Breast Cancer Archive

Heart attacks strike men at younger ages than women. But survival rates are worse in women. Why?

Compared with men, women are less likely to recognize and act upon the symptoms of a heart attack.
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Imagine someone in the throes of a heart attack. If you picture a man clutching his chest in agony, that's understandable. At younger ages, men face a greater risk of heart disease than women. On average, a first heart attack—the most common manifestation of this prevalent disease—strikes men at age 65. For women, the average age of a first heart attack is 72.

For women having children over age 35, the decision to induce labor is usually based on an increased risk of stillbirth. The duration of labor also factors into the decision, as does the possibility that induction could increase the chance of a cesarean birth, though current medical evidence does not necessarily support this assertion.

Researchers have wondered for a long time whether there might be a link between excess thyroid hormone and an increased risk of breast cancer. High levels of thyroid hormone have been shown to mimic estrogen, which fuels many breast cancers. A new study has suggested that there may indeed be a link — but it’s important to put the results into context.

The CDC recently advised all sexually active women of childbearing age, and who aren’t on birth control, to avoid alcohol completely because of potential harmful effects to an unborn child. The science behind the recommendation is sound, but the way it was delivered has raised quite a few eyebrows. In this piece, Dr. Ricciotti examines where the message fell short and describes how she emphasizes shared decision-making and autonomy when she counsels her patients.

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A research letter published online Jan. 21, 2016, in JAMA Oncology suggests that many older adults are getting unnecessary cancer screenings. Researchers looked at questionnaire answers from about 150,000 seniors (ages 65 or older) across the country, and found that about half had received prostate-specific antigen (PSA) testing or mammography in the past year. But a third of those screened did not have a 10-year life expectancy, a major guideline for screening. Unnecessary screening rates varied by state—for example, 11% in Colorado and about 20% in Georgia. "Undergoing a screening test may actually cause more harm than good, especially with older patients or those with significant medical conditions," says Dr. Marc Garnick, an oncologist at Beth Israel Deaconess Medical Center and editor in chief of Harvard's Annual Report on Prostate Diseases. So talk to your doctor about the guidelines. Both the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) recommend routine mammograms every two years for women ages 55 to 74. The ACS does not recommend mammograms in this age group if a woman has a life expectancy of less than 10 years.

For all men, the USPSTF recommends against routine PSA testing. The ACS suggests that men 50 or older (at average risk for prostate cancer) make the decision about screening with their doctor, but only if they have a life expectancy of at least 10 years, and only if they have been advised about the uncertainties, risks, and potential benefits of prostate cancer screening.

Even the newer, targeted cancer therapies may harm the heart.

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About 14 million people in the United States are living with cancer, a number that reflects the steady rise in cancer survivorship in recent decades. In 1980, only about half of people with cancer lived five years after diagnosis. Today, five-year cancer survival rates are greater than 70%.

Unfortunately, many cancer-suppressing treatments can have undesirable effects on the heart and blood vessels. The increasing awareness of these effects—coupled with the surge of older people being diagnosed with and surviving cancer—has spurred a new specialty known as cardio-oncology. Experts in this burgeoning field focus on promoting heart health in people with cancer, both during and after their treatment.

Here is one more way men and women are different: research published online Oct. 20, 2015 in Radiology found that male and female hearts do not age the same way.

For the study, researchers reviewed MRI heart scans performed on almost 3,000 older adults, ages 54 to 94, without existing heart disease. (Scans were given 10 years apart.) The scans showed that in both sexes, the main heart chamber—the left ventricle, which fills with and then forces out blood—gets smaller with time. As a result, less blood enters the heart, and less gets pumped out to the rest of the body.

Ask the doctor

Q: I have always had difficulty sleeping. Since I have taken to heart the advice for good sleep habits, I think I'm sleeping better, but I'm not sure. I'm in bed about 8.5 hours, but am often restless and get up to go to the bathroom a couple of times during the night. Is there a way to compute how much sleep I'm actually getting?

A: Adequate sleep is an important part of health. While the exact amount needed to maximize health and wellness is not totally clear, many experts recommend around seven to nine hours per night. Adequate sleep is associated with memory, improved mood, better weight control, improved diabetes control, greater resistance to colds, and fewer accidents.

Personalizing breast cancer diagnosis and treatment has resulted in therapies that are more effective and less toxic than in the past.

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The federal government's "Cancer Moonshot," with the expressed goal of curing cancer, is getting a lot of press lately. While the initiative's stated goal may be overly ambitious because cancer is actually 200 or more individual diseases, it promises to increase research funding and speed the availability of new treatments.

Amid the excitement, it's easy to overlook the fact that there has already been great progress in treating many cancers. Patients are enduring fewer side effects and living longer. Breast cancer is a prime example. "There's no question that breast cancer treatment is improving," says Dr. Ann Partridge, senior physician at the Susan F. Smith Center for Women's Cancers at Harvard-affiliated Dana-Farber Cancer Institute.