By Ma. Susana P. Padilla Campos
MARCH IS Women’s Month. This is a month set out to acknowledge the multiplicity of roles women have assumed in today’s society, to recognize them for the flair with which they deliver effectively and efficiently on these roles, and to ponder on the needs of women that will ensure that they can continue to function with pizzazz.
Globally, there has been a meteoric rise in the number of women all over the world who occupy key leadership positions in all facets of society. These same women remain responsible for birthing and minding the children. A woman’s nature is to create a supportive and nurturing environment for her family…after a full workday’s schedule. They provide answers to everyone’s needs in the family and oftentimes neglect their own needs, be they emotional, mental or physical needs.
It is high time more focus is given to Women’s Health realizing the pivotal role they play in family and in society. The three major areas I would want to address are: Cancer, Cardiovascular Health, and Mental Health.
According to the 2015 Philippine Cancer Facts and Estimates of the Philippine Cancer Society, 13 out of 100 males and 14 out of 100 females in the Philippines would have had some form of cancer if they would have lived up to age 75. At least one-third of all cancers are preventable, and at least one-third of all cancers can be cured if detected early. In 2015, the top leading new cancer cases among women (Globocan 2012) which comprise 79% of all cases are: breast (33%), cervix uteri (12%), colon/rectum (7%), lung (6%), ovary (4%), liver (4%), thyroid (4%), uterus (4%), leukemia (3%), oral cavity (2%).
Breast cancer ranks 1st among women and the incidence starts rising by age 30. The incidence has been steadily rising with an annual percentage increase of 1.2%. Prolonged and sustained exposure of breast tissue to estrogen increases the risk of breast cancer. Something as natural and most beneficial to a newborn as breastfeeding interrupts continuous production of estrogen, and therefore lowers the risk for breast cancer. Major factors that increase risk for breast cancer are personal history of ovarian, peritoneal or breast cancer, family history of breast, ovarian or peritoneal cancer, and radiotherapy to the chest between age 10 and 30.
Breast cancer is relatively easier to detect; a breast mass is in fact often palpated by the woman herself. In developing countries, monthly self-breast examination and examination by health care provider during clinic visits are the mainstays of early detection. Mammography is the best studied breast imaging technique that has been shown to decrease mortality. Although most experts recommend that routine screening mammography by age 50, the American Cancer Society recommends that this start at age 45, continue annually until age 55, then decrease to every 2 years thereafter. Remember: early breast cancer is curable!
Cancer of the cervix is the 2nd leading site of cancer in women. Two out of 100 women will develop cervical cancer before age 75. Cervical cancer is preventable. Human papilloma virus (HPV) has been identified as a causative agent. The virus is transmitted through sexual intercourse. The more numerous the sexual partners, and the status of the male partner increases the risk of being exposed to the virus. Safe protected sex decreases the number of HIV/AIDS cases, sexually transmitted illnesses and cervical cancer. HPV vaccines are available for peri-adolescent vaccination. A Papanicolau smear (Pap smear) should be done every 5 years after an initial negative test starting at age 30. In less affluent areas direct visualization with acetic acid wash is a reasonable alternative. Surgery and radiotherapy are curative for early cervical cancer.
The incidence of colorectal cancer rises by age 50 and equally among males and females. Risk factors include: family history, polyps in colon or rectum, diet (high fat, low fiber), inactivity and alcohol consumption. Changes in bowel habits (diarrhea and constipation), abdominal discomfort, change in stool caliber, blood in the stool, weight loss, anemia are among the common warning signs. Again, early identification of colo-rectal cancer is curable by surgery and chemotherapy. Those at high risk are encouraged to have colonoscopy done by age 40 years.
CARDIOVASCULAR DISEASE (CVD)
CVD, although lower in incidence than in men, is the leading cause of death in women. CVD includes coronary heart disease (heart attack), cerebrovascular disease (stroke), atherosclerosis and peripheral artery disease. The risk factors for CVD include: personal or family history of CVD, age 55, hypertension, high LDL cholesterol and low HDL cholesterol, diabetes mellitus, overweight and obesity, smoking, post-menopausal state, psychological stress and sedentary lifestyle. Smoking even just 1-2 cigarettes per day has been associated with half of all coronary events in women. The risk of a heart attack is 3 times higher in women smokers, than non-smokers. A BMI > 32 kg/m2 was associated with a 4-fold increase of death from CVD compared to women with a BMI below 19 kg/m2. A target BMI of 25 kg/m2 and a waistline less than 35 inches is suggested by the American Heart Association. Alcohol intake above 2 drinks per day increases the incidence of hypertension. Women aged 20 and above should have periodic cardiovascular risk assessment every 3 years to be able to identify CVD risk factors and be guided on the management of these risk factors.
With all the stresses women are subjected to in the workplace, striving to compete and prove their worth in our (still) male-biased society, over and above their expected responsibilities as wife, mother, homemaker, daughter to aging parents and in-laws, it is no surprise that women are twice more likely to develop mental health conditions: Depression, Anxiety Disorder, Eating Disorder, Manic-Depressive Illness, Obsessive Compulsive Disorder, Post-traumatic Stress Syndrome, Alcohol and Substance Abuse. Onset of mental illness has been associated with the timing of hormonal changes. We observe perinatal depression, premenstrual dysphoric disorder, perimenopausal depression, but hormones do not explain everything. Societal stress, lack of emotional support, loss of spirituality and its replacement by commercialism and materialism, social media, are all contributors. The symptoms to watch out for are: persistent sadness and hopelessness, change in sleeping or eating patterns, weight loss or weight gain, decreased energy level or fatigue, excessive fear or worry, body aches with no identifiable cause, irritability, social withdrawal, suicidal thoughts, visual or auditory hallucinations, alcohol or substance abuse. When you notice any of these, give that woman your special attention and seek professional help. Although mental illness is still taboo in our country, there are prominent personalities that have come forward to speak on the importance of recognition and acceptance of mental health illness as a condition that is as common as CVD and cancer, and therefore needs medical attention. Most mental health professionals are careful about maintaining confidentiality between patient and physician, while our society is still evolving in their acceptance of mental illness. Lives will be saved, and quality of life will improve with this awareness of mental conditions.
Think about what life would be like without a mother, a sister, a daughter, a wife, a grandmother, a BFF — it would be dreary and empty. No one smiles at you, hugs you, holds your hand like a woman does. Encourage the women you love to attend to their health and to pursue preventive measures that will keep them healthy, happy and positively influential in this world we live in. Preventive measures as espoused by WHO and the DoH are focused on: 1) avoidance of cigarette smoking and exposure to second hand smoke 2) a healthy diet and avoidance of overweight ad obesity, 3) increased physical activity, 4) avoidance of excessive alcohol consumption, 5) immunization against cancer-associated viruses: Hepatitis B, Human Papilloma Virus, 6) stress management, 7) regular consultations with health care providers . Let’s JUST DO IT!
Cheers to Women!
Ma. Susana P. Padilla Campos is a Pediatric Endocrinologist, graduate of the UP College of Medicine who completed her residency and fellowship at the Children’s Hospital of Buffalo. She was the Editor in chief of the Philippine Journal of Pediatrics from 2008-2017. She has assumed several positions in hospital management and is currently the Medical Director of ManilaMed (Medical Center Manila). She is married to Dr. Enrique E. Campos, an Interventional Cardiologist, mother to 4 sons, and sibling to 5 sisters, and 1 brother.