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Perspective on women's health: editors' 1997-1998 year in review
1Boston University School of Medicine, Boston Medical Center, USA.
Insights
In 1997, women faced higher heart attack mortality despite similar artery patency rates. Debates arose on mammograms for younger women and estrogen
Area of Science:
- Women's Health
- Cardiovascular Disease
- Oncology
Background:
- In 1997, key women's health issues included heart disease, breast cancer, and hormone therapy.
- Reports highlighted disparities in acute myocardial infarction (AMI) mortality between genders, despite similar early cardiac event responses.
Observation:
- Research on breast cancer etiology yielded modest gains but sparked debate on mammography screening for women under 50.
- Conflicting recommendations emerged regarding estrogen's benefits (e.g., memory) versus risks (e.g., increased breast cancer risk).
- Development of obesity pharmacologic treatments faced setbacks due to adverse effects of d-fenfluramine on heart valves.
Findings:
- Women experienced three times the mortality of men within 30 days of an acute myocardial infarction.
- Significant debate occurred regarding the optimal age and frequency for mammography screening in women under 50.
- Long-term estrogen use was linked to an increased risk of breast cancer, while also showing potential benefits for age-related memory loss.
Implications:
- The findings underscore the need for targeted research and clinical strategies to reduce mortality from heart disease in women.
- The conflicting data on estrogen necessitates careful consideration of hormone therapy risks and benefits, particularly concerning breast cancer and cognitive function.
- Advances in colorectal cancer screening guidelines and ethical discussions on reproductive technologies marked significant developments in women's health in 1997.
Abstract:
Heart disease, breast cancer, and hormone therapy were top clinical concerns in women's health in 1997. One of the major reports on heart disease confirmed that women are no different from men in terms of early infarct-related artery patency rates, reocclusion after thrombolytic therapy, and ventricular functional response to injury/reperfusion; nevertheless, women have 3 times the mortality of men in the first 30 days after an acute myocardial infarction. Research brought only modest gains in the understanding of breast cancer etiology in 1997, but engendered major debate on whether women younger than 50 years should have mammograms every 1 to 2 years. A National Institutes of Health consensus conference said no, but the National Cancer Institute's National Cancer Advisory Board said yes. Evidence of estrogen benefits and risks mounted: One report added to the data suggesting that estrogen may retard age-related memory loss, while another study reported that the risk of breast cancer significantly increased with long-term use of estrogens. The interest in selective estrogen receptor modulators (SERMs), also called "designer estrogens," grew. Efforts to develop pharmacologic treatment for obesity suffered a setback in 1997 when a team reported that 1 in 3 patients who used d-fenfluramine developed abnormal valvular thickening, with the most severe cases needing valve replacement. One of the most promising events in colorectal cancer, the third most common cancer in women, was the set of screening guidelines issued by the Agency for Health Care Policy and Research. The year ended with major ethical debates about multiple gestation and cloning.