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Menopausal Hot Flashes: Middle of the Night Sleep Intruders

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By Fiona C. Baker, PhD, SRI International, SWHR Interdisciplinary Network on Sleep Member

It was 2 am when SJ woke up feeling hot, clammy, and bothered. She threw off the blanket in hopes of cooling down. Unfortunately, this experience was nothing new for her. She knew it was going to take a while to get back to sleep.

While approaching and passing menopause, around 80 percent of women experience transient periods of flushing, sweating, and a sensation of heat known as hot flashes. When they occur during the night, they can also be called night sweats [1]. While an occasional flash lasting a couple of minutes may not sound like much of a problem, some women experience this many times throughout the day and even at night. A woman whose sleep is interrupted will soon notice additional interferences with her daily life. This impact will be reflected in her daytime functioning, mood, and health.

A laboratory study of 34 perimenopausal women by Dr. Baker’s lab at SRI International found that around 70 percent of nighttime hot flashes woke women up, disrupting their sleep (objectively measured with sensors that detect brain activity) [2]. Women were most attuned to wakeful periods that co-occurred with hot flashes during the night.

Hot flashes can be the cause of chronic sleep disruption and can perpetuate insomnia, keeping women awake by feeling like they are losing control over their sleep, worrying about the impact of hot flashes on their sleep quality, and consequently how well they will function the next day. Hot flashes can persist for several years past menopause and are therefore a potential long-term source of sleep disruption, which in turn, affects quality of life, including mental and physical health. Therefore, hot flashes are a priority symptom that women should discuss with their healthcare provider.

Treatments can be tailored to the needs of each woman, taking into account the severity of the hot flashes, whether or not they disrupt both daytime functioning and sleep, where they are in the menopausal transition (pre-, peri-, post-, or surgical menopause), and whether they may have any other medical conditions that could add to any sleep disruption, such as sleep apnea. Treatment options include hormone therapy, non-hormonal pharmacological treatments such as selective serotonin reuptake inhibitors and gabapentin, or non-pharmacological choices specifically targeting sleep disruption such as cognitive behavioral therapy for insomnia [3, 4]. Cognitive behavioral therapy along with a healthy lifestyle can help women cope with their menopausal symptoms and put them back in control of their sleep. So if hot flashes are disrupting your day-to-day activities and/or your nighttime sleep, ask questions and talk to your healthcare provider.

The Society for Women’s Health Research Interdisciplinary Network on Sleep is committed to promoting awareness of sex and gender differences of sleep and circadian rhythms across the lifespan, and the impact they have on health and wellbeing. Learn more about the Sleep Network here.

References:

  1. Melby, M.K., et al., Methods used in cross-cultural comparisons of vasomotor symptoms and their determinants. Maturitas, 2011. 70(2): p. 110-119.
  2. de Zambotti, M., et al., Magnitude of the impact of hot flashes on sleep in perimenopausal women. Fertil Steril, 2014. 102(6): p. 1708-15.e1.
  3. Baker, F.C., et al., Insomnia in women approaching menopause: Beyond perception. Psychoneuroendocrinology, 2015. 60: p. 96-104.
  4. Joffe, H., A. Massler, and K.M. Sharkey. Evaluation and management of sleep disturbance during the menopause transition. Seminars in reproductive medicine, 2010. 28: p. 404-421.

 

Woman_Man-staring-at-sky-webfriendly

Women and Alzheimer’s Disease: The Facts Behind the Headlines

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By Michelle M. Mielke, PhD, Mayo Clinic, SWHR Interdisciplinary Network on Alzheimer’s Disease Member

In the last few years, several reports have placed women at the forefront of Alzheimer’s disease (AD). These reports have generated misleading headlines stating that women are at greater risk of developing AD compared to men. However, the numbers behind these headlines are not clear. There has also been little discussion about risk factors for AD that may be more important for women than men. Below is some clarity on what the phrase “women are at greater risk” means and some AD risk factors that have been found to be stronger for women than men. Notably, women are more than twice as likely as men to provide care for affected family members [1]. Therefore, it is important to also understand AD risk factors that are stronger for men.

Are women at greater risk of developing AD?

The total number of women with AD is greater than the total number of men with AD [2]. The main reason for this is that age is the biggest risk factor for AD. Women live longer than men, therefore there are more women at older ages when the development of AD is most likely.

However, whether women are actually at greater ‘risk’ compared to men is not clear. For example, if you look at women and men of the same age, say 65 or even 85 years old, and compare their risk of developing AD over three years, virtually all studies from the U.S. suggest that women are not more likely to develop AD than men. The studies reporting that women are at greater risk of AD used data from European populations [3, 4].

Oftentimes, studies from the U.S. suggest that men may be at slightly greater risk up to the age of 75, women and men have the same risk from ages 75-84, and women at slightly greater risk after the age of 85. It is clear that these differences are not significantly different, therefore, headlines stating that women are at greater risk refer specifically to the total number of women with AD, which is partially explained by the fact that women live longer.

What risk factors are important?

While we cannot control our genes, there are modifiable risk factors for AD that we can address. Unfortunately, most studies of AD risk factors combine women and men, and do not attempt to identify risk factors that are more common or stronger among women versus men.

There is an ongoing push to highlight the need for this kind of research, and we are now beginning to identify some risk factors that vary in strength for men and women.

Education. Low socioeconomic status, education, and occupational attainment are risk factors for AD in both women and men. Due to women having historically less support to obtain higher education, the overall effect of this risk factor appears to be greater for women [3]. The increasing education levels and occupational attainments of women over the last few decades may be one explanation for why the incidence of dementia may be declining more for women [5, 6]. Education is not solely attained in the first two decades of life, therefore continuing one’s education through formal or informal classes during middle age and beyond retirement, can contribute to building up brain reserve. Social interactions can also be beneficial to brain health.

Cardiovascular risk factors. A diagnosis of hypertension, high cholesterol, and diabetes in mid-life has been associated with a greater risk of developing AD for both women and men, but the risk for women is greater than for men [e.g., 7]. Therefore, it is critical for women to make a conscious effort to prevent these risk factors through diet, exercise, weight management, and adequately treating them when they occur.

Hormonal therapies. Following data published by the Women’s Health Initiative study, which suggested that hormonal therapies were associated with an increased risk of dementia and cardiovascular disease in the mid-1990s, the frequency of hormonal therapies drastically decreased. However, an important caveat to this study was that women were randomized to the use of hormones an average of 10 years after menopause. It is now thought that initiation of hormones several years after menopause may increase the risk of adverse outcomes [8]. Recent randomized controlled trials of healthy women that start using hormones within 3 years of menopause have not found an increased risk of dementia or cognitive decline [9]. This research suggests that many women can safely use hormonal treatments for menopausal symptoms over short durations and that the treatments do not have adverse effects on memory or risk of AD. The ultimate decision to either start or stop these therapies should be based on a collaborative discussion between a woman and her healthcare provider.

Women who have had one or both ovaries removed prior to age 45 are also at an increased risk of developing AD. Research suggests that hormonal use up to the age of natural menopause (around 51 years of age), will reduce this increased risk [10].

Never married/widowed. Compared to women, men who have never married or are widowed, have a greater risk of developing AD [e.g., 11]. A potential reason for this consistent observation is that women are often the ones responsible for the healthcare of their family (e.g., getting kids and partners/husbands to doctors for regular check-ups, assuring everyone has a healthy diet, etc.), sometimes at the expense of their own health. Women also typically lead a couple’s engagement in social activities, which are beneficial for cognition. While these notions are a bit stereotypical and not true of all situations, they should not be ignored. Caregivers of older, single, or widowed men should be cognizant of this difference, and in turn help maintain regular check-ups and engagement in some type of social activity.

There is still more to be done in investigating new AD risk factors and discerning how established risk factors vary by gender. The Society for Women’s Health Research’s newly launched Interdisciplinary Network on Alzheimer’s Disease is committed to advocating for these goals in order to improve prevention, early detection, management, and care.

References

  1. Kasper JD, Freedman VA, Spillman BC. Disability and Care Needs of Older Americans by Dementia Status: An Analysis of the 2011 National Health and Aging Trends Study. U.S. Department of Health and Human Services. April 2014. Available at: https://aspe.hhs.gov/report/disability-and-care-needs-older-americans-dementia-status-analysis-2011-national-health-and-aging-trends-study. Accessed February 28, 2017.
  2. 2014 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 2014. 10(2): p. e47-92.
  3. Mielke MM, Vemuri P, Rocca WA. Clinical epidemiology of Alzheimer’s disease: assessing sex and gender differences. Clinical Epidemiology, 2014. 6: p. 37-48.
  4. Edland SD, Rocca WA, Petersen RC, et al., Dementia and Alzheimer disease incidence rates do not vary by sex in Rochester, Minn. Archives of Neurology, 2002. 59(10): p. 1589-1593.
  5. Langa KM, Larson EB, Crimmins EM, et al., A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Internal Medicine, 2017. 177(1): p. 51-58.
  6. Matthews FE, Arthur A, Barnes LE, et al., A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet, 2013. 382(9902): p. 1405-1412.
  7. Pankratz VS, Roberts RO, Mielke MM, et al., Predicting the risk of mild cognitive impairment in the Mayo Clinic Study of Aging. Neurology, 2015. 84(14): p. 1433-1442.
  8. Brinton RD. The healthy cell bias of estrogen action: mitochondrial bioenergetics and neurological implications. Trends in Neurosciences, 2008. 31(10): p. 529-537.
  9. Gleason CE, Dowling NM, Wharton W, et al., Effects of hormone therapy on cognition and mood in recently postmenopausal women: findings from the Randomized, Controlled KEEPS-Cognitive and Affective Study. PLoS Medicine, 2015. 12(6): p. e1001833.
  10. Rocca WA, Grossardt BR, Shuster LT. Oophorectomy, menopause, estrogen treatment, and cognitive aging: clinical evidence for a window of opportunity. Brain Research, 2011. 1379: p. 188-198.
  11. Miech RA, Breitner JC, Zandi PP, et al., Incidence of AD may decline in the early 90s for men, later for women: the Cache County study. Neurology, 2002. 58(2): p. 209-218.
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Who Should Be Screened For Sleep Apnea? The Answer Is Not Always Obvious

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By Rebecca Nebel, PhD, Assistant Director of Scientific Programs at SWHR

There is insufficient current evidence to assess the benefits and harms of screening for obstructive sleep apnea in asymptomatic adults [1], according to an assessment recently released by the United States Preventative Services Task Force (USPSTF). USPSTF, an independent, volunteer panel of national experts in prevention and evidence-based medicine, makes recommendations about the effectiveness of specific preventive care services for patients. USPSTF’s finding also applies to individuals with sleep apnea who are not aware of their symptoms or do not report symptoms as a concern. This is troubling, as it may impede primary care providers from discussing the signs and symptoms of obstructive sleep apnea (which we will refer to as sleep apnea) with their patients.

Sleep apnea affects 34 percent of men and 17 percent of women [2]. It not only increases the risk for a number of cardiovascular and metabolic diseases (e.g. heart disease, stroke, and diabetes), but also for motor vehicle crashes and mortality [1].

Data shows that the delay between development of symptoms and a sleep apnea diagnosis can be upwards of 7 to 10 years [3, 4]. This delay occurs despite many visits to primary care providers [3]. Many individuals with sleep apnea do not report “textbook” symptoms of sleep apnea, which include excessive daytime sleepiness and snoring. For example, one study found that over one-third of patients with moderate or severe sleep apnea reported excessive daytime sleepiness [5, 6]. This suggests that many individuals with sleep apnea would not necessarily report “textbook” symptoms to their primary care providers. In light of USPSTF’s recent statement about screening for sleep apnea, it is unlikely that these individuals would be viewed as candidates for such an evaluation.

There is also a need to address sex and gender differences in sleep apnea symptoms. Sleep apnea is a widely under-recognized disorder, particularly in women. Studies estimate over 90 percent of women with sleep apnea are not diagnosed [7]. One reason for this under-diagnosis is that many women do not have “textbook” symptoms and are more likely to report non-“textbook” symptoms such as fatigue, insomnia, and mood disturbances [8, 9]. Healthcare providers may not recognize these signs of sleep apnea, which can lead to misdiagnosis and mistreatment. Consequently, it is important to raise awareness of the differences in sleep apnea symptoms between women and men. USPSTF does not address the explicit need for improving recognition (and ultimately prevention and treatment of sleep apnea) in women, despite evidence that women are at high risk for sleep apnea related health problems, such as cognitive impairment [10] and heart failure [11]. Healthcare providers may continue to miss proper diagnosis in women unless they take sex and gender differences in sleep apnea symptoms into account during primary care visits.

Pregnant women are explicitly excluded from USPSTF’s recommendation. Pregnancy is often a time where sleep apnea is unmasked or becomes exacerbated [12]. Sleep apnea during pregnancy increases the risk for adverse outcomes for both mother and baby, including preeclampsia, gestational diabetes, preterm birth, NICU admission, and maternal death [12, 13].

Because current screening tools may not be sensitive to measuring how sleep apnea presents itself in pregnant women and women in general, it is important that healthcare providers be vigilant towards non-“textbook” symptoms in women across their lifespan. It is crucial for primary care providers to ascertain a patient’s medical history, including sleep apnea symptoms, and to recognize that “textbook” symptoms as well as non-“textbook” symptoms (insomnia, fatigue, mood disturbances) all may be indicators of sleep apnea.

The Society for Women’s Health Research Interdisciplinary Network on Sleep is committed to promoting awareness of sex and gender differences of sleep and circadian rhythms across the lifespan, and the impact they have on health and well-being. Learn more about the Sleep Network here.

References

  1. US Preventive Services Task Force., Screening for obstructive sleep apnea in adults: US Preventive Services Task Force recommendation statement. JAMA, 2017.
  2. Peppard, P.E., et al., Increased prevalence of sleep-disordered breathing in adults. American journal of epidemiology, 2013. 177(9): p. 1006-1014.
  3. Rahaghi, F. and R.C. Basner, Delayed diagnosis of obstructive sleep apnea: don’t ask, don’t tell. Sleep and Breathing, 1999. 3(04): p. 119-124.
  4. Redline, S., et al., Patient Partnerships Transforming Sleep Medicine Research and Clinical Care: Perspectives from the Sleep Apnea Patient-Centered Outcomes Network. Journal of clinical sleep medicine, 2015. 12(7): p. 1053-1058.
  5. Carter, G.S., Screening for Improvement of Health Outcomes in Asymptomatic Obstructive Sleep Apnea. JAMA neurology, 2017.
  6. Young, T., et al., Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep, 2008. 31(8): p. 1071-1078.
  7. Young, T., et al., Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep, 1997. 20(9): p. 705-706.
  8. Kump, K., et al., Assessment of the validity and utility of a sleep-symptom questionnaire. American journal of respiratory and critical care medicine, 1994. 150(3): p. 735-741.
  9. Valipour, A., et al., Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep, 2007. 30(3): p. 312.
  10. Yaffe, K., et al., Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA, 2011. 306(6): p. 613-9.
  11. Roca, G.Q., et al., Sex-Specific Association of Sleep Apnea Severity With Subclinical Myocardial Injury, Ventricular Hypertrophy, and Heart Failure Risk in a Community-Dwelling Cohort: The Atherosclerosis Risk in Communities-Sleep Heart Health Study. Circulation, 2015. 132(14): p. 1329-37.
  12. Louis, J.M., et al., Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. Sleep, 2014. 37(5): p. 843.
  13. Louis, J., et al., Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women. Obstetrics and gynecology, 2012. 120(5).

 

tired woman

Chronic Fatigue Syndrome: Diagnostic Tests, Treatment, and Prevention Urgently Needed

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By Clarissa K. Wittenberg

This blog was inspired by the good news that the National Institutes of Health (NIH) has doubled its research budget for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). However, it was shocking to see that the increase was from $7.6 million last year to $15 million this year. This is a very small research budget given that hundreds of thousands, even as high as 2.5 million men, women, and children suffer from this syndrome. Several studies use different criteria for diagnosis making for a wide variance in prevalence. The economic cost of ME/CFS is estimated at $17 to $24 billion annually [1]. NIH is the nation’s premiere biomedical research agency and as such, whatever budget is allotted, its influence adds credibility to the importance of studying ME/CFS.

Comparison: Budgets for Multiple Sclerosis and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

The NIH National Institute of Neurological Diseases and Stroke (NINDS) is the lead Institute for both ME/CFS and multiple sclerosis (MS). The 2017 budget for multiple sclerosis (MS) is $98 million, a decline from $115 million in 2016. The number of patients for MS and ME/CFS is similar and like ME/CFS, causation for MS has not been established, although there are accepted treatments for the disease. Both have serious symptoms and can cause severe disability. MS patients have benefited from research, medical treatment and emotional support, but ME/CFS patients continue to struggle. Both disorders need more generous budgets [2], however other disorders need increased funding as well. NIH current funding is at 2016 levels due to a Continuing Resolution and budgets for special projects such as the Cancer Moonshot, which are not yet accounted for. To date, the NIH budget has not kept pace with inflation [3].

NIH Confronts ME/CFS:

“Of the many mysterious human illnesses that science has yet to unravel, ME/CFS has proven to be one of the most challenging. I am hopeful that renewed focus will lead us toward the cause of this perplexing and debilitating disease so that new prevention and treatment strategies can be developed,” said Francis S. Collins. MD, PhD, Director of the NIH [4].

It is encouraging that NIH began an investigational clinical study of ME/CFS in October 2016, to determine new treatments and diagnostic tests in an effort to see if new technologies might aid in the understanding of the condition. Leading up to this effort is an NIH-sponsored Institute of Medicine report (now the National Academy of Medicine) [5], an NIH Pathways to Prevention meeting [6] as well an invigoration of the Trans-NIH ME/CFS Research Working Group. In 2015, NIH began an ME/CFS Special Interest Group to serve as a forum for finding the cause of ME/CFS and identifying clinically valuable treatments. 

What is ME/CFS?

What is this disorder? While the syndrome was long viewed cynically, ME/CFS is now acknowledged as a medical syndrome, not a psychiatric or psychological one [7]. It is not just a state of being tired or exhausted, it is a complicated disorder characterized by extreme fatigue, more intense than what is usually experienced after exhausting physical or mental work. The diagnosis demands the exclusion of other diseases with similar symptoms. ME/CFS fatigue is more comparable to the fatigue caused by radiation, head injuries, or other types of biological assault. Other symptoms are widespread muscle and joint pain, cognitive issues, and even headaches. The symptoms do not subside with rest and it is frequently noted that those who suffer from ME/CFS have higher rates of suicide.

Most people cannot overcome the fatigue through willpower, although there are stories of people with ME/CFS making extraordinary efforts on their best days to continue to carry out their life’s work. Laura Hillenbrand, author of Seabiscuit, and Unbroken: A World War II Story of Survival, Resilience, and Redemption, continued writing despite being homebound by her illness. Blake Edwards, the director of many movies including Pink Panther, worked for almost 15 years despite having ME/CFS. The majority cannot continue their normal lives and this disorder can last for months, years, or even a lifetime.

A Disease with 1,000 Names:

In 1860, the syndrome was identified and named “neurasthenia.” It was from that moment that the name changing began. Sometimes the syndrome was named after a preceding infection, such as “chronic Epstein-Barr syndrome,” “chronic mononucleosis syndrome,” or “atypical poliomyelitis.” It has been named after sites of outbreaks including “Iceland disease,” “Tapanui flu,” and “Lake Tahoe disease.” It has also been named after prominent patients such as Florence Nightingale and Charles Darwin. In 1993, the Centers for Disease Control and Prevention named it chronic fatigue syndrome. The Institute of Medicine report renamed it myalgic encephalomyelitis/chronic fatigue syndrome, however, since muscle pain (myalgic) and brain inflammation (encephlomylitis) are not the main symptoms, a change to systemic exertion intolerance disease or SEID is currently being considered.

The various names contain valuable clues about the nature of the syndrome. Each one in an effort to pin down its causation. Although the large variation in secondary symptoms probably played a role, the biggest mystery is why all these efforts have never connected. This suggests that new investigational and linkage studies such as the NIH clinical trial and the Open Medicine Foundation Big Data Study, conducted with severely ill ME/CFS patients, may offer new insights as they use novel technologies to interrelate genetics, immunology, neurology, sleep research, viral sequelae, and other domains together [8].

Doing Something About It:

Linda Tannenbaum is the CEO/President of the Open Medicine Foundation, which funds the study of ME/CFS and other chronic complex disorders. Tannenbaum learned about ME/CFS when her daughter was diagnosed with the condition. Similarly, Ron Davis, PhD and Professor of Biochemistry and Genetics at Stanford University School of Medicine and Director of the Board of the Open Medicine Foundation learned about the disease when his son was diagnosed with ME/CFS. These families know firsthand how lives are damaged by ME/CFS. The Foundation has begun its Big Data Study of Severe Cases of ME/CFS that will look into finding biomarkers and releasing that information to the scientific community. “Any one of us, regardless of age, can be fine one day and then struck with ME/CFS, and it can last a lifetime,” said Tannenbaum.

Patient Advocacy: A Relentless Force for Change

We live in an age of powerful patient advocacy, with patients now researching their own illnesses, writing blogs, shooting films, lobbying, and forming foundations in order to raise awareness about their conditions. In 2001, Kim Snyder, a highly honored filmmaker, released I Remember Me, as she was recovering from ME/CFS. Her film tells the stories of people with ME/CFS and is also available on YouTube. Unrest, a film by Jennifer Brea, premiered at the 2017 Sundance Festival. It depicts her life story beginning from a vibrant childhood to the sudden onset of ME/CFS while studying for her PhD. She has continued to be a highly visible advocate. Talking about her film, Brea ruefully remembers seeing I Remember Me when she was in high school and thinking, “change was just around the corner.”

These films convey the terrible disability, pain, and social crisis of ME/CFS in a way no written description could. Doctors are often taught via Grand Rounds where patients are presented so medical students can have a real sense of the disease. These films offer a similar opportunity for the public, as well as medical students and researchers.

Solving the Mystery

Improved communications can educate us all, as well as help patients to understand that they are not alone. Important questions such as the reason why the disease is more common in women, would advance the understanding and treatment of ME/CFS. Are men less likely to report this syndrome? Are there differences in treatment offered to women and men?

Clarissa K. Wittenberg was a science writer and senior communication officer at several NIH Institutes and Associate Director for Communications at the National Institute of Mental Health; a special assistant to the Director of the Office of Global Health, Office of the Secretary, HHS; and formerly a consultant for mental and overall health of underserved populations to the Department of Psychiatry and Human Behavior, University of Mississippi Medical Center. She is Creative Director of the Washington Film Institute.

References:

  1. http://www.iom.edu/Reports/2015/ME-CFS.aspx
  2. The Tragic Neglect of Chronic Fatigue Syndrome, Olga Khazan, October 8, 2015, The Atlantic
  3. Inside (the Beltway) Scoop) Jennifer Zeitzer, February 3, 2017) http://faseb.org
  4. NIH takes action to bolster research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. NIH News Release, October 29, 2015
  5. Beyond Myalgic Encephalomyelitis/Chronic Fatigue: Redefining an illness, Institute of Medicine, Report Brief, February 2015
  6. Advancing the Research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, NIH Office of Disease Prevention, December 9-10, 2014
  7. Beyond ME/CFS Syndrome: redefining an illness https://www.ncbi.nlm.nih.gov/25695122
  8. Open Medicine Foundation (OMF), End ME/CFS Project Biomarker Discovery: Severely Ill Big Data Study
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Sexual and Gender Minorities: The Silent Majority in the World of Mental Health

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By Natalia Gurevich, SWHR Communications Intern

This past year mental health has been at the forefront of national coverage, especially with the recent presidential election, where both nominees acknowledged mental health as an issue of public health concern. For one group in particular, sexual and gender minorities, mental health is an issue compounded by additional stressors that can occur daily. Sexual and gender minorities are affected by more discrimination and stigma throughout their lives than the general population [1]. As a result, mental health issues also disproportionately affect this group [1].

Sexual and gender minorities are a group whose sexual identity, orientation, or practices differ from the majority of the population [2]. Sexual and gender minorities usually comprise of lesbian, gay, bisexual, and transgender (LGBT) individuals [2]. The term sexual and gender minority is fairly new, and is currently used by the National Institutes of Health, which established the Sexual & Gender Minority Research Office in September 2015. While many studies and groups still use LGBT or LGBTQ, for the purposes of inclusion and for this post, SWHR will use the term sexual and gender minority.

The population is probably slightly larger than reported, but those who publicly identify as a sexual and gender minority only make up about 3.4 percent of the U.S. population [3]. However, for this small minority group, suicide is one of the leading causes of death among those aged 10–24 years. Sexual and gender minority youth contemplate or attempt suicide 4 times more frequently than the general population [1].

Sexual and gender minorities are also more affected by disorders, like depression and substance abuse. Most of these disorders affect sexual and gender minority adolescents at a higher rate than their cis gender, heterosexual peers [4]. A lot of internalized disorders (mental health) and external disorders (drug and alcohol addiction) that begin to develop in teenage years often manifest themselves into deeper issues continuing into adulthood [5]. Therefore, many researchers focus on adolescence in sexual and gender minorities in an effort to better understand the root cause of mental health issues within this group.

A study published in 2008 by the Journal of Child Psychology and Psychiatry, found that stress was the main compounding factor [4] to higher rates of mental health issues in sexual and gender minorities compared to the rest of the population. Chronic stress leads to dysregulated emotions and sexual and gender minorities face multiple stressors during adolescence, including peer victimization, and in some cases, physical assault and rejection from their family [4]. Coping with these extraneous stressors, along with various other issues facing adolescents in general, potentially keep sexual minorities from developing emotional maturity and adaptability relative to their heterosexual peers [4], which can extend into adulthood.

Another study published in 2010 by the American Journal of Public Health found that three categories for discrimination—gender, race/ethnicity, and sexual orientation—were often compounded together, and when combined, led to higher rates of substance abuse [6], particularly in adulthood. An estimated 20-30 percent of sexual and gender minorities abuse substances, compared to about 9 percent of the general population [1].

Substance abuse is an external disorder that often goes hand-in-hand with internal disorders. Because sexual minorities face discrimination and social stigma on a higher basis than other subpopulations, daily stressors often increase their risk for anxiety, depression, panic attacks, suicidal ideation, psychological distress, body image disturbance, and eating disorders [2]. While the president-elect has spoken on mental health in the past, he has yet to announce a formal platform on the issue [7]. SWHR hopes that the new administration will recognize the current issues surrounding mental health and develop new policies to combat this public health concern.

Education and awareness on sexual and gender minorities and mental health should be addressed as early as possible in adolescents and continue into adulthood. If you are a member of the sexual and gender minority community or even if you are not, talk to your healthcare provider if you have any questions relating to mental health.

At SWHR, we believe that mental health is an important issue that affects members of every community, either personally or through a loved one. Everyone is entitled to receive the proper care and support they deserve, regardless of sexual orientation, gender, or race/ethnicity. Sexual and gender minorities belong to a group greatly affected by mental health issues, but are vastly underrepresented in research. All the mental health implications will remain relatively unknown without more research and education on this minority group. Learn more about SWHR and the work we do on mental health here.

References:

  1. https://www.nami.org/Find-Support/LGBTQ
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657897/
  3. http://www.gallup.com/poll/158066/special-report-adults-identify-lgbt.aspx
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881586/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976222/#B1
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937001/
  7. http://www.huffingtonpost.com/entry/this-election-vote-with-your-mind_us_580678f4e4b08ddf9ece1139

 

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One More Mom to Teenage Daughter Talk: The School Bathroom

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By Clare E. Close, MD, FAAP, SWHR Interdisciplinary Network on Urological Health in Women Member

It’s early morning and your teenage daughter runs out the door to school. Much will happen today that you may or may not hear about when you see her again tonight. It’s unlikely that you will hear anything about the school restrooms, yet during her day at school, your daughter is developing habits that can affect her bladder for her lifetime [1].

Three hours into the school day your daughter needs to urinate but doesn’t ask to leave her class because she can’t afford to miss information that will be on this week’s exam. Also this teacher gives extra credit to students who don’t ask for bathroom breaks. A minute later her urge to urinate is gone. During her short passing period to lunch she walks by the restroom, but is too busy texting her friend and doesn’t stop. She eats her lunch and heads to her next class. Suddenly she feels her bladder again. She heads to the bathroom but turns around because the floor looks dirty. Sitting down in class she crosses her legs and does not feel her bladder so much, which is good because her teacher does not allow bathroom breaks right after lunch.

Eight hours after leaving home, classes are over, and your daughter’s bladder feels so full that it hurts. She heads to the bathroom but the door is now locked to prevent afterschool vandalism. Arriving home she rushes into her bathroom but leaks on the way.

Scenarios like this may seem hyperbolic, but they are happening to teenagers every day. Because bladder health is rarely taught in middle or high school health studies, your daughter most likely has no idea that she should be taking better care of her bladder. Unless she has an obvious bladder problem such as infection, you also will probably never think about discussing your daughter’s bladder health.

We know children commonly hold their urine and stool in elementary school causing incontinence, bedwetting, and infection [2]. In middle school and high school there many more social, time, and academic pressures that keep adolescents from going to the bathroom [3]. Over time if your daughter holds her urine all day her bladder can become abnormal with a thick wall that can make her feel a sudden urge to go as well as make her leak urine. These problems can continue into your daughter’s adulthood [4]. To grow a healthy bladder your teenager should urinate every two to three hours and take time to relax and empty their bladder completely. Healthy eating and drinking plenty of water will help her have normal bowel movements, which are also important for a healthy bladder [5].

Talking to your daughter about her bathroom habits may seem uncomfortable because of her desire for independence and privacy, but it is important to connect with her about issues of bathroom access, cleanliness, and safety. The school nurse may be the best person to reach out to if your daughter tells you about such problems. Her life-long bladder health may depend on it.

The Society for Women’s Health Research (SWHR®) launched its Interdisciplinary Network on Urological Health in Women in 2015 to promote bladder and urinary tract health across a woman’s lifespan. To learn more about the network or about urological health, visit swhr.org.

References

  1. Fitzgerald MP, Thom DH, Wassel-Fyr C, et al: Childhood urinary symptoms predict adult overactive bladder symptoms. J Urol 2006; 175: 989
  2. Sureshkumar P, Craig, JC, Roy LP, et al. Daytime urinary incontinence in primary school children: a population-based survey. J Pediatr 2000;137:814
  3. Bauer RM and Huebner W. Gender differences in bladder control: from babies to elderly. World J Urol 2013; 31(5): 1081-5
  4. Franco I. Pediatric overactive bladder syndrome pathophysiology and management. Paediatr Drugs 2007; 9: 379
  5. Burgers R, Liem O, Canon S, et al: Effect of rectal distention on lower urinary tract function in children. J Urol 2010; 184:1680

 

why-its-time-for-a-womens-bladder-health-revolution

A Little Leakage Goes a Long Way

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By Natalia Gurevich, SWHR Communications Intern

There have been many times when we have hated our bladders. For making us get up to use the bathroom in the middle of the night, or making us stop every hour on the otherwise fun family road trip. However, many of us take our bladder health for granted. Our bladders work hard, and sometimes they aren’t quite as effective as we would hope.  The majority of women, pregnant or not, have at some point in their lives dealt with incontinence, the unintentional loss of urine [1]. Urinary incontinence occurs more often in women than in men because of a variety of contributing factors: pregnancy, vaginal delivery, and menopause. Weak bladder muscles, overactive bladder muscles, and nerve damage may also cause urinary incontinence in women [1]. Incontinence is typically a minor and rare nuisance easily solved. But for some women, incontinence can be a chronic issue that significantly impacts their quality of life, depending on the type of incontinence and the cause.

There are several types of urinary incontinence in women, including stress urinary incontinence where urine leaks after pressure is put on the bladder (ex. coughing, sneezing laughing), urge incontinence where there is an urgent feeling of needing to urinate, overflow incontinence where the bladder is never empty, and mixed incontinence which is having two or more types of incontinence [5]. The most common type of mixed incontinence is stress and urge incontinence together [2, 5].

Female athletes, both amateur and professional often suffer from stress urinary incontinence (SUI), with a few exceptions [2]. Over 41 percent of young female athletes reported at least one episode of stress urinary incontinence during high impact activities [2]. Because female athletes spend time gaining muscle one would think the pelvic muscles would get stronger as a result, but actually the overuse of the pelvic muscles causes them to become weak and fatigue more easily [9].  In addition, approximately 25 percent of women under age 40 experience SUI during physical activity [2].

In 2002, a study published in the International Urogynecology Journal took a sample of 291 elite athletes and dancers, who were on average 23 years old [3]. The study showed a high prevalence of leakage within gymnastics, at 56 percent of participants suffering from incontinence, closely followed by ballet at 43 percent, and aerobics at 40 percent. Other sports like badminton, volleyball, handball, and basketball also had a high occurrence of women with incontinence [3].

Incontinence and other related urinary conditions are often viewed as harmless, but the results can be embarrassing and a constant source of worry and discomfort for the women affected, even leading to social isolation, marital distress, depression. Urinary incontinence is stigmatizing for many women. Almost 90 percent of women with a urinary incontinence don’t discuss it with their healthcare providers [2] and therefore do not get the proper support and treatment they need. And yet, the condition is so common among women, with seven to 37 percent of women between the ages of 20-39 reporting some degree of incontinence [6].

There are numerous treatments available for each type of urinary incontinence including medication, devices, surgery, discipline therapy, or Kegel exercises or pelvic floor exercises, which for the majority of women can be effective.

If you are a woman, and especially if you are an athlete, contact your healthcare provider if you have questions or concerns about your urological health. SWHR’s Interdisciplinary Network on Urologic Health in Women helps to raise awareness of the impact of bladder health on women’s well-being across the lifespan [2]. The network aims to identify and close the gaps in knowledge, research, policy and education and disseminate information and provide support to the general public [2]. Learn more about incontinence from SWHR’s new Urology Network Report here.

References:

  1. http://www.medicinenet.com/urinary_incontinence_in_women/article.htm
  2. Liliana Losada et al., “Expert Panel Recommendations on Lower Urinary Tract Health of Women across their Lifespan.” Journal of Women’s Health. Epub ahead of print (2016).
  3. Thyssen et al., “Urinary incontinence in elite female athletes and dancers.” International Urogynecology Journal. 2002;13(1):15-7.
  4. Simeone et al., “Occurrence rates and predictors of lower urinary tract symptoms and incontinence in female athletes.”Urologia. 2010;77(2):139-46.
  5. https://www.womenshealth.gov/publications/our-publications/fact-sheet/urinary-incontinence.html
  6. “Urinary Incontinence in Women.” National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 2 Sept. 2010. <http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/>
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327384/
  8. http://www.webmd.com/urinary-incontinence-oab/types-of-urinary-incontinence
  9. Jacome et al. “Prevalence and impact of urinary incontinence among female athletes.” International Journal of Gynecology & Obstetrics. 2011;114(1):60–63.
USA, New Jersey, Jersey City, Female army soldier saluting, American flag in background

Baby On Board With Military Maternity Leave Policy

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By Natalia Gurevich, SWHR Communications Intern

Veteran’s Day is a revered holiday that induces images of crisp uniforms, waving flags, and national pride. This Veteran’s Day, in addition to thanking all veterans for their service, SWHR has examined a national issue that has made some progress, but one we cannot be completely proud of  yet—maternity leave policy and subsequent health concerns for the average woman and for those serving in the armed forces.

Currently, all branches of the U.S. military provide a standard 12-week paid maternity leave. In January of this year, the Navy and Marine Corps slashed their maternity leave policies down from a generous 18 weeks to just 12 weeks [1]. This change was made in order to double the Army and Air Force’s previous six-week policies [2].

The current paid maternity leave policy for the military is generous compared to maternity leave policies offered by the majority of U.S. employers – most of whom do not offer paid maternity leave. However, compared to the rest of the developed world, the U.S. is sorely lacking in maternity benefits and care with private, federal, and public employers.

Only four states in the U.S. have instituted paid maternity leave laws: California, New Jersey, Massachusetts, and Rhode Island. California offers new mothers up to six weeks, at 55 percent of their salary. New Jersey offers six weeks and two-thirds of salary, while Rhode Island pays four weeks at 60 percent of salary [4]. In the United States, there is no federal mandate for maternity leave. However, the Family and Medical Leave Act (FMLA), which became law in 1993,  allows “qualified employees to take 12 weeks of unpaid, job-protected leave for specific family and medical reasons” [4]. Family planning, including having a baby, falls under this law, along with adoption and foster care of a child, caring for an immediate family member (spouse, child, or parent) suffering a serious health condition, or personal medical leave [8].

According to the Bureau of Labor Statistics, only 12 percent of Americans have access to paid parental leave and only five percent of low-wage earners receive paid maternity leave [4]. In contrast, women in the military have better care than the average woman in the workforce. Although women in the military only receive 12 weeks, the time is paid in full. U.S. Secretary of Defense Ashton Carter has also made supplemental changes for new mothers, including the installation of “mother’s rooms,” at military bases with more than 50 women, where women can go to breastfeed in privacy. In addition to family planning, Carter proposed to extend childcare facility hours to 14 hours a day on military bases, and is offering female and male soldiers the opportunity to freeze their eggs or sperm in case of an accident in combat.

While the U.S. military has a generous maternity leave policy compared to the rest of the country, the U.S. is one of only three countries in the world that doesn’t offer some standard form of paid maternity leave, along with Suriname and Papua New Guinea [5]. However, 12 weeks is the bare minimum, with several countries allowing 52 weeks or more of paid maternity leave [5]. Sweden and Norway offer a year of paid leave for the mother and the father, and research has shown that families are more productive in the workforce if they are given this length of time [6]. Mothers are also less likely to suffer from post-partum depression and anxiety if they are provided paid family leave [9]., Studies also show that paid family leave decreases chances of infant mortality, increases breastfeeding length and rates, and improves child development overall [9].

According to a 2011 study by California’s Center for Economic and Policy Research, after the state of California implemented paid leave, 91 percent of businesses said it had a positive effect on profitability or no effect at all [7]. Essentially, there were no disadvantages, and implementing paid leave encouraged those starting families to stay in the workforce. Many women who take paid leave wind up returning to work later, as opposed to leaving to become a stay-at-home mother[4].

The U.S. military provides a much needed maternity leave policy for our female armed service members. Women who serve now have a much needed sense of security for their family planning. However, the same courtesy should be extended to all women who work in the U.S., contributing to our economy and ultimately improving the standard of living. As a country, our maternity leave policies are severely lacking when compared to the rest of the world. The U.S. military’s maternity leave policy is a positive example of what other employers should follow.

SWHR believes women should have the comfort and support they need when and if they choose to start a family. This Veteran’s Day we commend the women who have served or are serving in our armed forces. We hope that all women in the workforce can one day benefit from a similar maternity leave policy as our female soldiers.

For more information about our work in women’s health, visit www.swhr.org.

References

  1. http://www.military.com/daily-news/2016/01/28/maternity-leave-slashed-for-sailors-marines.html
  2. http://www.govexec.com/pay-benefits/2016/01/female-service-members-will-get-12-weeks-paid-maternity-leave/125543/
  3. https://www.army.mil/article/163550/army_directive_2016_09_maternity_leave_policy
  4. http://www.techrepublic.com/article/10-things-you-need-to-know-about-maternity-leave-in-the-us/
  5. https://www.payscale.com/career-news/2013/05/these-9-countries-have-the-worlds-best-maternity-leave-policies-infographic-
  6. http://www.npr.org/2011/08/09/137062676/time-with-a-newborn-maternity-leave-policies-around-the-world
  7. http://cepr.net/documents/publications/paid-family-leave-1-2011.pdf
  8. https://www.dol.gov/general/topic/benefits-leave/fmla
  9. http://paidfamilyleave.org/pdf/NebwornFamilyLeave.pdf
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Zika: Do We Still Have To Worry? Yes.

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By Clarissa K. Wittenberg

A moment for reflection

The first shock of the Zika virus epidemic has passed, but the danger continues. On September 28, the U.S. Congress voted to pass a $1.1 billion package to respond to the Zika crisis after President Obama had asked for $1.9 billion back in February [1].

This delay occurred despite information from Brazil about Zika’s danger to pregnant women.  The births of babies with microcephaly and other birth defects should have galvanized legislators into action.  Even in July, when the Centers for Disease Control and Prevention (CDC) said that the virus was “silently and rapidly” spreading in Puerto Rico, funds were not forthcoming [2].  The delay caused public health experts to re-program funds to meet urgent needs and then when funding came, to play catch up – a strategy that tends to costs more than if funds had been available in the first place.  While the Southern U.S. has been hardest hit, many states have the people infected with Zika virus.

The paradox of a mild disease with potentially fatal consequences

Because the Zika virus is mild and many people never feel ill, they fail to take precautions. Four out of five infected people experience no symptoms [2]. Even for those who do feel ill, the symptoms are mild and include fever, rash, joint pain, and conjunctivitis (red eyes) and may go unnoticed. Condoms are recommended for all sexual acts if a sexual partner has traveled to an area where Zika is present, as either partner can infect the other. The virus has been found in the semen of infected men for as long as six or seven months [1].

In addition to semen, Zika can also be transmitted by blood, saliva or urine. The Food and Drug Administration (FDA) issued localized advisories to screen for Zika virus in the blood supply back in February, and issued a stronger advisory for universal testing of blood supplies in August [3].

Case counts

According to the CDC’s Zika map, as of October 26, 2016, there were 4,091cases with laboratory evidence of Zika virus infection in the United States, as well as 28,723 in U.S. territories.  In the U.S., there were 953 pregnant women with Zika and 2,027 pregnant women with Zika in U.S. territories.

Cases are divided into locally infected and infected through travel or intimate contact with travelers to areas with Zika outbreaks.  New York City, for instance, has a large Puerto Rican population and inexpensive airfares to the Island and so has many travel-related cases.  As of October 26, 2016, New York City had over 886 people with Zika virus, and a baby with microcephaly was born in New York in July 2016.

Evidence accumulating on a link between Zika and birth defects

At the early on-set of the breakout, it was assumed that Zika virus was linked to birth defects. However, evidence from Brazil and other countries now shows that if a pregnant woman becomes ill with Zika, it may cause severe birth defects in the fetus such as microcephaly, a devastating stunting of brain and skull [4]. Zika has also been linked to eye defects or hearing loss in a developing fetus, and impaired growth in infants [1]. There are disturbing reports that even babies seemingly normal at birth may develop problems as they grow. But the risk for neurological birth defects seems to be linked to a woman’s individual history of other infections.

For years, Zika seemed a rather mild virus without fetal damage.  Even now, when the birth defects are so alarming, The Washington Post  reported that while birth defects are linked to Zika, the fetal deformities predicted by models are fewer than expected except in northeast Brazil. It is suggested that dengue has not been seen in this area since 2003 and maybe women are lacking immunity to that virus, which is a similar virus spread by the same type of mosquito. The article also mentions “anecdotal evidence that more women have been quietly terminating pregnancies over worries that their babies might be deformed.” Research reports in September 2016 indicated that a previous or a co-infection with herpes simplex virus-2 (HSV-2) might enhance the breaching of the placental barrier that allows such birth defects.

There is much research still needed to be done on Zika infection.  Zika is similar to dengue fever, yellow fever and West Nile fever. For example, if an individual has previously had one of these illnesses, does it make the Zika virus more dangerous or provide some immunity?

The importance of continuing antiviral research

At the start of the Zika crisis, the National Institute of Allergy and Infectious Diseases (NIAID) used the antiviral drug screening program already in place for other viruses such as dengue, West Nile, yellow fever, and Japanese encephalitis, to create an urgently needed test that might be valuable for potential antiviral activity against the Zika virus [6]. More than 60 antiviral compounds were examined and 15 had moderate to high activity and are undergoing more study. The already advanced dengue virus research is helping to speed research on Zika.

A new approach to anti-viral drugs may be needed

NIAID points out the various recent viral pandemics and suggests that development of broad-spectrum antiviral drugs might be needed rather than infection-specific drugs or vaccines.  The challenge of research on these drugs is heightened by the fact that every step must be carefully tested to ensure pregnant women aren’t given anything that can cause birth defects.  Concern about safety is not limited to infectious diseases, but is an issue in other conditions such as heart disease and cancer in women as well.  It is to be hoped that the urgency presented by Zika virus will help across the board to shape safer clinical trials and drug development for pregnant women.

A search for answers

In June 2016, NIAID, Eunice Kennedy Shriver National Institute of Child Health and Human  Development, National Institute of Environmental Health Sciences and the Brazilian Fundacao Oswaldo Cruz-Fiocruz launched the multi-country Zika in Infants and Pregnancy (ZIP) Trial.  A prospective observational trial that plans to enroll as many as 10,000 pregnant women at up to 15 sites and follow them throughout their pregnancies to determine if they become infected with Zika virus, and to learn the outcomes for mother and child [5].

Public health falls to the States: Is more Federal help needed in emergencies?

Zika testing and medical care is a state responsibility.  The CDC does provide information, special teams and emergency grants but not a comprehensive national program. And although the CDC was prepared, until funds were allocated, emergency team activities could not begin until a request from the state is received. Public health laboratories have had a surge in demands for the complex high intensity Zika tests so desperately needed by women causing long waits for results. Controversy at the CDC about the efficacy of specific Zika tests also caused delays. Funds for these tests must compete with spraying for mosquitoes, case finding, and help for women without health insurance and maternal and child health programs in Puerto Rico and other territories. The crisis is intensified, as often the most cases are seen in the poorest women in the poorest states.

Environmental issues are health issues.

Aedes aegypti mosquitos also can transmit yellow fever, dengue, and chikungunya viruses.
Today, crowded cities, areas with poor conditions, and international travel contribute to potential pandemics. Aedes aegypti is a difficult mosquito to eradicate, as it can remain dormant during dry spells and then hatch during a rainfall.  Delays in spraying were also caused by debates over safety and efficacy of mosquito eradication compounds this year in both Puerto Rico and Florida. Various strategies for genetic modification of mosquitoes are being tested.  For the best information on safe and effective mosquito control, consult the U.S. Environmental Agency at www.epa.gov.

Will warmer temperature bring more mosquitoes?

Temperatures have been rising in the contiguous states since 1901.  (Environmental Protection Agency, “Climate Change Indicators: U.S. and Global Temperatures”, Data source, NOAA, 2016.)  Mosquitoes thrive in hot areas, so a very sophisticated approach involving many specialists is needed to predict patterns of infections and disease. Trade and travel are now global.  Surveillance of disease patterns must meet this challenge and each nation will need to monitor signs of impeding pandemics. The World Health Organization now counts 67 nations with Zika virus infections. Our public health depends upon better health across the globe.

 

References

  1. http://www.npr.org/sections/health-shots/2016/09/28/495806979/congress-ends-spat-over-zika-funding-approves-1-1-billion
  2. https://www.cdc.gov/zika/
  3. http://www.fda.gov/%20EmergencyPreparedness/Counterterrorism/MedicalCountermeasures/MCMIssues/ucm485199.htm
  4. http://www.nytimes.com/interactive/2016/health/what-is-zika-virus.html?_r=0
  5. https://www.nih.gov/news-events/news-releases/nih-launches-large-study-pregnant-women-areas-affected-zika-virus
  6. https://oversight.house.gov/wp-content/uploads/2016/02/2016-02-24-NIH-Dr.-Fauci-Testimony.pdf

Resources

About the Author

Clarissa K. Wittenberg served as a senior communications officer at several NIH Institutes, and the Office of Global Health of the Secretary for Health and Human Services. She was a consultant to the Department of Psychiatry and Human Behavior, the University of Mississippi Medical Center on mental and overall health of underserved populations.  She was a member of a select volunteer health issues committee for the first Obama campaign.

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Lung Cancer – What’s My Risk? What Are My Treatment Options?

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By The Society for Women’s Health Research and The American Lung Association

Lung cancer is a life-changing diagnosis that effects one in every 17 women .1 However, early detection methods and new treatment options are delivering the promise of improved survival rates and even the possibility of a future cure. But are you at risk? Should you be screened? And what are the treatment options if you’re diagnosed? These are questions every woman should consider.

Risk Factors Most women may not think they are at risk of lung cancer, but the truth is that for women, the lifetime risk of dying from lung cancer is 82 percent greater than the risk of dying from the next most likely cancer, breast cancer.1

It’s widely known that smoking is the leading cause of lung cancer. However, smoking is not the only cause – anyone can get lung cancer. About two-thirds of lung cancer diagnoses are in never-smokers and former smokers.2 Other known causes include exposure to secondhand smoke, air pollution, radon, and asbestos. Genetic factors also may play a role in one’s chances of developing lung cancer.

Screening

Early detection and treatment of lung cancer translates to higher survival rates. Unfortunately, most lung cancer cases are not diagnosed until later stages when treatment options are limited. Screening those at high-risk by low-dose computed tomography (CT), an imaging test that creates detailed scans of areas inside the body, can find cases earlier and so reduce mortality. Currently, CT screening is only recommended for those who meet all three of these criteria and are at high risk for lung cancer:

· current or former smokers who quit less than 15 years ago,

· with a smoking history of 30 pack years or more (2 packs a day for 15 years, 1 pack a day for 30 years, et cetera), and

· ages 55 to 80 years.3

Treatment Options If you are diagnosed with lung cancer, there are several treatment options available. Many promising new treatments have recently been approved, and more are on the horizon. You should talk to your healthcare provider about all of the treatment options available to you.

You may receive several different types of treatment for lung cancer. Each treatment option has potential side effects, which usually can be managed. Once your healthcare provider has determined your lung cancer profile, they will present you with one or a combination of the following options:

· Surgery – Surgery is not an option for all lung cancer patients. Surgery involves removing part or all of the lung.

· Radiation Therapy – Lung cancer radiation therapy uses powerful, high-energy X-rays to kill cancer cells or stop them from growing.

· Chemotherapy – Chemotherapy for lung cancer is used at different points in treatment to achieve different goals such as shrinking the tumor, killing any leftover cancer cells, or relieving lung cancer symptoms.

· Targeted TherapyTumor testing shows if a lung cancer tumor has a certain change or mutation that is making it act abnormally. Targeted therapies “target” these mutations in different ways.

· Immunotherapy – Immunotherapy uses medicine to activate a patient’s own immune system to recognize and kill cancer cells. So far, immunotherapy only has been approved to treat some forms of non-small cell lung cancer (NSCLC). However, research is advancing every day.

· Clinical trials – Clinical trials are regulated research studies that try to find better ways to prevent, screen for, diagnose, or treat a disease. Consider clinical trials as soon as you are diagnosed and every time you have to make a treatment decision.

· Palliative or Supportive Care – This medical specialty is focused on relieving pain, stress, and other symptoms to improve your quality of life. Palliative care can be a part of your treatment plan at any stage of your lung cancer journey.

The lung cancer treatment options that are available to you are determined by your lung cancer type, stage, and treatment goals. It’s important to take an active role and work with your care team to make decisions about your lung cancer treatment together.

Resources

To learn more, visit the lung cancer section of the American Lung Association’s website to access the Lung Cancer Toolkit, interactive videos, resource library, and comprehensive information about the lung cancer experience. The American Lung Association’s LUNG FORCE is an initiative to unite women against lung cancer and for lung health. LUNG FORCE works to increase awareness and understanding about the disease, provide patient advocacy and support, and fight for increased funding for lung cancer research.

Battling lung cancer is a critical priority for the Society for Women’s Health Research and our ongoing mission to advance the cause of women’s health. We urge women to take the risk of lung cancer seriously. Lung cancer is the number-one cancer killer of women in America. Learn more and take action!

References:

1. U.S. National Institute Of Health. National Cancer Institute. SEER Cancer Statistics Review, 1975–2013.

2. Centers For Disease Control And Prevention. Cigarette Smoking Among Adults — United States, 2006. Morbidity and Mortality Weekly Report. 2007; 56(44):1157-61.

3. U.S. Preventive Services Task Force. Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement. AHRQ Publication No. 13-05196-EF-3. http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm.

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