COMMENTARY

Women’s Health: 50 Years of Progress

JoAnn E. Manson, MD, DrPH

Disclosures

July 30, 2021

This transcript has been edited for clarity.

Hello, this is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I'd like to talk with you about a recent article that my colleague, Dr Cynthia Stuenkel at UCSD and I published in the New England Journal of Medicine in June, chronicling 50 years of advances in women's health, including prevention, early detection, and treatment. This was part of the National Academy of Medicine’s series, A Half Century of Progress in Health.

In parallel, we reviewed the key public policy milestones that have made the scientific progress possible, including improved access to contraception, greater reproductive autonomy in women, the banning of employment discrimination against pregnant women, and generally greater opportunities for women in society, together with federal initiatives to promote the inclusion of women in clinical research.

I'm going to focus on two areas: cardiovascular disease and cancer.

Progress in Cardiovascular Disease

In terms of cardiovascular health, several major nationwide studies have really helped to improve our understanding of women's cardiovascular and cardiometabolic health across the lifespan. These include the Nurses’ Health Study, the Women's Health Initiative, the Study of Women's Health Across the Nation, the Women's Ischemia Syndrome Evaluation, and many other studies. In parallel, policy milestones, such as the National Heart, Lung and Blood Institute’s The Heart Truth campaign, and the American Heart Association’s Go Red for Women campaign, raised awareness of the importance of heart disease in women.

Nonetheless, we continue to see lower rates of guideline-based care of cardiovascular disease in women, including lower rates of statin use and coronary reperfusion. We also have limited understanding of sex differences in cardiovascular disease—the conditions that are more prevalent in women, including microvascular disease and heart failure with preserved ejection fraction. We definitely need more research in these areas.

Although we have an improved understanding of the importance of complications of pregnancy and pregnancy as a window to women's future cardiovascular health, we still have limited understanding of how to prevent complications of pregnancy, such as pre-eclampsia, pregnancy-induced hypertension, gestational diabetes, and preterm birth, and also how to prevent the higher risk for cardiovascular disease associated with these conditions.

Progress in Cancer

In terms of cancer, I'll focus on breast and cervical cancer, where there has been great progress. Improved mammography screening and other imaging tests, improved preventive measures, more targeted treatments, and advances in genetic testing have all contributed to improved prognosis for breast cancer, currently at about a 90% 5-year survival rate.

In terms of cervical cancer mortality, there's been a tremendous reduction. Pap smear screening and improved understanding of the role of HPV in relation to cervical cancer, along with other advances have contributed to a 50% reduction in mortality from cervical cancer, which is really a major success story in women's health.

To maintain progress in women's health, we really need more research on sex and gender differences in health and sex- and gender-informed medicine. Together with forward-thinking public policy decisions, this research should help to ensure continued progress in women's health over the next half century. Thank you so much for your attention. This is JoAnn Manson.

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