Women’s Health

Stephanie Watson

Radiation for breast cancer can increase heart risks

Radiation, on its own or coupled with other treatments, has helped many women survive breast cancer. Yet radiation therapy can cause the appearance of heart disease years later. New research published in JAMA Internal Medicine estimates that the increased lifetime risk for a heart attack or other major heart event in women who’ve had breast cancer radiation is between 0.5% and 3.5%. The risk is highest among women who get radiation to the left breast—understandable, since that’s where the heart is located. The heart effects of radiation begin emerging as soon as five years after treatment. However, future heart risk should not be the reason to abandon this important component of treatment. Cancer experts are doing more and more to minimize the amount of radiation the heart receives.

Stephanie Watson

Women often fear sex after a heart attack

A heart attack can be a frightening wake-up call with long-lasting aftereffects. It’s no surprise that women often tread gently after having a heart attack—and many don’t tread back into the bedroom for sex. Up to 60% of women are less sexually active after a heart attack, often due to worries that sex could trigger a repeat heart attack. A new study suggests that although women believe sex is important for resuming a sense of normalcy and intimacy with their partners, many are fearful that it would be too much for their hearts to take. Reassurance from a doctor is sometimes all that’s needed to ease those fears. How does a woman know if she’s physically ready for sex after a heart attack? It’s safe to have sex if you can work up a light sweat without triggering symptoms like chest pain or shortness of breath.

Howard LeWine, M.D.

For early breast cancer, lumpectomy is at least as good as mastectomy

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

When it comes to fighting cancer, “get it out” is a common and understandable response. It’s what prompts some women with early-stage breast cancer to choose mastectomy, an operation to remove the entire affected breast. Results from the largest-ever observational study offers reassurance to women who choose a more conservative approach—removal of just the tumor and some tissue around it (lumpectomy) followed by radiation therapy. In fact, the study showed that, as a group, women who chose lumpectomy plus radiation had lower death rates from breast cancer and all causes than women who chose mastectomy. The women who appeared to reap the biggest survival benefit from lumpectomy plus radiation therapy were those over age 50 with estrogen-positive breast cancer, with 13% lower mortality from breast cancer and 19% lower for all causes. The results were reported online today in the journal Cancer. For early-stage breast cancer, mastectomy has been proven to cure or at least retard the disease. It’s a reasonable and understandable choice, especially given how well breast surgeons today can reconstruct a breast. For women who choose to have lumpectomy plus radiation therapy, the new study provides yet more scientific reassurance that this approach is at least as good as mastectomy.

Stephanie Watson

Fear of breast cancer recurrence prompting women to choose prophylactic mastectomy

Living through the physical and emotional toll of breast cancer is so traumatic that some women can’t bear the thought of doing it again. That’s why a growing number of women who have already been diagnosed with cancer in one breast are taking the drastic measure of having both breasts removed (a procedure called prophylactic mastectomy). Yet a University of Michigan study presented last week at the American Society of Clinical Oncology’s Quality Care Symposium showed that nearly three-quarters of women who had this procedure were actually at very low risk of developing cancer in the healthy breast. In other words, many women are unnecessarily exposing themselves to the potential risks of a double mastectomy—including pain, infection, and scarring. The new study suggests that more and better information about breast cancer recurrence—and the risks and benefits of prophylactic mastectomy—are needed as women consider this procedure.

Stephanie Watson

Researchers explore blood test to detect early breast cancer

Researchers at Kansas State University have developed a blood test that rapidly detects breast cancer (as well as non-small cell lung cancer) in very early stages, long before symptoms appear or the cancer can be seen by other methods. The experimental test identifies enzyme patterns that differ from one type of cancer to another. According to the researchers, the test can detect very early breast cancers (stages 0 and 1), as well as early lung cancers (stages 1 and 2), within an hour, with 95% accuracy. However, they tested only 32 participants with various stages of breast or lung cancer, as well as 12 people without cancer. Whether finding cancer that early makes a difference for treatment and survival remains to be seen.

Howard LeWine, M.D.

Study backs mammograms for women 50 to 69

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

For years researchers have been trying to weigh the benefits of finding early breast cancers against the risks related to false positives (the spots that turn out to be harmless). This work has sparked some bitter public debates and confusion for women over flip-flopping recommendations. The latest salvo comes from a review of the results of mammograms among more than 12 million women in 18 European countries. The results support the idea that routine mammograms can prevent deaths from breast cancer without causing undue harm. The findings support the U.S. Preventive Services Task Force’s recommendation that women between the ages of 50 and 74 have a mammogram every other year. Women at higher risk of developing breast cancer may need mammograms earlier than age 50, or more often than every other year.

Harvey B. Simon, M.D.

Biking and sex—avoid the vicious cycle

Harvey B. Simon, M.D., Editor, Harvard Health

Bicycling is a terrific way to get from one place to another. It’s also an excellent form of exercise. Some men and women avoid bicycling, though, because they worry that it may damage their reproductive organs and harm their sexual function. This mainly happens to people who cycle a lot. And it isn’t inevitable. One problem is the design of many bicycle seats, which put pressure on the perineum, a region of the body that runs from the anus to the sex organs. It contains the nerves and arteries that supply the penis in men and the clitoris and labia in women. You don’t have to give up biking to preserve your sexual function. Take a few simple precautions, like picking a wider seat, and shifting your position and taking breaks during long rides. These precautions will ensure that your passion for exercise doesn’t interfere with your passion in the bedroom.

Howard LeWine, M.D.

Rosie O’Donnell’s heart attack a lesson for women

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

You’ve probably heard the saying, “It takes a village to raise a child.” After reading about Rosie O’Donnell’s heart attack, I’d like to coin a new one: “It takes a celebrity to sound the alarm about important health issues.” The 50-year-old actress, comedienne, and talk show host suffered a surprise (aren’t they all) heart attack last week. Word got out when she wrote about it on her blog. O’Donnell brushed off some chest pain and arm pain as muscle aches related to some heavy lifting, ditto later feelings of nausea and clammy skin. When she went to the hospital the next day, a key artery in her heart was 99% blocked. At age 50, O’Donnell may have thought she was too young for those problems to signal a heart attack. She also wasn’t familiar with a heart attack’s sometimes sneaky signs and symptoms. O’Donnell urges “know the symptoms ladies/listen to the voice inside/the one we all so easily ignore/CALL 911/save urself.”

Stephanie Watson

Staying fit linked to lower breast cancer risk

Daily exercise appears to reduce a woman’s risk of developing breast cancer, according to a study published online in the journal Cancer. The type or intensity of the exercise didn’t seem to matter, as long as it was done often. How much exercise is needed to lower breast cancer risk? In this study of 3,000 women, 10 to 19 hours a week (about two hours a day) had the greatest benefit. Age didn’t seem to matter—physical activity reduced breast cancer risk in younger women during their reproductive years and older women after menopause. What did make a difference in the effect of exercise was weight gain—especially after menopause. Gaining a significant amount of weight essentially wiped out the benefits of exercise on breast cancer risk in older women.

Howard LeWine, M.D.

Studies question ban on alcohol during pregnancy

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

Drinking alcohol during pregnancy has been taboo for some time, largely because drinking too much can cause fetal alcohol syndrome (FAS). Because no one has been able to identify a clear threshold for “safe” drinking during pregnancy, doctors tell women to steer away from alcohol entirely. A series of five studies from Denmark published in BJOG An International Journal of Obstetrics and Gynaecology found that “low” (1-4 drinks per week) to “moderate” (5-8 drinks per week) alcohol consumption in early pregnancy did not harm the neuropsychological development of children evaluated at age five. Drinking more appears to be a different story. In one of the studies, five-year-olds whose mothers consumed higher levels of alcohol (9 or more drinks per week) during pregnancy were significantly more likely to have lower attention spans. The authors of the study do not argue that drinking alcohol during pregnancy is wise or to be encouraged. In fact, most doctors will continue to advise pregnant women not to drink alcohol. is there a middle ground? Perhaps. Deciding to have a sip (or glass) of champagne at a special occasion during pregnancy may not be an unreasonable or unsafe choice–one that each woman has to make for herself, ideally after talking with her obstetrician or midwife about this issue.