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Dr. Suzanne Steinbaum Headshot

Beyond the Breasts and Straight to the Heart

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It seems like this is the year of the woman. Stereotypes are shifting, at home and in the workforce. More women are being elected to political office, and women's voices are resonating in ways we have never heard before. Sheryl Sandberg boldly brought forward the truth about women in the workforce in her new book, More magazine continued the discussion with a great article on working moms and "non-working" moms, and these are just a few examples of a sea change that indicates women are becoming more effective, powerful, and control of our world.

However, there is a glaring exception. When it comes to women's health and women's bodies, we are still an antiquated culture. Medicine always lags behind research as new information trickles down into clinical practice. We are still in the age of "bikini medicine," where doctors tend to equate "women's health" with "women's breasts and the reproductive organs," end of story.

What I would like to suggest (radical as it sounds) is that women are made up of more than just breasts, a uterus, and a pair of ovaries. There is more to women's health than the care and cure of these three vital but non-comprehensive organs. We need to look beyond, to the forgotten whole woman, who is more than a sum of her parts.

Article after article in the well-respected New England Journal of Medicine makes the link between breast cancer and heart disease. I see this as a metaphorical arrow pointing away from the breasts and toward something much more central. At least we are making the connection between breast cancer treatment and what happens to the whole woman because of that treatment. I always say the heart is the center of each person's personal universe, and to me, it only makes sense that whatever we expose our bodies to will eventually and inevitably lead back to that central place.

There is good news on the "bikini medicine" front. Breast cancer mortality continues to decrease due to increasing collaboration between surgeons, radiation oncologists, and medical oncologists, but the truth is that cardiovascular disease is a much greater risk for women than breast cancer. It is in fact the leading cause of death in women, more than all cancers combined. I believe it is helpful to look at the connection, however. Let's not neglect one woman's health issue in order to pay attention to another one, because they are all connected. One study looking at women who had heart attacks or had stents put into their hearts showed that those women who received radiation therapy for breast cancer (which obviously exposes the heart to radiation, since it lies just behind the breasts) had increased rates of ischemic heart disease, with each additional gray (a measurement of radiation) leading to a 7.4 percent increase the risk of a cardiac event. This risk increases within five years after the treatment with radiation therapy and continues for the next 20 years.

Another common cancer treatment, chemotherapy, can also impact the heart. Studies link some of the chemotherapy treatments to decreased heart function, a dilated heart, and heart failure. In fact, for each dose of Anthracycline (doxorubicin or daunorubicin), a typical chemotherapy drug used in the treatment of breast cancer, the risk of heart failure goes up significantly. Tamoxifen, the gold standard in breast cancer treatment, has also been linked to cognitive impairment in those patients with increased risk of cardiovascular disease.

As we continue to open this Pandora's box wider and wider, I predict we will see a continuous flow of data that reveals how all aspects of women's health relate to all other aspects -- and how they all lead to or impact heart health. The American Heart Association Women and Heart Disease guidelines in 2011 discussed how elevations in blood pressure and pregnancy increase the risk of heart disease later in life. We are learning that miscarriages increase the risk of cardiovascular disease.

I'm excited about this tangible and palpable change. It is time that we understand that the treatment of one disease might effect and exacerbate another disease, and that everything that affects the body affects every cell within the body. We are at a crossroads and we can choose to forge ahead or fall back.

I want to call on women to start with their hearts and let their self-care and health-care radiate out from that center. If a woman is diagnosed with breast cancer, she should find a good cardiologist right away, to help in determining the best treatment plan to protect her heart as well as heal her breasts. Perhaps along with a breast biopsy, an evaluation of the nodes, and a proper staging, each woman should receive an ultrasound of her heart to assess her heart function (echocardiogram), an ekg, and an extensive risk factor analysis for heart disease. Perhaps if her risk for heart disease exceeds her risk of breast cancer, the plan of treatment should be altered. I'm thinking ahead here, but it's a future I think will more effectively and efficiently tackle today's women's health issues.

It's time for us to look at the big picture. It's time for us to see women for exactly who and what they are. We must go beyond the old paradigm of women and the problems they might be suffering behind their bikinis. In doing that, we must move past the breasts and into the heart, because it is the center of what keeps every woman alive, vital, vigorous, energetic, giving, loving, and joyful. Let's not forget where we begin, even as we work to save a woman's life and cure her cancer. Let's not forget what lies just behind her breasts. Let's not forget her heart.

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