Although breast cancer is the women's health issue making headlines today, heart disease is the leading killer of women, with an estimated six times as many women dying from heart attacks as from breast cancer.
And much of the cardiovascular disease could be prevented or delayed if women would take some basic steps, such as treating obesity, diabetes and hypertension. "It's the silent epidemic," says epidemiologist Dr. Diana Petitti, director of research for Kaiser Permanente Southern California. "It just hasn't risen to the top of the agenda as we take on the more dramatic issue of breast cancer."
Petitti was one of seven speakers at a symposium Thursday in Los Angeles taking a comprehensive look at women's health issues in the 1990s and beyond. It was a first-ever partnership of the California Elected Women's Assn. for Education and Research and Kaiser Permanente.
And while the symposium focused specifically on heart disease and older women's health, the repeated message was the need for women to be activists both in their own care and in reforming an unresponsive medical system.
"We are trying to do two things today: Increase awareness and work toward more partnerships," said moderator Jackie Speier, former state Democratic legislator who chaired the Assembly Consumer Protection Committee.
Recent changes in health care were emphasized by keynote speaker Sandra Smoley, secretary of California's Health and Welfare Agency. She described the state's many programs on women's health--from prenatal care to breast cancer--as measurable progress. "Only a few years ago, people weren't even talking about 'women's health.' "
With a panel consisting of two physicians, two consumer advocates, a legislator and a medical ethicist, the symposium dug into the many levels of today's health picture, starting with the arresting statistics on heart disease presented by Speier:
* Although women enjoy relative protection from heart disease until menopause, after that they are twice as likely as men to die within a few months of a heart attack.
* Women rate cancer as a greater concern than heart disease by more than a 2-1 margin even though heart disease is the No. 1 killer of women.
"How do we make health-care practitioners more aggressive in treating heart disease?" Speier asked the experts.
At least part of the explanation for the lack of vigilance is cultural. Susan Fogel, attorney for the California Women's Law Center, described the widely accepted image of a heart-attack victim: a high-energy, busy male executive, juggling phone, fax and meetings, burning the candle at both ends.
In fact, suggested Petitti, this image is so ingrown that women who get chest pains often don't even think they might be having a heart attack.
And when they see a doctor, women often describe their symptoms differently than men, said Dr. Rebecca Goldstein, director of outpatient geriatric services for Kaiser Permanente Downey.
"They may describe exertional problems such as getting short of breath when they do the housework or yardwork. They may have trouble sleeping, which could be breathing problems. It's important for women to have a health-care provider who listens carefully."
The seminar was peppered with suggestions for empowering women as health-care seekers--from taking a friend along on doctor's appointments for moral support to stressing the importance of developing a spiritual life. Women with breast cancer, noted Fogel, have "set amazing new models with support groups and networks."