More and more Americans are living longer these days, and women
now have an average life expectancy of nearly 80 years. According
to the most recent statistics from the Centers for Disease Control
and Prevention (CDC), the average life expectancy for an American
woman is 79.5 years and for an American man, 74.1 years.
With this increased longevity, however, comes increased health
concerns. Among women, two of the most important health threats are
cancer, especially breast cancer, and bone loss.
Breast cancer is the most common noncutaneous cancer in women
and is the second leading cause of cancer mortality. Only lung
cancer results in more deaths in women. According to the National
Cancer Institute (NCI), approximately 39,600 women will die of
breast cancer in 2002 (compared with 65,700 deaths from lung
cancer). An additional 203,500 women will be diagnosed with new
cases of invasive disease and 54,300 with in situ breast cancer
The direct medical cost for the treatment of breast cancer alone is
$6 billion annually, according to the American Cancer Society.
That's the bad news. The good news is that more women are
undergoing regular screening mammography to detect breast cancer at
its most treatable stage. In fact, the NCI reports that by 1997,
more than 70% of all women >= 40 years of age reported having
had a mammogram within the past 2 years.
The effects of widespread screening are reflected in the
mortality statistics. From 1973 to 1990, the mortality rate from
breast cancer remained relatively stable, increasing by just under
2% during that entire period. Since 1992, however, the age-adjusted
mortality rate has steadily decreased at a rate of approximately 2%
per year. Experts credit this dramatic decline to changing
demographics, improved treatment options, and the increase in
In fact, for most women, early detection is the key to survival.
According to the National Institutes of Health, the 5-year survival
rate for patients whose breast cancer is diagnosed at Stage 0 or I
is 95%. This rate drops to 36% for those diagnosed at Stage III;
and when the cancer is not detected until after it has spread to
surrounding tissue, the 5-year survival rate falls to just 7%.
Screening mammography not only saves lives, as a CDC-funded
program in Kentucky proved, it saves dollars as well.
In the early 1990s, 35% of women diagnosed with breast cancer in
Kentucky were found to have late-stage disease at the time of
diagnosis. In 1994, with funding from the CDC, Kentucky officials
were able to expand the mammography outreach programs within the
state. Within 2 years, the rate of late-stage diagnoses had dropped
to 30%. In addition to increasing the potential survival rate, the
state saved an estimated $4.7 million in treatment costs.
To help improve the overall detection rate, the NCI recommends
that all women aged >= 40 years undergo screening mammography
every 1 to 2 years. Those with increased risk factors should
consider a more frequent imaging schedule. Risk factors
* history of breast cancer
* history of breast cancer in a first-degree relative
* diagnosis of atypical hyperplasia or lobular carcinoma in
* BRCA1 or BRCA2 genetic markers
* delayed childbearing
* early onset of menses
* dense breasts
* history of radiation therapy, particularly before the age of
Although these risk factors are important, it's also important
to note that the vast majority of women who develop breast cancer
do not have any known risk factors. Therefore, regular mammography
examinations are important for all women, regardless of risk
Another important health threat to women is osteoporosis. The
National Osteoporosis Foundation (NOF) estimates that 8 million
women now have osteoporosis and an additional 34 million Americans
(55% of the population aged >= 50 years) already have low bone
mass, putting them at increased risk for developing osteoporosis.
Based on current trends in population, the NOF predicts that the
number of women with osteoporosis will nearly double to
approximately 14 million within 20 years.
The greatest cost of osteoporosis, in terms of both dollars and
mortality, is the number of bone fractures that result from this
disease. It is estimated that fully half of all women and 25% of
men over the age of 50 will experience an osteoporosis-related
fracture in their lifetime. The most recent statistics show that
osteoporosis is associated with more than 1.5 million bone
fractures each year, including more than 300,000 hip fractures, at
an estimated cost to the country of $17 billion annually.
More importantly, the National Institutes of Health report that the
1-year mortality rate for hip-fracture patients over the age of 50
is approximately 24% and among those who survive, nearly a quarter
will no longer be ambulatory.
In many cases, this disease is "silent," with approximately 80%
of patients unaware of their bone loss; they often discover the
disease only when they experience a fracture. There are, however,
several known risk factors:
* history of fracture after age 50
* low bone mass
* family history of osteoporosis or fracture in first-degree
* small frame/thin build
* estrogen deficiency as a result of menopause, especially early
or surgically induced menopause
* anorexia nervosa
* low lifetime calcium intake
* current cigarette smoking
* excessive alcohol consumption
* inactive lifestyle
The best defense women have against osteoporosis is to have had
a healthy childhood with plenty of exercise and a calcium-rich diet
in order to achieve maximal skeletal growth. By age 20, 98% of a
woman's bone mass has been created. Therefore, in adults, the goal
is to maintain that skeletal mass. This can be accomplished by
having a diet rich in calcium and vitamin D, a healthy lifestyle
with plenty of weight-bearing exercise, and the avoidance of
smoking and excessive alcohol use. In addition, women should
undergo bone densitometry to assess bone health and, if indicated,
follow a prescribed treatment regimen.
The NOF recommends that all women over age 65, as well as all
postmenopausal women regardless of age, who have experienced a
fracture or have one or more of the above-mentioned risk factors
undergo bone densitometry. They also recommend testing for women on
long-term hormone replacement therapy and those considering
The role of the radiologist
With breast cancer and osteoporosis, early detection is the key
to prevention or treatment, and the radiologist is on the
front-line of defense. New and improved technologies have made it
possible to detect diseases far earlier than ever before.
Computer-aided detection in mammography is helping to boost the
number of early cancers detected. Digital mammography helps
streamline the screening process and helps lower the radiation
dose. Bone densitometry allows the radiologist to assess bone
health before a devastating fracture occurs.
In the hands of skilled practitioners, these advanced
technologies can help women not only live longer but live healthier
lives as well.