Even though Bangalore homemaker Radhika Patel* was diagnosed with breast cancer, she insisted on postponing treatment until summer holidays had started for her two school-going children.
This mindset—putting the family’s wellbeing much before their own health—is typical of many women and, doctors opine, is one of the biggest health mistakes women make. It’s not always easy to shift the focus from work and family to oneself, but the likely payoff—a longer, healthier life—is worth the trouble.
1. UNDERESTIMATING HEART DISEASE
You may have heard that women don’t have to worry so much about heart disease—it’s a man’s problem. False! Cardiovascular disease is the leading cause of death among Indian women too, accounting for 17 percent of female mortality.
Some doctors are slow to recognize heart disease in women. According to studies, women wait longer than men to go to hospital when having a heart attack, and physicians are slower to recognize the presence of heart attacks in women because “characteristic” patterns of chest pain and ECG changes are less frequently present.
Also, India has the highest number of diabetics in the world. According to Dr Anil Mishra, medical director and senior consultant cardiologist at Kolkata’s B.M. Birla Heart Research Centre, men who have diabetes have double the chances of developing heart disease. But, he points out, the risk becomes four-fold in the case of women. “Stress at work, a very competitive lifestyle, eating out and fast food, smoking and alcohol intake are increasing in women especially in the 20 to 50 age group,” adds Dr Ashok Seth, chairman and chief cardiologist at New Delhi’s Escorts Heart Institute and Research Centre. “All these significantly increase their chances of developing heart disease at a younger age. Oestrogen, the female hormone, is known to protect women from heart disease until they reach menopause. But it’s becoming increasingly clear that recent lifestyle changes are neutralizing this protective role.”
“Women suffering from coronary heart disease often present atypical chest pain and shortness of breath,” Dr Mishra explains, “not the classic symptoms seen in men, such as crushing chest pain or pain down the left arm. Women suffer silent ischaemia more often than men, which means they may experience no pain at all.” So, many women mistakenly identify their heart-related symptoms as gas-related, and take antacids. By not understanding, or downplaying, the condition, women often delay seeking essential medical attention.
Women over 30 should take a lipid profile test to know their “bad” (LDL) cholesterol and triglyceride levels. Women with high total cholesterol due to high “good” (HDL should be above 50) cholesterol may not have an increased risk of heart disease. On the other hand, some women with only slightly elevated cholesterol levels may have high “bad” cholesterol, low “good” cholesterol and high triglyceride levels, and therefore be at increased risk.
2. PUTTING OFF PAP SMEARS
The Pap smear test is a simple examination of cervical cells for malignancies. It’s a shame there’s no national cervical cancer-screening program. Even worse, most Indian women are dismally unaware of the need to undergo regular screening.
Dr Suneeta Mittal, professor and head, department of obstetrics and gynaecology at New Delhi’s All India Institute of Medical Sciences, recommends that a woman should have her first Pap test three years after commencing sexual activity.
Thereafter, she should be tested every two years. Women testing negative over three consecutive Pap tests may choose to test once every three to five years. But those with increased risk (such as those with multiple sexual partners, a family history of cervical cancer, cervical dysplasia or human papillomavirus infections) should undergo an annual Pap smear.
Dr Mittal also advises women with symptoms of vaginal discharge (especially if it’s bloodstained), inter-menstrual bleeding or postcoital bleeding, to consult a gynaecologist. In short, don’t ignore these symptoms—early diagnosis and prompt treatment increases the chances of being cured.
3. NEGLECTING BREAST EXAMS
Dr D. Vasanthi, head, department of gynaecology, Apollo Hospital, Chennai, suggests that women undergo a mammogram at age 40. After that, an ultrasound scan of the breast may be made part of an annual health check-up. Only women at high risk, who have a family history of breast cancer, may be prescribed more frequent mammograms.
But hospital screening and mammograms aren’t foolproof. Experts estimate that about 20 percent of the cancers detected in a given year will be missed at the screening, but will become clinically evident in the period before the next screening.
That’s why regular self-examinations are important.
Dr Chittaranjan N. Purandare, noted Mumbai gynaecologist, who was until recently president of the Federation of Obstetric & Gynaecological Societies of India (FOGSI), advises women to make self-examination of their breasts a regular habit. “It is simply a question of checking to see if there are any changes in the appearance of the breast, or feeling a lump,” he says.
Why is this so important? The incidence of breast cancer in urban India is rising. And recent studies show that incidence of breast cancer has overtaken cervical cancer, cited as the most frequent cancer in Indian women only a decade ago.
Neerja Malik, 56, founder of the Apollo Cancer Support Group in Chennai and a two-time breast cancer survivor, also strongly endorses self-examination. “In spite of having done a mammogram, I detected my breast cancer myself both times at ages 44 and 51. The first time, I detected a lump myself 10 months after the mammogram. The next time, a lump had grown considerably and I felt some discomfort when I slept on my stomach,” she recalls. “I wish I had done breast self-examinations regularly; it may have helped earlier detection.” As Dr Rajendra A Badwe, director of Mumbai’s Tata Memorial Hospital, a leading centre for cancer care, observes, if the average of one in 28 women in India who will develop breast cancer during their lifetime detect the disease at an early stage, they have every reason to enjoy a longer life, the five-year survival rate in India being 80 percent.
4. NOT KNOWING FAMILY HISTORY
Knowledge of which diseases run in your family, especially those that developed before age 50, can sometimes help determine which tests a woman may need, and when.
After Geeta Kudva, a Bangalore mother of two boys, reached menopause at 42, her gynaecologist advised her to perform regular breast self-examinations, stressing that Geeta had a higher risk of developing breast cancer because she had reached menopause at a comparatively early age. At the time, Geeta tested negative for breast cancer. “I made it a point to keep tabs on my health,” she says. “Two years ago, when I was 52, I detected a pea-sized mass in my breast and immediately reported it to my gynaecologist. I was found to have a malignant tumour.”
While Geeta has completely recovered from cancer today, what is noteworthy is the fact that 20 years ago, Geeta’s maternal aunt had developed breast cancer also at age 52. She died within a year of diagnosis.
Knowing that a cancer runs in your family can help you decide on early testing. If it’s breast cancer, it’s best to start yearly mammograms five to 10 years earlier than the age at which a close relative developed breast cancer, but generally not before the mid- to late 20s.
5. IGNORING CALCIUM
Ten to 15 percent of Indian women over the age of 60 are likely to suffer an osteoporotic fracture. These include spinal breaks that cause “dowager’s hump,” and debilitating hip fractures.
To prevent osteoporosis, take steps now. A woman’s bone mass peaks by about age 30; after that, it decreases by a slight amount every year until menopause, following which the loss accelerates.
The higher you start your peak bone density, the better off you are, experts say. Staying active helps fight this bone-wrecking disease. Doctors recommend 1000 mg of calcium a day for women between 19 and 50, inclu-ding pregnant and lactating women, and 1200 mg for women 51 and over. Two cups of skim milk and 225 grams of curd together can provide about 1000 mg.
6. SKIPPING EXERCISE
No time? Regular exercise is one way to save time, since it gives you more energy for the rest of your day. Plus, it fights stress, lowers the risk of a slew of diseases and boosts overall health. And it promotes weight loss, making for one less thing to worry about.
Professor V.B.N. Prasad, head of the department of orthopaedics at Nizam’s Institute of Medical Sciences, Hyderabad, points out that even housework provides good exercise. He maintains that those who do a lot of housework can avoid or significantly postpone osteoporosis.
Health experts recommend 30 minutes of physical activity most days of the week. Even things like walking and gardening count. Muscle-strengthening exercises are also important.
Remember Radhika Patel, the dedicated mother who postponed her cancer treatment? “The children were my top priority,” she recalls, although taking care of her own health would in fact have been better for her children. Fortunately, her husband insisted she start treatment immediately. She underwent surgery and six months of chemotherapy, after which she was on medication for seven years.
If women neglect their health and miss screening and check-ups, or decide to postpone a treatment, it’s up to other family members to take charge. Today, 20 years after that grim diagnosis, Radhika Patel is doing fine, “thanks to prayer and positive thinking,” as she puts it, “and to my husband who understood that any delay could have had disastrous consequences.”
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