Although the life expectancy of women is on average higher than that of men, their quality of life, in particular in old age, is often unsatisfactory.
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Chart extracted from Women's Health in Europe - Facts and Figures across the EU.
This report published by the European Institute of Women's Health (EIWH) reviews the state of women's health in the EU-25. It covers health issues such as cardiovascular diseases, cancer, osteoporosis, reproductive health and mental disorders and considers health determinants, such as education, employment and life-style.
The report highlights substantial differences in women's health status, exposure to health risks and access to healthcare across Europe.
Click here to see full report.
The EIWH analysis gives policy recommendations on how to improve this unequal situation. It suggests, for example, that new member states could make greater use of structural funds for investing in the health sector, such as implementing the Council recommendation on cancer screening.
CVD covers a wide range of disorders affecting the heart and circulatory system - including coronary heart disease and stroke. It is now the main cause of death throughout Europe - but more so in women.
It has been estimated that at least 1 in 3 women will eventually die as a direct result of coronary heart disease or a stroke (WHO data 1999).
After reaching the age of 50, 38% of women who suffer a myocardial infarction (heart attack) will die within a year, compared to only 25% of men. 63% of women who die from coronary heart disease will have had no previous warning of their coronary risk.
And yet only a small minority of women consider cardiovascular disease to be the greatest threat to their health and well-being, worrying far more about cancer in general, and breast cancer in particular. In fact, coronary heart disease alone causes significantly more deaths in women than breast cancer.
Because high oestrogen levels in pre-menopausal women offer protection against harmful cholesterol, cardiovascular disease typically develops about 10 years later than in men3. This may be why CVD is not taken so seriously in women as in men, and why there is still evidence of underdiagnosis and inequalities in treatment.
More gender sensitivity is required in order to recognize symptoms and to treat them in good time. Women are not like men. This has to be taken into consideration in medical training and in treatment.
For example, many women and their doctors simply do not recognize the early signs of myocardial infarction or a stroke. Indeed, the presenting symptoms may be entirely different to those observed in men. For example, many women presenting symptoms with what is subsequently diagnosed as myocardial infarction, describe shortness of breath and extreme fatigue - in marked contrast to the severe crushing chest pain typically experienced by men.
Women are less likely than men to be evaluated for cardiovascular disease (CVD) risk factors and to undergo diagnostic and therapeutic procedures, making it less likely that they will benefit from the new range of non-invasive therapeutic interventions now available. Indeed, studies have shown that while men and women have a similar overall risk of developing CVD, men are almost twice as likely to receive diagnostic tests and treatment. Specialists also believe that some diagnostic tests- in particular, the exercise stress electrocardiogram (ECG) - may be less accurate in women. Meanwhile, women are less likely than men to be started on aspirin, antihypertensive drugs (e.g. beta-blockers, ACE inhibitors) or cholesterol-lowering drugs (e.g. statins, fibrates). Despite nearly equal rates of heart disease incidence, men receive2 69% of coronary artery bypass grafting (CABG) procedures; 67% of percutaneous transluminal coronary angioplasty (PTCA) procedures and 66% of implantable defibrillators.
Recent data from the World Health Organization have emphasized the importance of hypertension as a major risk factor for coronary heart disease in women (a 3.5-fold increase). Surveys have suggested that as many as 40% of women are hypertensive with a blood pressure (BP)>140/90mmHg, but most were previously undetected. When treated, target blood pressure was achieved in only a minority.
The number of male smokers has decreased significantly in recent years. However, the same has not been true of women. Smoking carries almost twice the risk for the development of cardiovascular disease (CVD) in women as in men, and heavy smoking is the major risk factor for pre-menopausal CVD.
According to Eurostat, about 21% of females in the EU are overweight or severely overweight. There are notable differences among Member States. Obesity is more frequent in Greece and in Portugal (31% of female population for both), and least in France (15%) and in Denmark (16%). Physical activity levels in girls show a sharp decline as they approach their teenage years, and few women take regular physical activity. In the UK, for example, as many as two-thirds are so unfit, they cannot work at a normal pace up a gradual slope without becoming breathless.
Many professional women have an excess intake of alcohol, causing weight gain and a rise in their blood pressure. According to Eurostat (March 2004), 50% of Irish women aged 15 to 24 are regular drinkers, compared with the EU average of 19%. In Italy the figure is just 5%. Very heavy drinking may precipitate heart rate abnormalities (atrial fibrillation).
A well-known fact today: cardiovascular disease, including heart disease and stroke, is the leading cause of death in the developed world. CVD kills over 4.35 million people in Europe each year, and over 1.9 million people in the 25 countries of the EU. But it is a less-known fact that more women die from CVD than men (44% of deaths under the age of 75 for women, against 38% for men).
What's more: there are huge disparities across Europe. Whereas in Western and Southern European countries, death rates for women have decreased drastically (between 1989 and 1999, by 46% in Finland and, 43 % in the UK for women between 35 -74 years), they have increased in Central and Eastern European countries (by 21% for women in Romania and by 25% for Russian women). The inequality is flagrant: 64% of female deaths in Lithuania are from CVD, whereas in France, "only" 34% of female deaths are from CVD. To paraphrase George Orwell: all Europeans are equal, but some are more equal than others...
See European Cardiovascular Disease Statistics 2005
To improve the cardiac health of women, the GROW program (Guidant Reaches Out to Women), has initiated a series of actions aimed at raising women's awareness of cardiovascular disease and at improving the diagnosis, treatment and outcomes for women with cardiovascular disease through partnering with physicians. Read more about this initiative
The main cardiovascular disease risk factors for women are as follows:
Somewhat worryingly, many European women have had none of the main women's health tests available today, according to a Special Eurobarometer report.
The European Commission report "Health, Food and Alcohol, and Safety" (Special Eurobarometer - December 2003) provides an overview of trends in the various EU Member States on topics as diverse as hormone replacement therapy, breast feeding, drinking and dietary patterns as well as women's health tests. There are a series of tests which are relevant for women only, primarily for detecting various forms of cancers, deterioration of bone (osteoporosis) and other disorders.
The most common test is the pap smear, or test for cervical cancer, which nearly a third of EU women had had in the previous twelve months. A manual breast exam, the most common test for breast cancer, was carried out for just over one-quarter of the women in 2002. Most disturbing is the trend since 1996 of decreasing examinations. While just 30.3% of women in 1997 had none of the tests discussed here, in 2002 the figure was 43.4 per cent. Only for mammography (breast examination by x-ray) has the percentage increased slightly from 1996; for other examinations, the percentage has dropped steadily (see figure below). Luxembourg and Austria have the highest percentage of women undergoing the most examinations while Ireland, the Netherlands and the United Kingdom have the lowest rates. Greece (56.5%), the Netherlands (56.5%), Spain (55.8%) and Ireland (52.4%) have the highest rates of "none of the above" while Austria (25.1%), Luxembourg (24.6%) and East Germany (22.3%, as opposed to 37.1% in West Germany) have the lowest rates. There is significant national variation on many of the tests, with 15.9% of Austrian women undergoing an osteoporosis exam, but just 2.9% of Dutch women and 3.1% of Spanish women doing so. Some 36.8% of Luxembourgish women and 31.8% of Austrian women have had ovary exams, in contrast to 2.2% of Dutch women and 2.4% of Irish women. Some 35.8% of Austrian women have had a mammogram in the previous twelve months, as have 31.3% of Luxembourgish women; just 9.4% of Irish women and 10.7% of Danish women had done so.
Chlamydia trachomatis infections are the most common sexually transmitted disease in the developed world. In Germany alone an estimated 1.1 million people are infected with Chlamydia.
It often has no obvious symptoms, but if left untreated Chlamydia can have a devastating impact. Serious health consequences for women include pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain and infertility. It is estimated that up to one in four cases of infertility result from Chlamydia infection. Chlamydial infections during pregnancy may increase the risk of premature delivery and stillbirth. Additionally, babies born to women with Chlamydia can become infected as they pass though the birth canal. Chlamydia infections are not limited to women. In men, the bacteria can cause infections of the urethra, prostate gland, and rectum, as well as epididymitis, a painful inflammation of the testicles. According to the World Health Organisation, 70 - 75% of women infected with Chlamydia are symptom free. The infection can therefore, be present for years, without any obvious signs. The highest prevalence of Chlamydia is observed amongst female adolescents. In the UK alone it is estimated that complications caused by Chlamydia infection cost at least £100 (€147) million annually. Yet if diagnosed early, Chlamydia is easily treated, with a course of a common antibiotic. In Sweden in 1985 a Chlamydia screening program was introduced across the country in a variety of health settings, including primary care and at specialist clinics. Rates of testing increased from 1985 to 1991 and a corresponding decrease occurred in the number of cases diagnosed. In one county the number of cases fell by 40%.
Infertility touches one in five couples. In the past two decades assisted reproduction techniques have progressed dramatically, allowing many couples to experience the joy of childbirth.
As the efficacy of in vitro fertilization (IVF) has increased, concerns have grown around the health and social implications of multiple gestations. Multiple births represent a significant health risk for pregnant mothers and a financial burden for the healthcare system. The prospect of selective reduction of foetuses presents an ethical dilemma to parents and providers. New technology now permits single embryo transfer, effectively.
Post partum haemorrhage, the uncontrolled bleeding from the uterus following delivery, is still one of the leading causes of maternal mortality in developed countries. In many cases the only hope of saving the mother's life was to perform a hysterectomy. A new type of catheter has been developed that can help control bleeding and reduce the potential of hysterectomy in one third of all cases of post partum haemorrhage. This simple solution can help preserve a woman's fertility and avoid the long term health issues associated with hysterectomy.
Abnormal uterine bleeding, the prolonged or excessive bleeding associated with the menstrual cycle is listed as the reason for nearly 30 percent of all gynaecology office visits. In the past, the only methods available for an accurate diagnosis included invasive surgical or X-ray procedures. Today physicians can use readily available ultrasound equipment to perform saline infusion sonohysterography. The quick and relatively painless procedure can be performed in the gynaecologist's office in a matter of minutes. The technique delivers high-resolution images that aid in a complete diagnosis.
As the population continues to age, many health problems related to aging demand better and more long-term treatment. A generation of women who are better educated and expected to remain more active, will seek a higher quality of life during their extended years.
Stress urinary incontinence effects one in every three women at some point in their lives. Traditional treatments have relied on diapers, catheters, pessaries or surgical procedures that used synthetic materials to support or obstruct the urethra. Historically, each of these treatments has been only a short-term solution. The ideal treatment would work with the body's anatomy to help the body heal and promote a long-term solution.
A new generation of biomaterials as a natural alternative to synthetics has been developed. One naturally derived biomaterial is currently being used in a variety of applications related to the treatment of stress urinary incontinence and a wide variety of pelvic reconstructive surgeries. This material incorporates natural tissue growth and is eventually replaced by new, healthy tissue. The result is a return to the natural state that can best provide a normal quality of life for the long term.
Bladders created in the laboratory from a patient's own cells and then implanted in seven young people have achieved good long-term results in all of them, a team of researchers reported last week in a medical journal. It takes about two months to grow the new bladder on a scaffold outside the body. After implantation, the engineered bladder enlarges over time in the recipient. The researchers say they expect that the new bladder will last a patient's lifetime, but the longevity will be known only as the children grow older.
BBC on-line story - New York Times story
The Bone and Joint Decade 2000-2010 (WHO) initiative has highlighted diseases associated with musculoskeletal disorders such as joint diseases, osteoporosis, osteoarthritis and rheumatoid arthritis which women are particularly vulnerable to.
According to a Bone & Joint Decade Report, fractures related to osteoporosis have almost doubled in number in the last decade; it is estimated that 40% of all women over 50 years in age will suffer from an osteoporotic fracture.
Advances in materials science have led to more resistant and comfortable joint replacement devices. Procedures such as hip and knee replacement surgery are increasingly minimally invasive, thereby reducing pain, scars, risk of infection and time spent in hospital. Bone and cartilage regeneration technologies could one day replace metal implants.
Cartilage can be found in the human body as "unstressed" cartilage, for example in the ear and nose, or as "stressed" cartilage as for example in joints or inter-vertebral discs. Cartilage is considered to have a limited capacity to regenerate itself, injuries do not heal easily - hence the value of tissue engineered devices.
Cells are seeded into a supporting matrix and grown ex vivo. The product is then implanted into the patient. As the original cartilage, the tissue engineered device serves as a supporting structure (nose, ear) or as a protective cushion (knee joint, for example).
Regenerative medicine is rapidly evolving and new materials are under development that will no longer require the use of human tissues or cells at all. The nano-scale properties of the biodegradable matrix alone will "attract" cells from within the patient's body to the site that needs to be repaired; and stimulate their development.
A US citizen advocacy organization "Alliance for Aging Research", founded in 1986 to promote medical and behavioural research into the aging process, has just released a publication entitled The Silver Book. Key message: investing in medical innovation can reduce the economic burden of chronic diseases.
The book provides lots of interesting data on cardiovascular disease, diabetes, neurological disease, Alzheimer's and Parkinson's diseases, and on cancer, including breast cancer. The authors comment that as the elderly population grows, the extreme strain of chronic disease on society will only worsen.
Medical innovation has already proven its value in not only improving the length and quality of life, but also in helping to contain medical costs. Resulting improvements in health care often far outweigh increased spending; every dollar invested in health care produces up to three dollars in health care gains. We must be sure to consider both the financial and human impact medical innovation can have on the burden of chronic disease. According to the authors, short-sighted efforts to reduce spending often target the initial expenses of investing in medical innovation, ignoring the remarkable returns.
Click here to view full report
Lung, colorectal and breast cancer represent the three most common incident forms of cancer, accounting for two-fifths of the total European cancer burden.
The Annals of Oncology Advance Access published show thatwith 2.886.800 incident cases and 1.711.000 deaths in 2004,cancer remains an important public health problem in Europe,and the ageing of the European population will cause these numbersto continue to increase even if age-specific rates remain constant. Lung, colorectal,stomach and breast cancers account for nearly half of all cancerdeaths in Europe.
The report explains that although there have been recent declines in breast cancer mortalityrates in some European Union countries this disease remainsof key importance to public health in Europe. According to the report, population screening with mammographyis effective at reducing mortality when quality control proceduresare in place and there are slow but continual increasestaking place in treatment outcome, reflected by the veryhigh ratio of the lifetime risk of getting the disease (7.8%)to that of dying from the disease (2%) observed in the EuropeanUnion. However, there is still a clear need to accelerate prospectsfor preventing women getting breast cancer as well as dyingfrom the disease. Full report
According to the report Health in Europe - Facts and Figures across the EU, published by the European Institute of Women's Health (EIWH), the lives of 25.000 women could be saved, if screening for breast cancer according to EU quality guidelines were available across the EU. Click here to see full report.
