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Smoking Called the Worst Threat to Women’s Health

Times Staff Writer

It appeared more clear than ever, to hear physicians at a conference on women’s health this week, that the single most important thing females can do to live longer, healthier lives is to avoid smoking.

Lung cancer in women is increasing so dramatically that one physician, cancer specialist Loretta Itri of the Hoffmann-La Roche drug company, predicted that the gap in life expectancy between women and men will close by the year 2000. Currently, women live an average of seven years longer than men.

“There is a population of women out there who started smoking after World War II who will develop lung cancer and die,” said Itri, who blamed the postwar increase on what was then considered the modern woman’s new-found freedom to smoke without being branded “loose.”

Along with that change in social attitudes came a trend in cigarette ads to target this gigantic new market, she said.

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The women who started smoking after the war have been smoking for 40 years, and “the graph on lung cancer in women,” said Itri, “is a straight upward line.

“Where the hope lies is in prevention efforts with adolescents.”

Other doctors disagreed with Itri’s claim that the life expectancy gap would disappear. But all agreed that lung cancer is epidemic in women, surpassing breast cancer as the No. 1 fatal cancer in women. According to National Cancer Institute projections, 39,900 American women will die of breast cancer this year, while 41,100 will succumb to lung cancer, compared with 18,600 just 10 years ago--an increase of more than 100%.

Other Health Problems

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The problem with women smoking is not limited to deaths from lung cancer. In sessions covering problems spanning infertility, osteoporosis (bone-thinning), incontinence (loss of bladder control), premenstrual syndrome and heart disease, it turned out that women who smoke tended to suffer all these ailments earlier and in greater numbers than women who do not smoke or have quit.

Other recommendations made at the Food and Drug Administration’s Conference on Women’s Health were the most obvious ones, but still the most important:

- Lose excess weight. This helps prevent hypertension, heart attacks, diabetes and other ailments. Weight-loss diets should be balanced and should be supervised by a doctor, not drawn from a fad diet book.

- Exercise. This helps prevent bone thinning and obesity and improves heart function. Weight-bearing exercise, which includes almost every activity except swimming, appears to be more helpful in preventing loss of bone mass, which particularly plagues post-menopausal women. Excess exercise, which stops the regular function of the menstrual cycle, is still an area of mystery and therefore not specifically recommended, as many doctors fear it may have adverse effects on fertility, hormonal function and bone density.

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- Cut down on alcohol. Heavy drinking is a complicating factor in almost any disease, and evidence increasingly suggests that women should not drink any alcohol during pregnancy.

- Become an educated medical consumer. Women, said medical consultant Wendy Schain, spend more time investigating their laundry soaps and beauty aids than they do their medical problems. If you discover you have an illness, read about it and ask questions of your doctor about all the available treatments, not just the one she or he recommends. Be assertive with your physician. If a doctor tells you to take the blue pill in the morning and the green pill at night but you have trouble telling colors apart, say so. Do not be afraid of being branded “a cranky old woman.” Schain would like to see grade schools incorporate health consumerism into physical education classes. “I’d rather have my daughter learn that than how to climb a rope, a skill she will never need,” she said. “She’ll only need to climb a rope if I lock her in a tower.”

- Take calcium supplements. Daily intake of one gram of calcium is a fairly new and somewhat controversial recommendation, but most doctors believe it probably will help prevent bone thinning and its major complication in older women, debilitating hip fractures. Women who suffer from calcium kidney stones should not take calcium supplements, and anyone with any ailment should check with a doctor before taking them.

Early Tests Recommended

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Dr. Barbara Weissman, of Brigham and Women’s Hospital in Boston and a radiology professor at Harvard Medical School, recommended that women who are at high risk for osteoporosis take advantage of the new screening techniques that can catch the disease early.

Those at risk, said Weissman, include post-menopausal “thin women with fair skin, smokers and heavy drinkers,” she said.

Dr. Richard Rivlin, a nutritionist at Memorial Sloan-Kettering Cancer Center in New York, said smokers “tend to be thin and have earlier menopause,” contributing to osteoporosis.

While everyone on the osteoporosis panel recommended a daily calcium supplement, Rivlin pointed out there is very little information on which of the many forms is absorbed the best.

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“There needs to be an evaluation of products on the market,” said Rivlin.

But another osteoporosis panelist, Dr. Soloman Sobel of the Food and Drug Administration, said laws prevent the FDA from overseeing the vast area of diet supplements.

“FDA authority is not clearly established there,” he said.

When buying calcium supplements, Rivlin said, a consumer should check the product for milligrams of elemental calcium. He said it might be better to take it before bed instead of with meals to avoid having the food hinder absorption of the drug.

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Hope for Incontinence

Some of the newest information at the two-day conference, held at the National Institutes of Health, involved treatment of incontinence, which strikes older women more often than men and is often viewed as an irreversible problem caused by advancing age.

Dr. Neil Resnick, a gerontology specialist at Brigham and Women’s Hospital, said as many as two-thirds of incontinent people can be cured and the others significantly helped, through the use of behavioral and drug therapy, exercises or minor surgery.

Resnick called incontinence a “devastating” illness--and not just a part of aging--that tends to go untreated because people are too embarrassed to tell a doctor about it, or they cannot find the right help in this relatively new field of study.

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Incontinence “is often the straw that breaks the camel’s back in terms of people putting their aged parent in a nursing home,” said Resnick. And not enough nursing homes are using the latest techniques to treat the problem, nor are enough doctors aware of them, he said.

“Even if you are old and demented and frail, you can still be made dry. There’s about a 35% chance of it,” he said.

Resnick recommended that anyone suffering from incontinence should seek treatment for the condition. If the person’s regular doctor cannot help, Resnick recommends contacting the nonprofit Simon Foundation in Chicago at 800-23-SIMON for information.


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