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Leveling the Playing Field

Understanding the unique healthcare needs of women at every stage of life

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When it comes to health, women and men are not equal. Multiple variables, including biological, societal, and economic factors, impact the lifetime health of women. From a biological perspective, there are many conditions and diseases with greater prevalence in women versus men or that affect women differently than men. Even with this disparity in disease prevalence, women tend to live longer than men, but they often experience fewer healthy years of life. 

Understanding the unique healthcare needs of women -- at every stage of life -- provides the foundation upon which clinical professionals can make informed decisions that advance the health and vitality of their female patients. In this regard, laboratory diagnostics plays a critical role by delivering the information clinicians need to better diagnose, treat, and monitor conditions and diseases that have a significant impact on women's health. This article looks at three such areas: cardiovascular disease, thyroid cancer, and reproductive endocrinology.

Women and Cardiovascular Disease (CVD)
The World Health Organization (WHO) attributes one-third of all deaths in women to CVD  (which is also the leading cause of death in American women).1,2 Unfortunately, many women are unaware of their risk for heart disease and often think of CVD as a "man's disease."3 This is particularly troubling given that mortality rates and complications, such as stroke,  are greater for women than men.

Risk factors for CVD also differ in women. For example, while dyslipidemia is a common risk factor for CVD in both sexes, low blood levels of HDL cholesterol appear to be an even stronger predictor of heart-disease death in women aged 65 and older. Additionally, elevated triglycerides in women are a strong predictor of heart disease and metabolic syndrome.4  

Fortunately, cardiovascular disease is largely preventable, and simple blood tests can help assess a person's risk. Blood tests commonly used in risk assessment of cardiovascular disease include:

  • Total cholesterol
  • HDL cholesterol
  • LDL cholesterol
  • Apolipoprotein A1
  • Apolipoprotein B
  • BNP/NT-proBNP
  • Lipoprotein (a)
  • hsCRP
  • Fibrinogen
  • Myeloperoxidase

When a woman is experiencing a heart attack, she is more likely than a man to have atypical symptoms, such as dizziness, fainting, pain in the lower chest or upper abdomen, and extreme fatigue.5,6 This can make diagnosis challenging. Fortunately, sensitive troponin assays help improve the diagnostic accuracy and rapid detection of myocardial infarction (MI). Cardiac troponins are regulatory proteins within the muscular layer of the heart wall. They are released into circulation when damage to cardiac-muscle cells has occurred. Serum troponin is a very sensitive marker of myocardial injury and is necessary for establishing a diagnosis of MI.7 By facilitating earlier detection of myocardial injury, sensitive troponin assays enable clinicians to quickly diagnose patients and initiate appropriate therapy.  

Women and Thyroid Cancer
Thyroid cancer is one of the most common forms of endocrine malignancy worldwide, affecting three times more women than men.8,9 In fact, thyroid cancer is the seventh most common cancer in women globally.10 

Women typically develop thyroid cancer earlier in life than men, and while men usually have more-aggressive disease, the mortality rate for women is still significant at 21.6%.11 Unfortunately, incidence rates of thyroid cancer have increased over the past four decades, particularly in the U.S., Canada, and Europe.12 

Reducing the burden of thyroid cancer in women includes understanding risk factors, making rapid, accurate diagnoses when symptoms occur, implementing appropriate therapies, and monitoring treatment. There are many immunoassays involved in the diagnostic measurement of thyroid cancer. One example is the calcitonin test, which is used to help establish disease diagnosis. Since calcitonin levels relate to tumor size, the calcitonin test is also used to help establish prognosis. During routine monitoring, rising or elevated calcitonin levels may be associated with disease recurrence or incomplete treatment and should trigger further investigation. In addition to immunoassay testing, physicians also employ other markers -- as well as various imaging modalities -- in detection and monitoring of thyroid cancer.

Women and Reproductive Endocrinology
The reproductive years bring changes to both men and women. However, as women transition from childhood into puberty and eventually to menopause, the normal modulation of sex hormones can contribute to a number of unique conditions.

For example, early in life, precocious puberty -- or the appearance of signs of pubertal development at an abnormally young age -- has been demonstrated to occur 5 to 10 times more frequently in girls than boys.13,14  Along with potential psychological difficulties and behavioral and emotional problems that can accompany a perceived difference from one's peers, precocious puberty can also lead to reduced adult height. Laboratory tests that can help detect precocious puberty include estradiol, DHEA-SO4 and thyroid tests. Also, clinicians may use diagnostic imaging techniques, such as X-rays of the hands and wrists, in suspected cases of early female puberty.15 

Later in life, changes in sex-hormone levels lead to menopause in women and andropause in men. For both men and women, these changes impact health, but appear to have a greater effect on women. Decreasing estrogen levels put women at greater risk for osteoporosis and cardiovascular disease. Also, after menopause, women are more likely to suffer from a number of conditions, including poor bladder function, an increased risk of Alzheimer's disease, increased wrinkling due to loss of skin elasticity, poor muscle power and tone, and vision problems such as cataracts and macular degeneration.16 

To help women understand and best manage symptoms and struggles related to menopause, laboratory tests measuring sex hormones and some of the thyroid hormones are important. These tests help healthcare professionals guide female patients through the dramatic changes at this stage of their reproductive lifecycle.

Making Women's Health a Priority
These are just a few examples of diseases and conditions that have a greater impact on women or are more prevalent in the female population. Making women's health a priority within our families, our healthcare systems, and our world requires education, commitment, and action. In this regard, Siemens Healthcare Diagnostics has launched a new initiative to raise awareness of the important role of laboratory diagnostics in women's healthcare and enable clinicians to provide better care for their female patients throughout the continuum of life.

Sherry Jennings is senior global marketing manager, Siemens Healthcare Diagnostics. To learn more about the range of diseases and conditions affecting women's health, including educational resources, downloads, related links, and information about Siemens' diagnostic solutions, visit www.siemens.com/her-health.

References

  1. www.who.int/gho/women_and_health/mortality/causes_death/en/index.html
  2. FACT SHEET: Cardiovascular Disease: Women's No. 1 Health Threat. AHA/HPFS/1/2012.
  3. http://circ.ahajournals.org/content/123/4/e18; accessed 11/14/12.
  4. http://circ.ahajournals.org/content/93/10/1928.full#sec-14
  5. http://womenshealth.gov/heartattack/symptoms.cfm?q=know-the-symptoms; accessed 11/27/12.
  6. www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp; accessed 11/27/12.
  7. Daubert M, Jeremias A. The utility of troponin measurement to detect myocardial infarction: review of the current findings. Vasc Health Risk Manag. 2010;6:691-99.
  8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788231/; accessed 3/19/13 (pdf).
  9. http://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-risk-factors
  10. Future Oncol. 2010 November;6(11):1771-1779.
  11. Breakaway: The global burden of cancer-challenges and opportunities. Economist Intelligence Unit Limited. 2009.
  12. Annals of Oncology 21 (Supplement 5): v214-v219, 2010.
  13. www.patient.co.uk/doctor/Precocious-Puberty.htm
  14. www.ncbi.nlm.nih.gov/pubmed/16322154
  15. http://emedicine.medscape.com/article/924002-workup#a0719; accessed 4/9/13.
  16. http://my.clevelandclinic.org/disorders/Menopause/hic_Menopause_The_Short-Term_Effects_and_Long-Term_Risks.aspx 



     

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