Questions about health concerns such as heart disease, breast cancer risk factors, lesbian health issues, and common herbal remedies often leave women facing difficult choices. Presentations designed to help women make informed decisions about health care will be provided by UC San Francisco experts during the seventh annual Women's Health 2000.
The popular event -- which draws more than 500 participants each year -- will be held from 8:30 am to 4:30 pm, Saturday, March 18, at UCSF, 513 Parnassus Ave.
The conference includes 30 sessions that will focus on a myriad of health related topics, including using acupuncture to treat PMS, cramps and hot flashes, myths and realities of the biological clock and new ways to control fertility. In addition, the conference sessions will address issues that affect many women's lives such as survival skills for those who are caregivers to the elderly and exploring the relationship between spirituality and health.
The registration fee is $50 and includes participation in seminars, continental breakfast, lunch, snacks and live entertainment. To register, call (415) 399-1379 or e-mail womenh@aol.com.
The following are descriptions of some conference sessions:
Preventing Breast Cancer: Is It Possible?
Breast cancer is the most common type of cancer in American women and is the second leading cause of cancer related death among women, following lung cancer. One of the issues that will be discussed in this forum is risk stratification, said Leah Millheiser, MD, who will present this talk with Debu Tripathy, MD, assistant clinical professor of medicine in the UCSF Carol Franc Buck Breast Care Center.
"Risk stratification is defined as trying to identify who is truly at high risk for breast cancer,"
Millheiser said. "Every woman is at risk but certain women have a higher risk."
Risk factors include: a family history of breast cancer, age, never having borne a child, late onset of menopause, late age of full, first term pregnancy, having your first menstrual period at an early age and previous diagnosis of breast cancer.
Over the past several years, researchers have been investigating the drugs tamoxifen and raloxifene for breast cancer prevention. The FDA approved- tamoxifen is a selective estrogen receptor modulator that binds the estrogen receptors in the breast and blocks natural estrogen from attaching to those receptors-possibly preventing cancer from forming. It has been prescribed to high- risk women and to women who have already had breast cancer to prevent recurrences.
"The idea is that by binding to the estrogen receptors normally inhabited by estrogen, tamoxifen may prevent cell proliferation and possible cancerous change," Millheiser said.
Investigators are also looking at using raloxifene -- which is already used in the treatment of osteoporosis -- in preventing breast cancer and comparing it with tamoxifen.
"With all the information that's disseminated via the Internet, magazines or mass media, it's important for women to know what their true risk factors are and to know whether they are in that higher risk group," Millheiser said. "In addition, there have been many new and exciting advancements in the field of breast cancer prevention regarding both screening techniques and research."
Special Lesbian Health Issues
Lesbians have recently been identified as an underserved population by the health care system in the United States, according to a report produced by the Institute of Medicine. Lesbians may also have a higher risk than heterosexual women of developing specific medical conditions, such as breast cancer, according to Patricia Robertson, MD, co-director of the newly established UCSF Center for Lesbian Health Research and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences.
"I'll address differences in reproductive cancers, mental health issues and substance use. I'm also going to discuss gay and lesbian parenting," said Robertson, a speaker at Women's Health 2000.
Robertson also will talk about the lesbian health research center at UCSF, which opened in September 1999. One of the center's goals is to debunk common misconceptions held by both lesbians and physicians, such as lesbians do not need regular pap smears because they are not intimate with men.
"Lesbians are at risk for cervical cancer too," Robertson said. "There's evidence that the human papillomavirus can be passed from woman to woman, which is a risk factor in developing cervical cancer. So lesbians need to get regular pap smears from their providers."
The lesbian health center has several studies underway, including one that is looking at HIV transmission between women. Another study follows the children of lesbian couples from infancy to grade school to see how well they do in school and how socially adjusted they are.
Robertson is also co-founder of Lyon-Martin Women's Health Services established in 1978 to provide medical care to low-income lesbians and other women in the Bay Area.
Heart Disease: the #1 Killer of Women:
Heart disease is the leading cause of death among women and since 1984, more women than men have died from the disease each year. This gap continues to grow.
"Heart disease is the leading cause of death in women. That's the main reason women should know about heart disease," said Rita Redberg, MD, UCSF associate professor of medicine. "Typically, one in two women will die of cardiovascular disease in the U.S."
But many women do not recognize heart disease as a problem for them and are not aware of the factors that can bring on the disease, said Redberg, who will speak on this topic at Women's Health 2000. Laurel Dawson, MD, UCSF assistant clinical professor of medicine, will also speak on this issue.
"The American Heart Association just did a survey recently that found that less than half of women in this country know of their risk for heart disease," Redberg said. "They think they are more likely to die from breast cancer than heart disease."
Some of the factors that contribute to heart disease are: smoking, high blood pressure, diabetes, high cholesterol, sedentary lifestyle, a family history of premature heart disease, and previous heart attack.
One important strategy women should use to prevent heart disease is having regular clinical checkups, especially since women with high blood pressure or cholesterol often feel fine and do not know they have these risk factors. Healthy behaviors are also important in preventing heart disease, Redberg said. Eating a well balanced diet, not smoking and exercising regularly can significantly reduce high blood pressure, lower cholesterol and decrease excess weight. And all of these factors have a direct impact on lowering a woman's risk of heart disease.
"I think the key point is heart disease is a major risk for women and it's preventable," Redberg said. "It's important that women are aware of this and know how to prevent heart disease."
The Most Common Herbal Remedies
In the past decade, more people have turned to herbal supplements to treat a variety of conditions, such as depression, memory loss and insomnia. In 1997, about 42 percent American adults used some form of alternative medicine. Based on a survey of the top selling herbs in the first six months of 1999, the herbal product with the highest sales increase was black cohosh, used for menopause. Sales of this herb jumped up by 477 percent, according to the study published in Herbalgram, a journal produced of the American Botanical Council.
"Clearly, women are using these products for menopause, given their fear over risks of hormone replacement therapy," said conference speaker Cathi Dennehy, PharmD, assistant clinical professor in the UCSF Department of Clinical Pharmacy. "The decision of using hormone replacement or dietary supplements to control immediate symptoms is an individual one and should be based on the patients personal beliefs and personal and family history."
A large percentage of adults view alternative medicine as natural and safe. Herbal remedies are also easily accessible over the counter in most drug stores. But unlike traditional pharmaceutical products, the U.S. government does not regulate herbal supplements to ensure product content and safety.
"Many believe that botanicals are "natural" products, and therefore safe and effective. But consumers need to be aware that just because herbs are classified as nutritional supplements, does not guarantee that what they buy over the counter is necessarily safe, effective or manufactured with strict quality standards," said Ellen Hughes, MD, associate clinical professor in the UCSF Department of Medicine and interim director of the UCSF Osher Center for Integrative Medicine. "Also, very little is known about herb-to -herb or herb-drug interactions. Our presentation will review the latest data on which of the top ten or so herbs work and any cautions consumers should be aware of."
The following are some of the most commonly used herbs, according to the American Botanical Council:
(Note: The indications listed below represent common uses for these herbs. In some cases, clinical trials that support these uses may be either lacking in sufficient scientific rigor or be insufficient in number. Herbs that have a preponderance of literature that supports the stated claim have an asterisk (*) next to them.)
Ginkgo*
used to improve mental performance in patients with mild to moderate
dementia and improve circulation
St. Johns Wort*
used to treat mild to moderate depression
Ginseng
may have mild estrogenic proprieties, used to improve mental and physical
performance
Garlic
used to lower cholesterol levels in the bloodstream
Echinacea*
used to improve symptoms and shorten duration of the common cold
Saw Palmetto*
used to improve symptoms associated with benign prostate hypertrophy
Kava*
used to treat mild to moderate anxiety
Cranberry
used to prevent urinary tract infections
Valerian
used for insomnia and anxiety
Evening Primrose Oil
used to treat PMS symptoms, breast pain and menopausal symptoms
Bilberry
used to strengthen the eyes and circulatory system
Milk Thistle
used to improve liver function and protect against liver damage
Women's Health 2000 is sponsored by the UCSF National Center of Excellence in Women's Health, the Mount Zion Health Fund and the UCSF Obstetrics and Gynecology Research and Education Foundation.