Women’s Health Advances, Wellness Tips
The average life expectancy for women in the U.S. has steadily increased during the past few decades. This is largely due to advancements in medical technology and an increased awareness about the benefits of maintaining a healthy lifestyle. Some recent medical revelations include new guidelines about cholesterol for heart health, diagnosing and treating breast cancer, and the impact stress may have on fertility and overall well-being.
Cholesterol is a waxy, fat-like substance produced in the liver and other body cells. It is also present in most dairy products, eggs and meat. Some cholesterol is required by the body to produce hormones, Vitamin D and the bile acids that aid in fat digestion, but too much is not a good thing.
"Like rust in a pipe, excess cholesterol builds up in the arterial walls and creates plaque that will obstruct the flow of blood to the heart," says John Sinden, M.D., adult cardiologist at Raleigh Cardiology. Eventually, this accumulation of plaque can cause atherosclerosis and heart disease, Sinden says.
Know your numbers
If you are 20 years or older, health professionals recommend that you have a fasting lipoprotein profile every five years. This blood test reveals total cholesterol, as well as your levels of low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides.
The American Heart Association's guidelines call for a total cholesterol count of less than 200 mg/dL; HDL ("good cholesterol") of 60 mg/dL or above; and LDL ("bad cholesterol") level of less than 100 mg/dL, and less than 150 mg/dL in triglycerides.
Cholesterol guidelines focus on the LDL level, according to Sinden. "An LDL level of 130 used to be OK, but recent recommendations have lowered it to 100, or 70 if you have risk factors for heart disease. These more aggressive guidelines for lower LDL are the result of several large studies on cholesterol. Each one reinforced the one before, concluding that a lower LDL is important to preventing heart disease," he says.
Other risk factors for heart health
Controlling your cholesterol is an important step toward overall cardiac health. An even more basic approach, though, is to maintain a healthy weight and a lifestyle that includes good habits like regular exercise, according to Sinden.
Some people have a genetic predisposition to high cholesterol, and women tend to have higher HDL ("good cholesterol") levels than men. Often, cholesterol is easily controlled by diet, exercise and lifestyle choices. "HDL increases and LDL decreases when you exercise," Sinden says. Smoking lowers the "good cholesterol" HDL levels while moderate alcohol consumption increases it.
Overall, a person's risk for heart disease, heart attack and stroke is dependent on multiple factors, including family history, diabetes and hypertension, as well as cholesterol levels.
"Even if your cholesterol levels are elevated, that doesn't necessarily mean you need medication. Take control by maintaining a healthy diet and regular exercise. These simple choices are the foundation of effective cholesterol treatment," Sinden says.
BREAST CANCER BREAKTHROUGHS
Aside from non-melanoma skin cancer, breast cancer remains the most common form of cancer in women, according to the U.S. Centers for Disease Control and Prevention. The good news is that researchers continue to find new and more effective ways to diagnose and treat this disease.
Recent recommendations about mammography screening and breast self-exams by the U.S. Preventive Services Task Force (USPSTF) stirred a controversy among medical professionals.
Specifically, the USPSTF recommended biennial screening mammography for women ages 50 to 74, and discouraged routine screening for women 40 to 49 years. It recommended against doctors teaching women how to perform breast self-exams, and determined there was "insufficient evidence" to support use of digital mammography or MRI vs. film mammography to detect breast cancer. The USPSTF is an independent, voluntary body supported by the Agency for Healthcare Research and Quality.
The USPSTF's recommendations conflict with those from other organizations, including the American Cancer Society, and the American College of Radiology, according to Lola Olajide, an oncologist at Rex Cancer Center in Raleigh. "Limitations of the USPSTF review include lack of studies in older women, lack of digital mammography studies and lack of MRI studies," Olajide says.
Olajide and most oncologists continue to recommend annual mammography screening, beginning at age 40. Women with a strong family history, known genetic mutation (BRCA) or other
high-risk profile may be advised to undergo mammography before age 40.
"I do not discourage periodic self breast exams. It is important for women to know what their breasts feel like and promptly report any abnormalities to their doctor. In premenopausal women, breast self-exam should be performed at the end of a menstrual cycle," Olajide says.
Olajide also encourages women to have a clinical breast exam by a gynecologist or primary care physician every one to three years, between ages 20 to 40, and annually after age 40. Women with a high risk for breast cancer should discuss having more frequent exams with their doctor.
Expanding, honing treatment options
Tamoxifen is a drug commonly given to women with estrogen receptor-positive breast cancer. However, due to genetic variants of the CYP2D6 enzyme, some women (up to 30 percent) are unable to effectively metabolize the anti-cancer effect of this drug in their bodies. A new test can now identify patients who would be most likely to benefit from Tamoxifen. Although this screening is not currently routine, it is available to be used at the treating oncologist's discretion.
The Oncotype DX assay is a new test that helps doctors determine the likelihood that a tumor will recur. The assay also predicts which patients would benefit most from chemotherapy, and those who should forgo chemotherapy for treatment with Tamoxifen.
In addition to chemotherapy, targeted agents that interfere more directly with cancer cell growth and proliferation are being used more frequently. The majority of these targeting agents have focused on treating metastatic breast cancer. However, clinical trials are under way to examine using these agents in early-stage breast cancer.
The most recent type of targeted therapy to treat breast cancer is the PolyADP-ribose polymerase (PARP) inhibitor group of drugs. PARP is one of the repair pathways that cells use to overcome DNA damage. All cells have multiple ways to repair ongoing damage to cell DNA. If a cell is unable to repair such damage, it cannot survive.
"The PARP inhibitor group of drugs is a new class of anti-cancer therapy in breast cancer that has generated quite a bit of excitement in the scientific community," Olajide says.
In particular subsets of breast cancer patients (i.e., BRCA mutation carriers or those with the "triple negative subtype"), there is an inherent lack of cell DNA repair mechanisms. By administering a PARP inhibitor, the drug impairs a second repair pathway for these cancer cells, making them more likely to die. Adding DNA-damaging chemotherapy in this instance may also lead to irrevocable damage to the cancer cell that lacks BRCA and a PARP inhibitor pathway. Currently, in the U.S., PARP inhibitors are only being used in clinical trials.
When it's genetic
The average woman's lifetime risk of developing breast cancer in the U.S. is about 12 percent. However, when a woman is born with an alteration in one of the genes that control cell growth (i.e., BRCA1 or BRCA2), the risk of developing breast cancer increases to as high as 85 percent.
Hereditary breast cancer accounts for 5 to 10 percent of all breast cancers. In the U.S., an estimated 200,000 new cases of breast cancer develop each year, and up to 20,000 of these can be attributed to mutations in a couple of genes, according to Cecile Skrzynia, assistant professor and director of Cancer Genetic Counseling Services at the Department of Medicine and Department of Genetics at UNC-Chapel Hill.
"The good news is we are getting better at finding mutations in genes, such as BRCA1 and BRCA2, that are associated with hereditary breast and ovarian cancer. Through the use of new technology, we are also able to search for other genes that contribute to this condition," Skrzynia says.
Recent advancements in genetic testing for breast cancer include a shortened turnaround time (less than two weeks instead of one month); new technology that can detect genes and some types of mutations that were not detectable a few years ago; and increased awareness among health care providers about genetic counseling and test availability. Identifying those who carry such mutations allows tailored care with reduced risk.
One of the biggest improvements in the area of genetic testing has benefited patient rights. "Patients who undergo genetic testing are now protected by federal law so this information cannot be used against them in any way in the realms of health care and employment," Skrzynia says. "In other words, people no longer have to worry about losing their insurance coverage or their job because they underwent genetic testing."
Breast cancer is not caused by one specific factor. Instead, a combination of chance and several contributing genetic and environmental factors affect its development, according to Skrzynia.
Whether or not there is a genetic risk, Skrzynia says the same advice applies to help prevent breast cancer. The following steps tend to lower a woman's risk of developing breast cancer, according to Skrzynia:
* Get regular physical activity starting in adolescence;
* Maintain a healthy weight and avoid obesity, particularly after age 40;
* Breastfeed and have children before age 30; and
* Limit alcohol consumption.
Finally, if a woman is in the minority of individuals who have a mutation in BRCA1 or BRCA2, there are specific strategies that can dramatically lower their high risk of breast cancer. To determine if genetic testing would be beneficial, consult a genetic counselor or medical geneticist.
STRAIN OF STRESS
High stress levels can negatively impact overall health, and recent research suggests stress may also affect fertility. A recent study by Oxford University and the U.S. National Institutes of Health is one of the first studies to evaluate how stress might affect fertility, according to Julia Woodward, Ph.D., director of the Psychological Services Program at Duke Fertility Center and assistant professor in the Department of Psychiatry & Behavioral Sciences at Duke University Medical School.
"I'm pleased to see the relationship between stress and fertility being examined," Woodward says. "However, the results of this study — showing a 12 percent decrease in fertility within a small sample of healthy women — are preliminary."
Further research, with a longitudinal sample of fertile and infertile women, is needed. In addition, behavioral factors such as substance abuse, smoking and diet should be taken into account, Woodward notes. "This study emphasized the results of women with elevated levels of alpha-amylase (an enzyme that can be induced by stress) who did not become pregnant. Within the same study, though, women with elevated levels of cortisol (a stress hormone) were more likely to get pregnant, so the jury is still out on this," she says.
Mechanics of stress
Stress activates the sympathetic nervous system and shuts down recuperative processes like digesting food and repairing injuries. This allows the body to focus its energy on the "fight or flight" response. High levels of stress become detrimental when they interrupt eating and sleeping patterns and trigger panic attacks. Such extreme stress produces increased levels of cortisol and adrenaline and is related to elevations in heart rate and blood pressure.
"Fertility is probably affected by extreme stress. However, it is inaccurate to tell women that the key to becoming pregnant is to 'just relax'," Woodward says. "Women become pregnant during all types of stressful situations — war, prison, rape — so the idea that you can't become pregnant if you're stressed is a big misconception."
Woodward advises her patients to focus on physical self-care: pain management (if coping with migraines or other chronic pain issues), weight management (by maintaining a healthy diet), and exercise for cardiovascular health. These efforts will help lower stress and may give fertility a boost.
In addition, Woodward suggests a variety of relaxation strategies to engage the parasympathetic nervous system so that the body can "rest and digest." These are helpful for everyone, whether you are coping with infertility or not.
Deep breathing, acupuncture, yoga, meditation, progressive muscle relaxation and biofeedback can help reduce stress. "These strategies become more effective with practice and help to balance your system. The mind and body are connected, so a reduction in stress is definitely health-promoting," Woodward notes.
In addition, studies have found that moderate exercise and social support (friends) are also ways for women to successfully reduce stress.
"We live in a 24/7, instantaneous, multitasking culture of constant responsiveness. Women need to counter that by making time for themselves to disconnect and relax," Woodward says "Whatever you choose to do, it should be fun for you. Once you commit to that, you'll see impressive results in how you feel physically and how you cope with the stresses of life."
Maria J. Mauriello is a freelance writer, communications professional and the mother of two children. She lives in Raleigh.