The Harvard Women s Health Watch is committed to helping women un cover helpful information for staying healthy. This report discusses some of the latest breakthroughs in women s health. You ll read about the best breast cancer test for women over 50 and heart attack signs women get that men don t. We ll also share news research on colon cancer and aspirin, and give you tips to end embarrassing urine leaks. We hope this information is useful to you and to the other women in your life. Options beyond the traditional mammogram for detecting breast cancer There are several ways to detect breast cancer in its earliest and most treatable stage. One is by doing breast self-exams. Another is a clinical exam by a doctor or nurse. They can sometimes find a lump that you might miss on a self-exam. Finally, the special x-ray known as a mammogram can spot cancers that can t be felt. The mammogram isn t a perfect test, but it s the best one we have right now for identifying breast cancers early. For the woman at average risk for breast cancer, it is the only proven screening test, says Dr. Robyn Birdwell, section head in the Division of Breast Imaging at Harvard-affiliated Brigham and Women s Hospital. But some women need more than a traditional mammogram. Digital mammography stores images of the breast as pixels on a computer disc, like a digital camera. Manipulating these digital images can help doctors see cancers that can t be seen as clearly on film. Digital mammography is especially effective at spotting tumors in women who have dense breast tissue. 3D mammography is done by taking x-rays of the breasts from different angles. Research suggests it slightly increases breast cancer detection rates, but it exposes women to slightly more radiation than a traditional mammogram. Magnetic resonance imaging (MRI) is recommended for women with a high lifetime risk for developing breast cancer. In this test, a contrast material that shows up on an MRI scan is injected into the blood and circulates throughout the breast, where it helps highlight suspicious areas. None of these techniques has yet replaced traditional film mammograms, but the technology is improving and one of them could someday be the new test of choice. The Harvard Women s Health Watch will keep you informed. The test some women need to detect heart disease when the standard men s test doesn t work! Heart disease is definitely a women s disease. Women are more likely to die of heart disease than men, and are two times more likely to have a second heart attack within 2
six years of the first. One possible reason for these differences is that women have smaller hearts and coronary arteries the blood vessels that nourish the heart itself. That can make surgery more difficult and make some diagnostic tests, such as coronary angiography, less effective. An exercise electrocardiogram can sometimes detect heart disease. And the special x- ray known as angiography can spot cholesterol-filled plaques that bulge inward from artery walls. These fatty plaques can limit blood flow through arteries and, when they break open, cause a heart attack or stroke. But plaque tends to be flatter in women s arteries, and less likely to bulge inward. So an ordinary angiogram may not detect a problem. In addition, women are more likely than men to have microvascular disease narrowing or stiffening of the microscopic tributaries of the coronary arteries. These microvessels are too small to be probed by an ordinary angiogram, but they can prevent the heart from getting enough oxygenated blood even when the main coronary arteries are clear. In some women with chest pain, an electrocardiogram or angiogram may show that everything is normal. In those cases, a nuclear stress test or stress echocardiogram may be a good option. A newer form of imaging, intravascular ultrasound still in the test stages may prove especially helpful for women. Intravascular ultrasound can detect whether the microscopic vessels are adequately feeding the heart muscle. Another procedure, called coronary flow reserve, can measure blood flow through small arteries in response to increased demand. In addition to getting the proper tests for heart disease, it s important for women to recognize heart attack symptoms. The classic warning sign of a heart attack is crushing chest pain. Some women have this. Others have different warning signs that, unfortunately, can be confused with other problems. These include: Pain in the arm (especially the left arm), back, neck, abdomen, or shoulder blades. Often written off as pain from an injury or overdoing it. Pain in the jaw or throat. Often written off as a tooth problem or muscle strain. Unexplained nausea and vomiting. Easily chalked up to food poisoning or stomach flu. Overwhelming and unusual fatigue. Attributed to not getting enough sleep. Dizziness or lightheadedness. Often said to be due to not enough sleep or dehydration. The best advice is to take care of your heart by staying informed! 3
Best way to end stress incontinence. Cures 80% of women! Many women live with stress incontinence the involuntary leakage of urine when laughing, coughing, sneezing, or bending over. One of the best ways to end stress incontinence is with exercises known as Kegels. These exercises strengthen the pelvic floor. This is the collection of muscles, ligaments, connective tissues, and nerves that support the bladder, uterus, vagina, and rectum. With cure rates as high as 80%, Kegel exercises are often recommended to women who want to avoid surgery. The key to success is doing the exercises correctly. Here s how: Locate your pelvic muscles. Pretend you are trying to avoid passing gas; you could also pretend to tighten your vagina around a tampon. Choose your position. Start by lying on your back until you get the feel of contracting the pelvic floor muscles. Later, try the exercises while sitting or standing. Practice contractions. Start by holding a contraction for 3 to 5 seconds, then consciously relax the muscles for the same amount of time as the contraction. As you get used to doing the exercise, add a second or two and gradually build up to 10-second contractions with 10 seconds of rest in between contractions. Keep other muscles relaxed. When doing pelvic floor exercises, don t contract your abdominal, leg, or buttock muscles, or lift your pelvis. Repetitions. Try to do at least 30 to 40 Kegels (10 repetitions three or four times) a day. This is actually more effective than doing them all at once. Practice. Practice consistently, using a schedule that works for you. It may take a few months for you to notice an improvement in your symptoms. Put them to use. Practice using these exercises to control urinary symptoms. If you have stress incontinence, tighten your pelvic floor muscles just before lifting, coughing, laughing, or whatever may cause urine leakage. Do one or more Kegels when you have the urge to urinate and doubt you are going to make it to the toilet. This should give you enough time to walk to the toilet under control. Help stop colon cancer with aspirin. Among women, colon cancer is the third most common type of cancer, after breast and lung cancer. There are several things you can do to help lower your risk of colon cancer. Three of the best strategies: Exercise regularly. Don t smoke. And eat a diet rich in plant foods and low in red and processed meats and alcohol. 4
Studies also show that women who regularly take aspirin have a lower risk of colon cancer. Aspirin may be most helpful among those who have had precancerous growths called adenomas. While most adenomas don t turn in to colorectal cancer, most colorectal cancers begin as adenomas. A large study combined the results of four clinical trials among people who had previously had an adenoma and were treated with either 81 or 325 milligrams of aspirin or a placebo. After approximately three years of follow-up, the aspirin takers had an overall 17% lower risk of adenomas. Curiously, the lower aspirin dose (which is also the recommended dose for preventing heart attack) reduced the risk more than the higher dose! To help lower your risk of colon cancer, adopt the three strategies mentioned above. It might also make sense to ask your doctor if a low-dose daily aspirin (81 mg.) should be part of your colon-cancer prevention plan. In addition to working to prevent colon cancer, it s important to do what you can to detect it while it is still in its early and most treatable stage. The best way to that is by getting a colonoscopy regularly after age 50 (or earlier, depending on your family history). 5
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