy is often used for early-stage localized tumors when it is possible to remove only the tumor and some surrounding tissue. A separate incision may be made to remove the axillary lymph nodes (lymph nodes in the armpit area). A partial or segmental mastectomy involves the removal of some breast tissue and some of the lymph nodes. A simple mastectomy involves the complete removal of the breast but not the lymph nodes under the arm or the chest wall muscles. A radical mastectomy is the removal of the entire affected breast, the underlying chest muscles, and the lymph nodes under the arm. Although once a very common surgery, this procedure is used less often today because of the disfigurement and the side effects it causes. A modified radical mastectomy has become the standard surgical procedure for most breast cancers that require removal of the entire breast. It involves removing the breast, some of the lymph nodes, and the lining over the chest muscles. Adjuvant therapies—treatments that enhance surgical effectiveness—include chemotherapy, hormone therapy, and radiation therapy.
- Lung cancer kills more women than any other form of cancer. It is almost always caused by exposure to tobacco smoke, although asbestos exposure is also a major risk factor. Since 1987, more women have died each year from lung cancer than from breast cancer, and lung cancer remains the leading cause of cancer deaths among women. This disease is deadly, with overall 5-year survival rates of only 15% for patients at all stages of diagnosis. If detected in early states, the survival rate is 49%; however, only 15% of lung cancers are detected at this early stage.
- Cervical cancer is another important form of cancer for women. This form of cancer is caused by certain “high risk” strains of a sexually transmitted virus called human papillomavirus. Although all cases of cervical cancer appear to be caused by HPV, many women will have HPV without ever developing cervical cancer. Approximately 12,000 cases of cervical cancer occur every year, with an estimated 4,000 deaths—despite the fact that cervical cancer is nearly 100% preventable. Death rates from cervical cancer have declined over the past 40 years, largely due to widespread cervical cancer screening programs using the Papanicolaou (Pap) test. Other techniques and prevention methods may reduce this number even further.
- Just as not all lumps in the breast are signs of breast cancer, there are benign growths and conditions of the reproductive tract. Fibroids are benign tumors composed of muscular and fibrous tissue in the uterus. They often begin developing in women between the ages of 25 and 35. Fibroids are the primary cause of an abnormally enlarged uterus and one of the most common reasons for hysterectomy. Endometriosis is another benign condition of the uterus. In this condition, tissue that looks and acts like endometrial tissue begins to grow outside the uterine lining. Treatment of endometriosis involves hormones to prevent ovulation. When hormonal drugs fail to relieve symptoms of pain or when the endometriosis has progressed to the point of forming large cysts, surgery may be indicated. Endometrial hyperplasia is an increase in the number of normal cells lining the uterus. Although the condition is not cancer, it may develop into cancer in some women if left untreated. Hyperplasia is caused by a constant production of estrogen and a lack of progesterone, which results in an abnormal thickening of the endometrium. Its most common symptoms are heavy menstrual periods and bleeding between periods.
- Uterine cancer typically begins in the tissue lining of the uterus, the endometrium. Endometrial cancer is most common in women between the ages of 45 and 74. With the decline in the use of estrogens and changes in the composition of replacement hormones used in postmenopausal women, the incidence of endometrial cancer has declined. The greatest risk factor for endometrial cancer is being older than 50 years. Risk factors of uterine cancer in general are believed to involve excess stimulation of endometrial cell proliferation by estrogen in the absence of progesterone. Treatment of endometrial cancer depends on a number of factors, including the stage of the disease. Because uterine cancer may spread rapidly, treatment of early-stage disease involves removal of the uterus as well as the fallopian tubes and ovaries. A combination of surgery and radiotherapy is effective in the treatment of localized disease. Because endometrial cancer affects the inside of the uterus, the tumor initially cannot be seen or felt during a pelvic examination. Unfortunately, a pelvic exam and Pap smear are only partially effective in the diagnosis of endometrial cancer, and the disease is not usually detected until symptoms appear.
- Ovaries are another area where benign or malignant growths may occur. Cysts are fluid-filled growths that are extremely common. Ovarian cysts are usually benign and rarely cause discomfort or pain. If symptoms do occur, they often include pain or pressure in the pelvic cavity, irregular periods, and pain during intercourse. Ovarian cancer, the fourth most common cancer in women, causes more deaths than any other cancer of the female reproductive system. Ovarian cancer, often called the “silent cancer,” usually remains asymptomatic until it is relatively advanced. Definitive treatment for ovarian cancer consists of surgery, radiation, and chemotherapy. Surgical treatment involves removal of the uterus, fallopian tubes, and ovaries. If a woman desires to have children and has a slow-growing tumor, her doctor may remove only the affected ovary. Chemotherapy and radiation therapies are used after surgery to kill remaining cancer cells and improve survival.
- Cervical cancer is another form of cancer of the female reproductive tract. It is discussed in more detail in the discussion of sexually transmitted infections in Chapter 7. All cases of cervical cancer, as far as is known, are caused by a sexually transmitted virus called human papilloma virus (HPV). There are many types or strains of this virus, which is very common. Only a very small percentage of women with some specific types of HPV will ever develop cervical cancer. Because so many women have HPV, however, detection with either a Pap test or a test that directly looks for HPV is extremely important. A recently developed vaccine can protect women from some, but not all, kinds of HPV.
- Colorectal cancer is the third most common cancer in men and women. This disease develops in a gradual, progressive manner and may present anywhere in the colon and rectal areas. Dietary factors are thought to be an important determinant of colon and rectal cancer risk. An increased incidence of these cancers appears to be associated with diets that are high in fat and low in fiber or other components of fruits and vegetables. Surgical removal of the colorectal tumor is the primary treatment. When detected at an early localized stage, the 5-year survival rate is 96%; after regional spread, this rate drops to 55%; and with distant metastases, the rate is 5%.
- Cancer of the skin, another very common form of cancer, can be classified as either nonmelanoma or melanoma. The nonmelanoma skin cancers are the most common skin cancers and include two types: basal cell carcinomas and squamous cell carcinomas. Melanoma is a cancer arising from pigment-producing cells in the skin, called melanocytes. Although not nearly as common as basal and squamous cell carcinomas, it is a much more serious condition. The major risk factor for melanoma is ultraviolet radiation from sunlight. The rates of melanoma are 20 times higher in Whites than in African Americans. It is believed that the greater pigmentation of dark skin affords more protection against radiation. The presence of moles is also an indicator of increased risk of melanoma. Early detection of all skin cancers is critical and is essential to the outcome of melanoma. The American Cancer Society emphasizes four warnings of melanoma (the ABCD system).
- There are several things that a woman can do to try to reduce her risk of CVD and cancer. Lifestyle is a critical part of maintaining a woman’s health and preventing disease. Such efforts also help to minimize problems when a woman is affected by a disease. Prevention and health enhancement include quitting smoking (or never starting), limiting alcohol intake, avoiding illegal and dangerous substances, practicing safe sex, being physically active, using sunblock while in the sun, maintaining an appropriate weight, and eating a proper diet. Prevention and early detection of cancer and CVD also involve knowing one’s family history and possible genetic risks, and engaging in screening practices (such as regular mammograms) to know one’s risks and to find any diseases early when treatment is most effective and easiest. [Ask the students what kinds of preventive and screening habits they perform regularly. How could they improve these habits? What obstacles make better prevention and screening habits difficult? How could these obstacles be avoided or reduced?]