Chapter 10

Cardiovascular Disease and Cancer

Cardiovascular Disease and Cancer

The greatest causes of death in the United States and the world

• Cardiovascular disease– Heart disease– Cerebrovascular disease (stroke)

• Cancer– Can affect any area– In women, most likely to affect breasts,

lung, reproductive system and skin

Epidemiology of Cardiovascular Disease

• 450,000 U.S. women die annually of CVD• If all major forms of CVD were eliminated,

life expectancy would increase by 7 years• Of the various forms of CVD

– Coronary heart disease is the leading killer, killing nearly 480,000 people

– Stroke kills over 150,000 people per year (about 1 of 5 CVD deaths)

– 60% of stroke deaths are women

Economic Dimensions

• Estimated cost annual cost for cardiovascular disease:

– Direct costs: health expenditures, hospital and nursing home services, medications, home health care

– Indirect costs: lost productivity (both to people with CVD and their caretakers)

Cardiovascular System

Coronary heart disease

• Occurs when the coronary arteries become blocked or narrowed with plaque

• Clots forming in an artery can also lead to blockages

• Can lead to a heart attack (death of part of the heart)

If Plaque Causes CHD, what Causes Plaque?

CHD begins with plaque buildup inside the lining of the coronary arteries.

Plaque begins with LCL cholesterol moving inside the arteries; white blood cells can also get stuck inside the lining and die.

Plaque can grow until it takes up 95% of the space in an artery.

Other Forms of Heart Disease

Congestive heart failure• Weak heart muscles that cannot perform the

pumping function with proper vigor• Often a disease of older women who have

suffered heart damage from other causes

Arrhythmias • Problems with the heartbeat (can be fast, slow, or

irregular

Other Forms of Heart Disease, Cont.Rheumatic heart disease• Results from bacterial infection with Streptococcus,

which can cause damage to heart valves. Can usually be cured with antibiotics.

Angina pectoris• Chest pain resulting from insufficient supply of blood

(oxygen) to heart muscle• Disease of the extremities (arms/legs) in which blood

supply is diminished, resulting in lack of nutrients and oxygen

Metabolic syndrome

• Group of disease that occur together and cause CVD. Risk factors include:– Elevated waist circumference– High blood lipid levels– Low HDL levels– High blood cholesterol– Elevated fasting blood glucose level

Metabolic syndrome is a greater risk for women than it is for men.

Cerebrovascular Disease, aka Stroke

• Blood vessels either within or leading to the brain becomes damaged, blocked, or burst.

• This leads to portions of the brain being unable to receive oxygen, and thus dying.

• Often survivors have a long, difficult recovery process—many things may have to be relearned.

Stroke, Cont.Types of stroke

• Ischemic stroke—the most common type, caused by a cerebral thrombus or embolism

• Hemorrhagic stroke—caused by ruptured blood vessels such as an aneurysm

• Possible warning sign: transient ischemic attacks (TIAs)—brief memory loss, garbled speech, or other symptoms

Recovery From a StrokeRecovery statistics• 50% to 70% of survivors regain functional

independence• 15% to 30% are permanently disabled• 20% require institutional care within three months after

onset• 25% of women with a stroke die within a year (risk of

death and future strokes increases with age)Rehabilitation• Depends on area affected—may require physicians,

nurses, physical therapy, speech therapy, mental health professionals, or others

Risk Factors for CVD

• High LDL (“bad”) cholesterol, low HDL (“good”) cholesterol

• Diabetes• Hypertension• Overweight and obesity• Cigarette smoking• Age (for women, after menopause)• Physical activity• Race/ethnicity• Physical inactivity

Risk Factors for CVD, Cont.

• Age

• Genetics

• Race

• Obesity

• Smoking

• Hypertension

• Elevated cholesterol

• Sedentary lifestyle

• Diabetes

• Menopause

Gender Differences of CVD

• Before menopause, women’s hormones protect them from CVD. But afterward, their risk increases more sharply with age

• Symptoms and signs of a heart attack vary among genders; women tend to have fewer, “quieter” symptoms– Fewer sharp, intense pains– Shortness of breath– Cold sweat, nausea, dizziness

• Women more likely to die from heart attack

Cigarette Smoking and CVD

• Smoking is a major risk factor for CVD (as well as lung and other cancers)

• Carbon monoxide, nicotine, and other substances in cigarette smoke constrict and injure arteries

• Health risks for smoking decline the earlier a woman quits

• Secondhand smoke is a CVD (& cancer) risk factor

Cancer and Related Terms

• Cancer: disease caused by uncontrolled cellular growth or reproduction

• Tumor: any abnormal cell growth; can be benign (contained) or malignant (growing/spreading)

• Metastasis: the process of cancer spreading throughout the body

• Carcinogen: a substance that can cause cancer

Cancer and Women: Epidemiological Overview

• Cancer is the second-leading cause of death in the United States.

• 75% of cancers are diagnosed in people aged 55 and older

• Breast cancer is the most common cancer for women

• Lung cancer is the second most common, but causes the most deaths (lower survival rate)

• Third most common cancer = colorectal

• Fourth most common cancer = endometrial

Breast ConditionsMost women will find a lump in their breast at some

point in their lives. In 9 of 10 cases, this is not cancer.

Benign breast diseases include:

• Fibrocystic breast disease (cystic mastitis)

• Hyperplasia

• Fibroadenoma

Breast Conditions

Breast cancer is a frightening, misunderstood issue in women’s health. It can usually be successfully treated if detected early.

• Five levels– In situ: Too small to be felt; nearly 100%

5-year survival rate– Stage I: < 2 cm in size, localized– Stage II: 2–5 cm in size, localized– Stage III: > 5 cm in size, grown into chest wall,

skin, or lymph nodes– Stage IV: Growth spread to other parts of body

Risk Factors for Breast Cancer

• Gender• Age• Family history• Never had children or first child after 30 • Early menarche (before 12) or late menopause

(after 55)• Consumption of high-fat diet or alcohol• Environmental factors• Obesity• Oral contraceptive use?

Breast Cancer Screening

• Breast self-exam

• Clinical breast exam

• Mammography

Treatment

• Lumpectomy

• Partial or segmental mastectomy

• Simple mastectomy

• Radical mastectomy

• Modified radical mastectomy

• Chemotherapy, radiation therapy, and hormone therapy may be used alongside surgery to improve chances of recovery.

Lung Cancer

Cigarette smoking is responsible for almost every case of lung cancer, the deadliest form of cancer for men and women.

• Lung cancer often spreads to other parts of the body before it can be detected.

• Common symptoms are persistent cough, weight loss, bloody sputum, recurring bronchitis, pneumonia, and chest pain.

• Treatment is very difficult but can include surgery, radiotherapy, and chemotherapy.

Cervical Cancer• Caused by “high risk” strains of HPV• Modern medicine has the potential to prevent

almost all cases of cervical cancer • Screening: Pap smear, HPV test (for women 30

and over)• Vaccination can prevent most, but not all, cases

of cervical cancer (screening still needed)• Treatment: cyrosurgery, cone biopsy, laser cone

biopsy

Gynecological ConditionsBenign uterine conditions

• Fibroids

• Endometriosis—when it grows into wall of uterus, called adenomyosis

• Endometrial hyperplasia

• Treatments include hormone therapy or surgery (myomectomy, laparoscopy, hysterectomy)

Malignant Uterine TumorsRisk factors• Age (over 50), obesity, diabetes, high blood pressure,

early menarche or late menopause, history of infertility, family or personal history of other cancers, long-term high-dose ERT, cigarette smoking, use of Tamoxifen for breast cancer

Difficult to detect—too high up to be found on a pelvic examination

Treatment may involve surgery and/or radiotherapy.

Benign Ovarian Growths• Cysts—follicular, hemorrhagic, epithelial, dermoid• Polycystic ovarian syndrome

Ovarian Cancer• A deadly, stealthy, and largely misunderstood form of

cancer. • Risk factors: no children, early menstruation, late

menopause, pregnancy after age 30, previous cancer, long-term use of some fertility drugs

• Early symptoms: pelvic pressure, abdominal swelling, gas pains, indigestion, vague abdominal discomfort

• Treatment: surgery, radiotherapy, chemotherapy

Cervical Cancer

• Caused by HPV, a very common sexually transmitted virus

• Only high-risk strains of HPV can cause cervical cancer

• Most women with high-risk HPV will NOT develop cervical cancer

• Easily treated if found early (Pap smears, HPV test)

• A new vaccine can now protect against some high-risk strains of HPV

Colorectal Cancer• Increasing age and familial adenomatous

polyposis (FAP) are major risk factors; high fat, low-fiber diet is also a risk factor

• Warning signs: blood in stool, cramping in lower abdomen

• Screening: digital rectal exam, sigmoidoscopy, fecal occult blood testing, colonoscopy

• Treatment: surgery, radiotherapy, chemotherapy

Skin CancerSkin cancer• Melanomas vs. nonmelanomas (basal cell and

squamous cell carcinomas)• Risk factors: UV from sunlight, moles, family history,

race• Screening and diagnosis: skin exam looking for ABCD

– Asymmetry– Border irregularities– Color irregularities– Diameter

• Treatment: surgery, radiation therapy, electrodessication, cryosurgery, laser therapy

Reducing Your Risk of CVD and Cancer

• Importance of preventive lifestyle habits

• Knowledge of family history, genetic risks

• Importance of screening for early detection

What are you doing to reduce your risk of CVD and cancer?