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African American women continue to be hit hard by the HIV epidemic in the United States.  They are diagnosed with HIV at disproportionately high rates relative to white and Hispanic/Latina women - 15 times that of white women and almost 5 times that of Latino women.

New HIV Diagnoses Among Women in the US and Dependent Areas, 2017 by Transmission Category and Race/Ethnicity   (CDC)        
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I was surprised to learn recently that in contrast to decreasing incidence rates for lung and colorectal cancers, the rate of new uterine (endometrial) cancer cases has been increasing. Overall incidence rates have increased ~ 12% (0.7% per year on average) between 1999–2015 and death rates have increased 21% (1.1% per year) during a similar period.  The most recent data from 2015-2016 indicate a total of 53,911 new cases and 10,733 deaths from uterine cancer.  

In addition, closer inspection reveals significant racial and ethnic disparities.  For example, incidence among black women increased 46% (2.4% per year) and 32% (1.8% per year) among Hispanic women compared to 9% (0.5% per year) among white women.  Similarly, death rates among Hispanic (33%; 1.7%) and black (29%; 1.5%) women exceeded those among white women (18%; 1.0%).  Black women were more likely to present at a later stage and with more aggressive histologic types, which might in part account for their higher death rate.

One reason postulated for this observed increase may be elevated body mass index (BMI).  Women who are overweight (BMI = 25.0–29.9 kg/m2) or obese (BMI ≥30 kg/m2) are approximately two to four times more likely to develop endometrial cancer than those with normal weight.  According to the CDC, in recent years approximately 40% of women in the United States have been diagnosed as obese, including 56% of black women and 49% of Hispanic women.

So what can be done to reverse this trend?
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Dr. Bernadine Healy, first female director of the National Institutes of Health (NIH), recognized that most of the research centered on the diagnosis and treatment of coronary artery disease in men, not women, thereby making men the normative standard.  Because of this, women’s symptoms became underappreciated or atypical, with fatigue being the most common complaint especially in older adult women with acute myocardial infarction. Women often present with nausea, jaw tightness, shortness of breath, muscle pain, dizziness, and chest pressure, although their symptoms are often milder than those of their male counterparts. Up to 30% of women may have no chest pain at all. This is important because heart disease is the leading cause of death for women in the United States, accounting for over 398,000 deaths per year (American Heart Association). This figure is greater than the next two leading causes of death in women, cancer and accidents, combined (American Heart Association). While it has been shown that men have myocardial infarctions at earlier ages than women, myocardial infarctions result in greater mortality in women than in men.

 

The pathophysiology and risk factors are also different in women. Women often exhibit coronary microvascular dysfunction, which is marked by smaller vessels and increased vascular stiffness with diabetes and hypertension being the most common risk factors in women. Many women with hypertension are undiagnosed or, if diagnosed, poorly controlled. Smoking increases heart disease risk significantly in women, raising it to the same level as in men. Interestingly, in women, the cardiovascular risk varies relative to menopause. Prior to menopause, protective high density lipoprotein levels, are elevated. After menopause, they decrease and women lose the protective advantage. Early induction of menopause has also been associated with increased cardiovascular risks.


Maureen Farrel   DUCOM 2021

 


 
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