By Tiffany Rider - Senior Writer
November 20, 2012 - The 2012 National Vital Statistics Reports, produced by the U.S. Centers for Disease Control and Prevention (CDC), cites the top five leading causes of death in women of all ages and races as (in order) heart disease, cancer, chronic lower respiratory disease, stroke and Alzheimer’s disease.
While researchers continue to search for a cure to each of these diseases, representative organizations and individual physicians preach prevention as the best medicine for long-term health. Most preventative measures for these diseases are based on lifestyle changes – quitting smoking, eating a more balanced diet, maintaining a healthy weight and increasing physical activity.
In addition to data from health associations, local and regional healthcare professionals offer insight on how these top five health problems impact women and what is being done to find a cure.
#1 – Heart disease
“Heart disease is the No. 1 killer of women, but the good news is that 80 percent of cardiac events in women may be prevented if they make the right lifestyle choices,” Dr. Vyshali Rao, boardmember of the American Heart Association Greater Los Angeles Division and medical director of Huntington Hospital’s Women’s Heart Program, wrote in an e-mail to the Business Journal.
The most common form of heart disease is coronary artery disease, which can lead to heart attack, according to the CDC. Heart attack occurs when the heart muscle’s blood supply is cut off by a blood clot in one or more pulmonary veins or arteries. Symptoms of heart attack include shortness of breath, chest pain, back pain, left arm or shoulder pain and feeling weak or faint.
When having a heart attack, physicians recommend immediately calling 9-1-1. According to Harvard Health Publications, chewing an aspirin speeds up the delivery of its antiplatelet effects, thinning the blood.
This is why heart attack survivors are recommended to take aspirin daily to help prevent future heart attacks.
“The American Heart Association believes that small efforts toward improving your heart health can lead to big outcomes and recommends simple steps, called Life’s Simple 7, to prevent cardiovascular disease from happening in the first place,” Rao said. “Get active, eat better, lose weight if you need to, stop smoking, control your cholesterol numbers, manage your blood pressure and reduce your blood sugar levels.”
In agreement with Dr. Rao, Long Beach Memorial Medical Center cardiac nurse practitioner Cindy Peters told the Business Journal, “Stress and lifestyle choices are up there” in terms of risk factors. “We cannot do anything about our genetic background or our age, but we can stop smoking, increase physical activity and [improve our] diet.”
Peters noted that obesity is a “huge factor,” and that there are disparities among women of color as well. “There is much more hypertension in African American women and much more diabetes in Hispanic women than in the other two groups,” she said. “They are not as savvy about heart attack. We’ve improved on women knowing that, but women of color are behind.”
There is currently no cure for heart disease. “It’s not like you can chew an aspirin and have your heart disease go away,” Peters said. “What we are trying to do is identify risk factors ahead of time and control them.”
#2 – Cancer
According to documented medical research, cancer is a group of diseases that impact humans on a cellular level, causing individual cells to multiply out of control. These cells tend to form a mass, or tumor, and the type of cancer is named for the area at which the mass originates.
According to the CDC, the three most common cancers among women are breast cancer, colorectal cancer and lung cancer. The top killer of women among those is lung cancer.
While it is less common in women than breast cancer, it is twice as lethal, according to Dr. Robert A. Nagourney, oncologist with Long Beach Memorial Medical Center and founder of cancer-testing laboratory Rational Therapeutics in Long Beach.
“Lung cancer is associated with exposure to toxins and smoke,” Nagourney said. The disease typically forms in the lung tissues in cells lining air passages. “However, more female non-smokers are beginning to show up with lung cancers caused by recently discovered gene mutations: epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK). They constitute 10 to 15 percent of lung cancers. It appears to be a genetic abnormality.”
As the number of people who smoke diminishes, the percentage of people who develop cancer as nonsmokers will tend to increase, Nagourney said. For now, drug treatments for these genetic mutations are short-term solutions that could prolong life for anywhere between six months to a year before resistance. The American Cancer Society (ACS) estimates that there will be 109,690 new cases of lung and bronchus cancer in American women in 2012. Of those, ACS estimates 72,590 will succumb to the disease.
“We now realize that lung cancer is not a disease but many diseases,” Nagourney said. “We are also beginning to realize that there are very fundamental pathways in metabolism that may be associated with lung cancer. That type of work will begin to offer prevention of genetic mutation. Early diagnosis, better symptom/side effect control, and these unfolding discoveries that are showing us that cancer is comprised of different subsets . . . there are a lot of favorable findings on the horizon.”
Nagourney noted screening techniques for prevention, such as the Spiral CT scan. “With intermittent screening, patients can reduce their mortality by 20 percent,” he said. “People who are predisposed with smoking or toxin exposure should consider Spiral CT screening.”
The second least common cancer among women is colorectal cancer, but it is still more lethal than breast cancer. “We see more death from colorectal,” Nagourney said. “That disease is associated with a relatively high rate of recurrence.”
According to the CDC, colorectal cancer develops in either the colon or rectum, both of which are part of the digestive system. A colorectal cancer tumor typically takes 10 to 15 years to develop and begins as a noncancerous polyp. There are four stages of colorectal cancer: in situ, meaning the tumor has not yet invaded the wall of the colon or rectum; local, meaning the tumor has grown into the wall of the colon and rectum, but has not permeated through; regional, meaning the cancer has spread through the wall of the colon and rectum; and distant, meaning the cancer has also spread to other parts of the body.
Risk factors for colorectal caner include age, being at least 50 years old; personal history of colon polyps or cancer; personal history of inflammatory bowel disease; family history of colorectal cancer; type 2 diabetes and racial and ethnic background. Lifestyle-related factors are physical inactivity and smoking. According to the ACS, African Americans have the highest colorectal cancer incidence and mortality rate of all racial groups in the United States and Jews of Eastern European decent have one of the highest colorectal cancer risks of any ethnic group in the world.
ACS estimates about 103,170 new cases of colorectal cancer among both men and women in the United States in 2012. Of those, 51,690 are estimated to die from the disease. “The lifetime risk of being diagnosed with cancer of the colon or rectum is about 5 percent for both men and women in the U.S.,” according to the ACS Colorectal Facts & Figures 2011-2013.
Nagourney said he thinks there is a likelihood of colorectal cancer being cured. “This cancer is very curable,” he said. “To undergo a routine colonoscopy annually starting at age 50 can reduce the risk of death from the cancer. Colonoscopy and other preventative screenings are highly supported by the literature. When it comes to cancer, it is much easier to prevent [than to cure].”
Breast cancer is the most common cancer among women. The disease forms in the breast tissue and most cancer masses are benign, meaning they do not spread and are not life threatening. Breast cancer in situ tumors are found in the breast ducts or lobules connected to the nipple. In 2012, the ACS estimates 226,870 new cases of invasive breast cancer diagnoses and 63,300 additional in situ cases. Of those, the ACS estimated 39,510 women would die of the disease this year.
Lillian Herrera, office manager of the breast health center at St. Mary Medical Center, said more women are surviving breast cancer due to increased education and lifestyle changes, as well as early detection and treatment. Treatment has “changed very much” over the years, she said, with more doctors opting to conduct minimal, non-invasive procedures on breast cancer patients who have non-aggressive cancers in the early stages.
According to the ACS Cancer Facts & Figures 2012, “Death rates for breast cancer have steadily decreased in women since 1990, with larger decreases in younger women; from 2004 to 2008, rates decreased 3.1 percent per year in women younger than 50 and 2.1 percent per year in women 50 and older. The decrease in breast cancer rates represents progress in early detection, improved treatment and possibly decreased incidence.”
Doctors are promoting a healthy lifestyle rather than cutting off the breast to reduce incidence, Herrera said, and new clinical trials for treatment are coming out every day. Women also have the opportunity to get a genetic test to determine their likelihood of breast cancer development, but there’s no guarantee, Herrera said.
While the typical age for women to begin mammograms has been 40, in 2010 the CDC Preventative Task Force decided to increase the age to 50. The healthcare industry reacted negatively to the recommendation, and many lobbied to have it reinstated to 40. The state cancer detection program listened, according to Gail Daly, COO of St. Mary Medical Center, and California reinstated that mammograms should begin at age 40.
“Early detection is key,” Daly said. For women with a family history of breast cancer, mammograms should begin earlier – sometimes at age 30. St. Mary Medical Center’s program, Every Woman Counts, allows women without insurance to get screened, and according to Daly the yearly enrollment has grown from 2007 to 2012. “It’s remarkable that we’ve got a 61 percent increase in women having the screening done,” she said.
In terms of developing a cure for cancers affecting women, Nagourney said ovarian cancer is the most likely due to its responsiveness to drug treatments. “That’s a disease we can possibly cure,” he said.
#3 – Chronic Lower Respiratory Disease
Chronic lower respiratory diseases include chronic obstructive pulmonary disease (COPD), which is a combination of emphysema and chronic bronchitis, and less common diseases like pulmonary fibrosis. In 2009, according to the CDC, 72,234 women died of chronic lower respiratory diseases. This represented 5.9 percent of all causes of death among women that year.
Emphysema, Chronic Bronchitis And COPD
Emphysema is a lung disease that makes it difficult to breathe. The air sacs in the lungs are progressively destroyed. Chronic bronchitis is the inflammation of the bronchial tubes, or airways, to the lungs. The inflammation reduces the amount of air that moves through the bronchial tubes, causing excess mucus or phlegm to be produced.
The most common cause of both emphysema and chronic bronchitis is smoking, according to the CDC. Chronic bronchitis cases can also be attributed to bacterial or viral infections. Together these form COPD, which is the third leading cause of death in the U.S. for both men and women, according to the American Lung Association (ALA).
“It causes serious long-term disability and early death,” according to the ALA website. “At this time there is no cure for COPD. More than 12 million people are known to have COPD and up to 24 million may have the disease due to some not even knowing it.”
Signs of COPD include constant coughing (sometimes called “smoker’s cough”), shortness of breath, excess mucus or phlegm production, wheezing and difficulty taking a deep breath. The basic test for COPD is called Spirmetry, which includes blowing air into a mouthpiece attached to a small machine that reads the amount of air blown into the tube and the speed at which the air is blown. A complete health history and health exam helps support test results.
Severe COPD is treated with either partial or constant oxygen therapy, and in rare cases requires surgery. COPD and the diseases that support it – emphysema and chronic bronchitis – are preventable. According to the ALA, the most effective treatment for COPD among smokers is to stop smoking. Doctors may also prescribe an inhaler, allowing users to breathe in a steroid treatment that helps prevent swelling in the airways.
While less common, pulmonary fibrosis (PF) is a deadly respiratory disease that impacts up to 500,000 Americans, according to Mishka Michon, CEO of the Coalition for Pulmonary Fibrosis based in Culver City.
“PF is fatal, so getting the word out in order to educate the public and help us put pressure on the government to find answers is absolutely critical,” Michon told the Business Journal in an e-mail. “The word ‘chronic’ only applies to PF in that you can survive for a few months to a few years with it, but it is always progressing, and the average survival rate is only 2.5 years. The rise in diagnosis of women with PF only continues.”
According to ALA, PF is scarring of tissue deep in the lungs, which makes it hard to breathe. The disease is marked by shortness of breath, a dry cough, gradual unintended weight loss, sleepiness, joint and muscle pain and sometimes clubbing – the growth and rounding of the fingertips and toes. Tests for PF can include a lung function exam, a chest X-ray, blood tests to determine oxygen levels, a lung biopsy, a CT scan and others. While some cases can be directed to a cause, most have no known cause. It can develop at a slow or rapid pace, and there is no cure.
According to a study in the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society in 2007, PF mortality rates have risen significantly in recent years to nearly 28.4 percent in men and at a higher rate in women, who have seen a 41.3 percent increase.
Treatments available are only short-term fixes and cannot reverse existing lung scarring. Lung transplant is considered for those with PF under age 65, are of good health and are not responding to medicines. However, Michon said only 1 percent of those diagnosed with PF have the opportunity for lung transplant, and survival is challenging.
#4 – Stroke
Lakewood Regional Medical Center internist Dr. Shivanand Polé works in the emergency room (ER) with stroke patients. He told the Business Journal that stroke is slightly more common in women, but because women have a longer life expectancy than men the incidence in women equals out over the course of their life. More than 800,000 people die in the U.S. from stroke each year, according to the CDC.
There are two types of stroke. Ischemic stroke, meaning blood flow to the brain is blocked by a clot, occurs in about 85 percent of stroke cases. Less likely is the hemorrhagic stroke, which occurs when a blood vessel bursts in the brain.
Treatment for ischemic stroke within the first three hours of symptoms can help break up blood clots and result in minimizing harm. Hemorrhagic stroke is more difficult to treat; the only way to possibly stop the bleeding is surgery.
“If there is an aneurysm and they are bleeding after the stroke, and it’s not related to lifestyle, then they do certain interventions like going to the arteries of the brain and blocking the artery that is bleeding,” Polé said. “That is specifically for people with internal hemorrhage. This is a last resort method.”
“Women have certain other risk factors than men,” Polé said. “Usual risks are family history, smoking, having high blood pressure, diabetes and high cholesterol. But in women, some risk factors that are unique are taking birth control pills, hormone replacement therapy and chronic migraine.” Smoking is also one of the major risk factors, as well as irregular heart rhythm. “People with irregular heart rhythm should be on a blood thinner like Coumadin or another anti-coagulant to prevent stroke,” he said.
Common symptoms of stroke are sudden numbness, weakness, especially in the face and one side of the body, confusion, trouble speaking, there could be visual problems, lack of balance. “When someone has an acute stroke and is brought in the emergency room, they are treated with something called t-PA (tissue plasminogen activator),” Polé said. “It is a medication that breaks the clot and helps improve their outcome. If someone is treated in the first three hours with t-PA the outcome is very good. Very early recognition and coming into the ER can help save a lot of their brain function.”
According to the CDC, at least one in eight stroke survivors has another stroke within five years. In those who survive, stroke can cause paralysis, speech difficulties and emotional problems.
“Patients who have had a mild stroke should realize how important it is to make lifestyle changes and to stay on aspirin every day,” he said. “It reduces the chances of recurrence tremendously. Also, make sure they follow up with their physician to check on their blood pressure and cholesterol, and if they are diabetic they should be on top of that.”
#5 – Alzheimer’s
Alzheimer’s disease is the most common form of dementia, which is the gradual decline of memory and interruption of normal thinking and behavior. The disease develops slowly, and over time there is a decline in overall function that can lead to difficulty conducting typical daily tasks – from buttoning a shirt to balancing a checkbook.
Behavioral changes occur as onset progresses and the impacted individual is less capable of daily living. It can lead to delusion, agitation, repetitive questioning, hallucinations and forgetting who they are, according to Debra Cherry, Ph.D, executive vice president of the Alzheimer’s Association California Southland Chapter.
At the end stages of the disease, the affected person has a hard time coordinating the body to, for instance, sit in a chair. Toward the very end, swallowing becomes difficult and the individual can become mute.
“Pretty far into the disease people can retain very good social skills, even as they are losing their cognitive capacity,” Cherry said. “All of this can happen as short as two or three years, or as many as 20 years.”
Alzheimer’s greatest risk factor is age. Most people are diagnosed after age 65, however Cherry said the association is seeing a growing number of younger people with the disease. “You are more likely to see it as a genetic disorder when it occurs in younger people,” she said, or if the individual has had a head injury that lead to loss of consciousness. “When people get it later in life, say, in their 80s, it’s more idiopathic.”
More women are diagnosed with Alzheimer’s disease than men, Cherry said, mostly because women live longer than men but also in some areas that are controlled for age. “There is a hypothesis that there is a connection between estrogen and Alzheimer’s,” she said, noting that women who are on hormone replacement therapies are at greater risk of heart attack, stroke and vascular dementia.
“We can reduce our risk for Alzheimer’s disease by doing many of the recommended heart healthy activities,” Cherry said, “Exercise, a diet of low saturated fats, avoiding diabetes or managing it well if you have it are all recommended. Secondarily, staying engaged and cognitively aware.” Unfortunately, some people can still follow the healthy lifestyle recommendations and still get the disease, she said.
There are cognitive tests for individuals showing symptoms of Alzheimer’s disease. For those who are asymptomatic, an imaging test called a PET scan to observe any signs of the disease affecting on-brain tissue. As more individuals get screened, doctors can appropriately attribute deaths to Alzheimer’s as opposed to being diagnosed with pneumonia or dying of old age.
“Federal investment in cancer is $6 billion; for heart disease it’s $4 billion. Alzheimer’s disease gets $0.5 billion from the NIH (National Institutes of Health),” Cherry said. “We’ve made great progress in AIDS, and we invest $2 billion in AIDS. I’m not saying we shouldn’t support AIDS research. Alzheimer’s is going to be the epidemic of the current century. This is the first time people have lived this long. The number of people with Alzheimer’s in our country is going to double by 2030 and triple by 2050.”