Breast Health Awareness: Understanding Breast Cancer Risk Factors & Screening Guidelines 

Ivy Le

March 2024

Overview: 

Breast cancer continues to be one of the most prevalent health concerns among women worldwide. In the pursuit of women’s wellness, understanding breast health is crucial. From recognizing risk factors to adhering to screening guidelines, knowledge is power in the fight against breast cancer. 

What is Breast Cancer? 

Breast cancer is a complex disease that is characterized by the uncontrolled growth of abnormal cells in the breast tissue. It typically begins in the milk ducts or lobules of the breast, where cells undergo genetic mutation that cause them to proliferate uncontrollably. As mutated cells multiply and accumulate, they form a tumor within the breast tissue. These tumors can be benign, meaning they are non-cancerous and confined to their site of origin, or malignant, indicating cancerous growth with the potential to invade nearby tissues and metastasis to distant organs. These mutations can occur from a variety of factors in which we will discuss in this article. 

Knowing the Risk Factors: 

Awareness begins with understanding the factors that can influence breast cancer susceptibility. While some risk factors are out of our control, such as genetics and family history, others are modifiable through lifestyle changes. For instance, age is a significant risk factor with the likelihood of breast cancer increasing as women grow older. Additionally, reproductive factors like early menstruation, late menopause, and nulliparity (never giving birth) can impact risk levels. 

Lifestyle choices also play a role. Excessive alcohol consumption, smoking, a sedentary lifestyle, and a diet high in processed foods have been linked to increased breast cancer risk. Conversely, maintaining a healthy weight, regular exercise, and a diet rich in fruits, vegetables, and whole grains can potentially lower the risk of breast cancer. 

Genetic mutations, such as those in the BRCA1 and BRCA2 genes, are known to significantly increase the risk of breast cancer. These mutations can be inherited from one’s parents or acquired over time due to exposure to carcinogens or other factors. Hormonal influences also play a crucial role in breast cancer development. Estrogen, in particular, can stimulate the growth of breast cells, making hormone receptor-positive breast cancers more prevalent.

Knowing the Symptoms: 

Recognizing the symptoms of breast cancer is crucial for early detection and prompt intervention. While symptoms may vary among individuals, common signs may include: 

• New lump or mass in the breast or underarm area 

• Changes in breast size or shape 

• Nipple discharge 

• Nipple inversion 

• Skin changes on the breast, such as redness, dimpling, or puckering 

• Persistent breast pain or discomfort 

Women should familiarize themselves with the normal look and feel of their breasts and promptly report any changes to their healthcare provider. Breast self-exams aren’t a substitute for a regular screening, but can serve as a valuable tool in early detection. 

The Importance of Screening:

Early detection remains the cornerstone of breast cancer management, greatly improving treatment outcomes and survival rates. Therefore, adhering to recommended screening guidelines is crucial for every woman. 

For women with average risk, screening typically involves mammograms, which are X-ray images of the breast tissue. Guidelines from organizations such as the American Cancer Society recommend starting annual mammograms at age 40, although individual risk factors may prompt earlier or more frequent screen discussions with healthcare providers. 

Women at a higher risk, such as those with a family history of breast cancer or genetic mutation like BRCA1 and BRCA2, may require additional screening modalities, such as breast MRI or ultrasound, and may begin screening at an earlier age. 

Breast Cancer Treatment: 

Breast cancer treatment approaches vary depending on factors such as the stage of the cancer, its specific characteristics, and the individual’s overall health.

• Surgery: Lumpectomy (removal of the tumor and a small portion of the surrounding tissue) or mastectomy (removal of the entire breast), which is sometimes followed by reconstructive surgery. 
• Chemotherapy: Using drugs to kill cancer cells or stop their growth. 
• Radiation therapy: Using high-energy rays to target and destroy cancer cells.
• Hormone therapy: Blocking the effects of estrogen or progesterone on breast cancer cells.
• Targeted therapy: Attacking specific vulnerabilities in cancer cells. 

Facts About Breast Cancer: 

• In the United States, approximately 240,000 cases of breast cancer are diagnosed in women and about 2,100 in men annually. 
• Presently, over four million women in the United States have a past experience of breast cancer, encompassing those undergoing treatment as well as those who have completed their treatment.
• Typically, women carrying a BRCA1 mutation face a lifetime risk of breast cancer of around 72%, while those with a BRCA2 mutation have a risk of up to 69%. Breast cancer linked to BRCA1 or BRCA2 mutations tends to manifest more frequently among younger women.
• Black women face a higher likelihood of succumbing to breast cancer compared to women from other racial or ethnic backgrounds. This is attributed in part to the fact that approximately one out of every five Black women is diagnosed with triple-negative breast cancer, a proportion higher than that observed in any other racial or ethnic group. 

Conclusion

Breast health awareness is a journey that begins with understanding and ends with action. By empowering women with knowledge about breast cancer risk factors and screening guidelines, we can strive toward more effective prevention, early detection, and treatment strategies, ultimately carving a path of a future where women know more about their health and well-being. 

References

[1] Breastcancer.org Staf . “Breast Cancer Facts & Statistics.” Accessed 15 March 2024, Breastcancer.org, https://www.breastcancer.org/facts-statistics. 

[2] CDC Staf . “Breast Cancer Awareness.” Accessed 15 March 2024, Center for Disease Control and Prevention, 

https://www.cdc.gov/cancer/dcpc/resources/features/breastcancerawareness/index.htm

Long-Lasting Effects of Social Media: Understanding How Online Misogyny is Affecting Our Youth

The Dynamics of In Vitro Fertilization and Embracing Autonomy 

What is in vitro fertilization (IVF)? 

Over the past five decades, IVF has emerged as a transformative treatment option for women,  representing a substantial technological advancement in assisting families grappling with  infertility and yearning for children. This intricate process entails a multi-step journey,  requiring dedication and meticulous planning.  

IVF involves several steps, with specific timing playing a crucial role throughout the process.  Reproductive specialists explain that each IVF cycle begins with a patient self-injecting  hormones daily for about 10 to 12 days to stimulate egg production within the ovaries. Regular  monitoring follows until the eggs reach maturity, after which a different hormone triggers their  retrieval under anesthesia – the second step.^[1] 

Subsequently, retrieved eggs are placed in a dish with sperm for fertilization, marking the third  step in the process. The fourth step is the creation of a fertilized egg which is then cultured in a  lab for approximately three to seven days until it reaches the blastocyst stage. This stage  signifies a well-developed embryo containing cells for both the placenta and fetus.^[1] 

The last step in the IVF process involves either transferring the embryo into the woman’s uterus  or freezing it for future use. Often, a combination occurs with one embryo transferred while  any surplus embryos are frozen. The entire IVF cycle, from hormone administration to embryo  implantation, typically spans about 2.5 weeks. However, frozen embryos may be transferred  into the uterus in a separate cycle.^[1] 

Demand for IVF has surged globally, with IVF conceptions accounting for approximately 2%  of all babies born in the United States. This percentage is projected to rise to 10% in the future  as scientific advancements and reliance on IVF persist.^[2] 

Reproductive rights continue to divide the nation 

As of March 2024, IVF remains at the forefront of discussions, marking it as one of the most  talked about topics of the year. Following the reversal of Roe v. Wade, the discussion surrounding IVF also opens another dimension, inviting further scrutiny to women’s  reproductive rights. This ongoing dialogue promises to reignite discussions and inquiries into  the broader landscape of reproductive health and autonomy.

In a recent unprecedented ruling, the Alabama Supreme Court categorized embryos as children,  sparking legal ambiguity regarding fertility treatments. This caused some IVF providers to  suspend services for fear of wrongful death lawsuits when handling their routine disposal of  nonviable and surplus embryos. Along with the potential liability for inadvertent destruction, it  has ignited new debates within the realm of reproductive medicine in the United States.^{[3, 4]} 

This decision prompted public outrage and resulted in lawmakers taking political action by  swiftly passing legislation to offer legal immunity to IVF providers. Following the enactment  of the law, two of the three major clinics in Alabama resumed IVF services. However, legal  experts say the future of those protections are on shaky ground.^[4] 

Medical professionals and advocacy organizations in the reproductive field have expressed  apprehension over the ruling’s potential adverse effects on fertility treatments not only within  Alabama but also across the nation as the discussions continue to evolve on the future of IVF.^[3] 

The future of IVF hangs in the balance 

The Alabama Supreme Court ruling increased apprehension among IVF providers in Alabama  and triggered political turbulence on a national scale, prompting Republicans to distance  themselves from the decision amidst a pivotal election year where reproductive rights are one of  the top issues. 

As the debate rages on surrounding women’s autonomy and the complexity of reproductive  decisions, a critical question remains: Will women emerge victorious in the struggle for control  over their bodies, including the disposition of their eggs and embryos? It is essential that women  are entrusted with this choice as it directly concerns their bodies. Women should be free from the  constraints of legislation, honoring individuals’ rights to make deeply personal decisions  regarding their lives and futures. Since the inception of IVF in 1978, the fundamental goal of  infertility treatment remains the same – helping to build happy, healthy, and flourishing  families.^{[2, 5]} 

References 

[1] Godoy, M. (2024, February 23). The science of IVF: What to know about Alabama’s  “extrauterine children” ruling. NPR. https://www.npr.org/sections/health shots/2024/02/23/1233023637/ivf-alabama-frozen-embryo-personhood-abortion-supreme court.  

[2] Kushnir, V. A., Smith, G. D., & Adashi, E. Y. (2022). The Future of IVF: The New Normal  in Human Reproduction. Reproductive Sciences, 29(3). https://doi.org/10.1007/s43032-021- 00829-3.  

[3] Epstein, K. (2024, February 22). Major Alabama hospital pauses IVF after court rules  frozen embryos are children. www.bbc.com. https://www.bbc.com/news/world-us-canada 68366337. 

[4] Baker, L. (2024, March 6). Alabama lawmakers pass IVF immunity legislation. NPR.  https://www.npr.org/2024/03/06/1235907160/alabama-lawmakers-pass-ivf-immunity legislation.  

[5] Eskew, A. M., & Jungheim, E. S. (2017). A History of Developments to Improve in vitro  Fertilization. Missouri Medicine, 114(3), 156–159. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140213/.

Learning to Exercise With, Not Against, Your Cycle 

Autism in Women: Why it Can Easily Fly Under the Radar 

Rachel Moseley, a Psychology Lecturer at Bournemouth University, recounts how she had endured bullying, social isolation, and depression throughout her adolescence.^[2] Her strange incapability to fit in with everyone else was a shadow that loomed over her head for years.^[2] However, when she received an autism diagnosis during adulthood, it felt like a “light in the darkness.”^[2] She stopped blaming herself for her differences and found her footing in the world. 

Still, this revelation isn’t the norm for many autistic women; in truth, autistic women constantly struggle to be understood by friends, family, and even medical professionals.^[2] 

Society’s View of Autistic Men vs Autistic Women^[1][4] 

The medical world has largely treated autism as a traditionally “male” condition, with studies showing that men are four times more likely than women to receive a diagnosis successfully.^[1][4] The traits and behavior problems autistic men display are a contributing factor, since they tend to be obvious and visible, such as aggression or hyperactivity.^[4] On the other hand, women tend to internalize their symptoms, with these categorized as the following: sensory sensitivity, intense interests, social difficulties, and often coexisting conditions (ADHD, eating disorders, depression, etc.).^[2][3][4] 

It doesn’t help that the comprehension of autism within the medical community derives mostly from research conducted on autistic men^[3] This leads to medical professionals having a minimal understanding of autistic traits unique to women. They’re more likely to brush off women seeking an autism diagnosis, discouraging women from ever seeking professional help again. 

The Truth Behind the Mask 

As autistic girls grow up, most become adept at hiding their autistic traits. Incidentally, there is a word that autistic women use to describe this behavior: masking.^[1][2] They may mimic the behavior of people nearby, force themselves to make eye contact with others, or prepare jokes and phrases in advance for a social setting.^[4] 

In an autistic woman’s world, every social interaction is a challenge—not a time for leisure. If

they slip up, they risk becoming prime targets for harassment and bullying.^[2] Therefore, their “social disguise” becomes the only way they can feel they can navigate their lives. Still, this mask isn’t without its drawbacks. Suppression of their symptoms undoubtedly contributes to the low diagnosis rates.^[4] 

The Grim Consequences of Going Unnoticed 

Studies show that autistic women have higher rates of poor mental health compared to autistic men.^[4] When their narratives are weaved by neglect and powerlessness, it’s no surprise that this is the reality. It also seems that the time of diagnosis and mental health are inextricably connected.^[4] An earlier diagnosis naturally leads to fewer mental health risks, while a later or even no diagnosis fuels the deadly flames of mental illness. 

Sometimes, the outcome is a grim one—indeed, there are high rates of suicide among undiagnosed autistic women. 

A Rocky Road to Support 

Many autistic women who struggle to obtain a professional diagnosis often peruse online forums and social media for a like-minded community of autistics. While this is certainly beneficial, it should not be the only way they feel they can comfortably find help. A professional diagnosis can provide easier access to a multitude of resources.^[3] For instance, it can open up the pathway to receiving cognitive behavioral therapy (CBT), social skills training, or medications for coinciding mental illnesses.^[1][3] Also, it can provide a welcomed gift of validation and support that autistic women have long craved 

The truth is this: when we focus on increasing awareness, we give autistic women the courage to seek out a diagnosis, bolstering their chances of attaining acceptance and freedom from shame. 

References 

[1] Autism in Women: Why We Get Diagnosed Late. A Center for Mental Wellness. https://www.acfmw.com/autism-in-women-why-we-get-diagnosed-late 

[2] Moseley, Rachel. (2023). Like many women, I didn’t know I was autistic until adulthood – how late diagnosis can hurt mental health and self image. The Conversation. https://theconversation.com/like-many-women-i-didnt-know-i-was-autistic-until-adulthood-how late-diagnosis-can-hurt-mental-health-and-self-image-212561 

[3] Osborn, Corrine. (2023). Understanding Autism in Women. HealthLine. https://www.healthline.com/health/autism-in-women#takeaway[4] UCLA Health. (2023). Understanding undiagnosed autism in females. Ucla Health. https://www.uclahealth.org/news/understanding-undiagnosed-autism-adult-females

Scientists have proven that humans have been reading and writing for about 5,000 years.^[4] This can be traced back to 3,000 BCE in Ancient Mesopotamia.^[4] Literacy rates have drastically risen in the last 200 years.^[4] Reading has not only been used for acquiring knowledge and information from academic fields, but has long been a staple activity done for pleasure. I am unsure if it was always consciously well-known, but reading has now been proven to impact mental health. 

I fell in love with books at the tender age of 4. Once I learned how to read on my own, I became consumed by a plethora of stories written by children’s authors. My love for reading evolved as time went on. As a teen, reading became an escape from the effects of teenage angst. In a 2021 study by Civic Science, it was discovered that 44% of adults read for fun every single day. Therefore reading is a healthy escape.^[3] 

When you go to the doctor, they sometimes ask you if you have been experiencing any stress or anxiety lately. Stress levels are at an all-time high due to the state of the world. Relational and systemic problems plague our daily lives. If your doctor advised you to read more as a form of routine stress management, would you do it? We are often tense, we may feel our muscles aching and our chests tightening when feeling stressed. “Reading can lower your heart rate and ease tension in your muscles.”^[2] 

I mentioned that reading was an escape from my teenage angst and it is still one of my favorite escapes. Reading is deemed a healthy escape for a multitude of reasons. It helps us to become more creative, more understanding, feel less alone, etc. Most people can create visuals as they read. This allows them to become further entrenched in what they are reading. Literary fiction, in particular, has been found to improve empathy. This is due to the fact that “literary fiction focuses more on the psychology of characters and their relationships.”^[1] I am an avid reader of literary fiction and I become enthralled by the inner worlds of a character or all characters presented in a story through introspective dialogues. Literary fiction is a genre that emphasizes social behaviors and often teaches readers about human differences. This, in turn, may help us to develop a better understanding or empathy for those who are different from us. At the same time, we must keep in mind that different book genres can help us become more resilient, and empathetic as well as help us with social skills, mindfulness, and so on.

I have recently discovered “Bibliotherapy.” According to Psychology Today, it is a mental health intervention that is basically reading therapy. “It mainly refers to structured book reading programs run by libraries, clinics, or schools with the purpose of promoting recovery in people with mental health difficulties. The term bibliotherapy is also used to refer to self-initiated book reading pursued by an individual with mental illness. This can be supported by a clinician, family member or peer supporter, or pursued alone.” ^[5] 

“Several studies have examined whether bibliotherapy can facilitate recovery from mental illness.”^[5] According to multiple studies, women read more than men do. However, reading can benefit everyone’s mental health, and I would like to encourage people to try finding books or genres that they enjoy reading. If you do not like to read physical books or e-books, you can try listening to audiobooks. While reading will not fully eradicate the mental health crisis in the United States, it can improve your mental health. 

Reading should be accessible to everyone. There are often literacy programs at public libraries that will assist in learning how to read. I would also like to encourage others to obtain a library card. “I am aware that this is not always possible due to not having a permanent home address, among other reasons, among other reasons, but it is worth trying.” A library card can give you access to free books and programs in person and through apps like the Libby app. Additionally, places to purchase inexpensive books include eBay and local used bookstores. Since reading can be a healthy coping strategy, it is important to be aware of the benefits that reading can offer to individuals and the benefits to mental health. Reading may have a surprising impact on your life! 

References

[1] Chiaet, J. (2013, October 4). Novel Finding: Reading Literary Fiction Improves Empathy. Scientific American. https://www.scientificamerican.com/article/novel-finding-reading-literary-fiction-improves-empa thy/ 

[2] National Alliance on Mental Illness. (2020). Why Reading is Good for Mental health. NAMI California. https://namica.org/blog/why-reading-is-good-for-mental-health/ 

[3] Rittenberg, J. (2021, June 10). 44% of U.S. Adults Who Like to Read, Do So for Fun Every Day. CivicScience. https://civicscience.com/44-of-u-s-adults-who-like-to-read-do-so-for-fun/#:~:text=In%20a%20ne w%20survey%2C%20CivicScience,for%20fun%20every%20single%20day.

[4] University of Texas Permian Basin. (2024). The Evolution of Literacy Education. University of Texas Permian Basin. 

[5] Whitley, R. (2019, May 24). Can Reading Books Improve Your Mental Health?. Psychology Today. https://www.psychologytoday.com/us/blog/talking-about-men/201905/can-reading-books-improv e-your-mental-health

Despite the amount of biology, anatomy, and even sex education classes taught in schools, the vast majority of people still do not grasp the basic foundational knowledge of menstruation or female health and sexuality in general. Unfortunately, this can be for so many reasons such as the unwillingness of society or the government to invest in women’s health education, the idea of menstruation or female sexuality being shameful, a taboo, or just simply “disgusting” or “unimportant.” 

It is time to start from scratch. 

Menstruation is simply monthly bleeding that occurs in the female body, famously known as the “period,” or jokingly, “the time of month.” It is the biological flow of blood and tissue, from the shedding of the uterine lining traveling all the way to the cervix and then eventually unleashed through the vagina. Not the vulva. The vulva is the external part of the female genitals while the vagina is the inner muscular channel that connects the vulva to the cervix. 

As a whole, the menstrual cycle is the sequence of events or phases that take place in the body to prepare for pregnancy and reproduction. The normal average length of a menstrual cycle is 28 days. There are four phases: menstrual, follicular, ovulation, and lumenal phases. This guide will explain all of the phases of cycles in the simplest ways possible. 

Menstrual Cycles

Menses Phase

Starting with day one, if pregnancy still has not occurred, the lining of the uterus( endometrium) shreds through the vagina. 

Follicular Phase

This is the first day of the period when estrogen levels increase which leads to the uterine lining growth and thickness 

Ovulation Phase

This is the last day of the period where you ovulate. At this time, estrogen is still on the rise but along the way, there was a sudden rise in another hormone. This hormone is called the luteinizing hormone aids in making the ovary unleash its eggs. 

Luteal Phase

After the eggs get unleashed from the ovary and make their way through the fallopian tubes to the uterus, the level of progesterone begins to increase in the process of preparing the uterine lining for pregnancy. 

Pregnancy will occur if the egg becomes fertilized with sperm and the egg becomes implanted too. However, if not then all levels of hormones will drop and the thick lining of the uterus sheds during the period. 

If you would like to learn more about menstruation and the menstrual cycle in detail then stay tuned for future articles explaining cycles and more detailed information about menstruation. 

References

[1] Parenthood, Planned. “What Is Menstruation?: Get Facts about Having Your Period.” Planned Parenthood, professional.
[2] Cleveland Clinic Medical. “Menstrual Cycle (Normal Menstruation): Overview & Phases.” Cleveland Clinic.

The speculum is often cited as the most uncomfortable part of a gynecologist visit.^[10] It lies at the center of an important preventative health care service: the pelvic exam.^[16] The speculum is a medical instrument that has two arms that meet at a hinge – the arms look similar to a duck’s bill.^[6] The health care provider inserts the speculum into the vagina and opens the speculum to widen the vaginal walls so the provider can view the vagina and cervix more easily.^[6] For many individuals, the speculum causes pain and discomfort.^[4] This is unsurprising given that the modern speculum has remained essentially unchanged since 1870.^[15] In addition, physicians have not yet widely adopted practices that may reduce a patient’s pain and anxiety during the pelvic exam.^[7]

The speculum’s origins may inform some of the issues patients experience today. The modern speculum has a legacy of causing pain: it was invented by James Marion Sims in the 1840s when he conducted experiments on slave women – Lucy, Anarcha, and Betsey – without anesthesia even though it was available at the time.^[12] Needless to say, the speculum was not designed with the patient’s comfort in mind. Sims did not use anesthesia while developing the speculum because he held the erroneous belief that black people did not experience pain like white people did.^[12] In addition, the women were further stripped of their autonomy because Sims only required consent from their owners to conduct the experiments.^[12] Today, around 35% of women* experience pain or discomfort during pelvic exams and about 35% of women experience fear, embarrassment, or anxiety before or during the pelvic exam.^[4] 

The speculum is not specialized enough to be used for all populations who require its use.^[24] Since pain and emotional discomfort are subjective experiences, providers should utilize an individualized approach for speculum insertion and pelvic exams.^[19] As Roger Fillingim, director of the Pain Research and Intervention Center of Excellence at the University of Florida, indicates, “you treat the pain that the patient has, not the pain that you think the patient should have.”^[3] According to various studies, it appears that educating patients about pelvic exams and specula as well as encouraging patients’ personal control during the exam may decrease pain and emotional discomfort.^[8],[19] Informing patients that pain is not normal and informing them of pain management options may improve patient outcomes during pelvic exams as patients can try to mitigate the pain before it occurs.^[20] Given that the pelvic exam places people in a vulnerable position, it makes sense that bolstering the patient’s autonomy could ease the psychological discomfort surrounding the exam.^[9] For example, based on research findings, certain women indicated that they would feel more comfortable with the speculum insertion if their provider informed them of each step of the process or allowed them to look at the speculum before the exam.^[24],[9] Others indicated that they would likely feel more comfortable if the provider gave them the option to insert the speculum themselves.^[2]

While pain and emotional discomfort should be considered for updating the speculum and how it is used, such issues are trivialized when reported by women. Women’s pain is often perceived as an overreaction rather than reality in part because women are more likely to express pain.^[3] More often, physicians prescribe less pain medication for women than for men.^[11]

Providers also seem unwilling to adopt new specula into practice if they have not been rigorously tested because the current speculum is the standard.^[24] There are both economic barriers and social barriers to testing. Historically, women have been excluded from medical research. For example, the National Institute of Health did not require that scientists account for sex as a variable in medical research until 2015.^[22] It also appears that there is a gender bias against studying medical issues that primarily affect women. When analyzing funding allocation among diseases, the United States National Institutes of Health applied a disproportionate portion of its resources to diseases primarily affecting men.^[17] Issues arising from the use of the speculum or updates to the procedure have likely not been addressed or publicized to the majority of the population given that the last general overview of the speculum was published in 2008.^[24] 

In addition to the unwillingness to fund research surrounding speculum updates, doctors may not adopt new tools or updated practices due to cost. The current speculum is inexpensive, rarely needs replacing, and is easy for practitioners to use.^[7] Lack of insurance coverage and limited provider time to see patients may affect the provider’s ability to utilize pain management options or individualized solutions to pain and emotional discomfort.^[7]

By failing to address the physical and emotional harm the speculum causes, women’s health is impacted. For example, while cervical cancer is preventable through regular screenings, researchers have found that the rates of timely cervical cancer screenings for eligible adults have decreased since 2005.^[23] One of the main ways to screen for cervical cancer is through a pap smear, also known as a pap test, during the pelvic exam.^[18] Using the speculum, the health care provider checks for any irregularities and then collects cells from the cervix that are later tested for signs of cervical cancer.^[6] According to data from 2018, only about 51% of women go to the gynecologist at least once per year^[14]. Lack of access to health care remains a significant problem for marginalized groups, especially Black women.^[13] However, lack of access as a reason for being overdue for a cervical screening declined overall.^[23] By contrast, pain continues to be a significant factor in whether people continue seeking cervical cancer screenings.^[13] More specifically, some studies indicate that people refrain from seeking cervical cancer screenings because they have experienced pain during the pap smear in the past.^[13] The decline is screenings is concerning considering the American Cancer Society estimates that there will be approximately 13,820 new cases of invasive cervical cancer diagnosed in 2024.^[1]

In order to improve patient experiences and reproductive health overall, it appears more funding is required for speculum updates. Patients should also be better informed about the speculum and the pelvic exam. Lastly, providers should become zealous advocates for their patients and make their patients feel comfortable undergoing these essential diagnostic procedures. 

*This article uses “women” and “men” when the underlying source uses these categories. This article recognizes that women are not the only population that goes to the gynecologist.

References 

[1] American Cancer Society. (2024, January 17). Key Statistics for Cervical Cancer. Cervical Cancer Statistics. https://www.cancer.org/cancer/types/cervical-cancer/about/key-statistics.html. 

[2] Bergman, S. (2022, June 20). How enduring use of 150-year-old speculum puts women off smear tests. The Independent. Retrieved February 10, 2024, from 

https://www.independent.co.uk/life-style/women/speculum-use-smear-tests-pain-sexism-b21051 11.html. 

[3] Bever, L. (2023, December 13). From heart disease to iuds: how doctors dismiss women’s pain. The Washington Post. Retrieved February 10, 2024, from https://www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/.

[4] Bloomfield H.E., Olson A., Cantor A., et al. Screening Pelvic Examinations in Asymptomatic Average Risk Adult Women. Washington (DC): Department of Veterans Affairs (US); 2013 Sep. RESULTS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224895/ 

[5] Chaney, P. (2020, March 18). Speculum Speculations: The Past and Future of an Iconic Gynecology Instrument. Empowered Women’s Health. https://www.volusonclub.net/empowered-womens-health/speculum-speculations-the-past-and-fut ure-of-an-iconic-gynecology-instrument/#:~:text=The%20speculum%20is%20a%20familiar,unc hanged%20for%20over%20150%20years. 

[6] Cleveland Clinic. (2022, October 3). Speculum. Speculum: Design, Purpose, Types, Exams & What to Expect. https://my.clevelandclinic.org/health/drugs/24238-speculum 

[7] Davenport, E. (2023, June 15). Let’s liberate women from the speculum. The Boston Globe. Retrieved February 10, 2024, from https://www.bostonglobe.com/2023/06/15/opinion/liberate-women-from-the-speculum/.

[8] Domar A.D., Psychological aspects of the pelvic exam: individual needs and physician involvement. Women Health. 1985-1986 Winter;10(4):75-90. doi: 10.1300/j013v10n04_07. PMID: 3832651. 

[9] George, R. (2018, April 23). How to redesign the vaginal speculum. The Guardian. Retrieved February 10, 2024, from https://www.theguardian.com/lifeandstyle/2018/apr/23/how-to-redesign-the-vaginal-speculum.

[10] Haar, E., Halitsky, V., & Stricker, G. (1977). Patientsʼ Attitudes toward Gynecologic Examination and to Gynecologists. Medical Care, 15(9), 787–795. https://doi.org/10.1097/00005650-197709000-00006.

[11] Hoffmann, D. E., & Tarzian, A. J. (2003). The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. The Journal of Law, Medicine & Ethics, 13–27. https://doi.org/10.2139/ssrn.383803.

[12] Holland, B. (2018, December 4). The ‘Father of Modern Gynecology’ Performed Shocking Experiments on Enslaved Women. History.com. https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experimen ts-on-slaves 

[13] Hoyo, C., Yarnall, K. S. H., Skinner, C. S., Moorman, P. G., Sellers, D., & Reid, L. (2005). Pain predicts non-adherence to pap smear screening among middle-aged African American women. Preventive Medicine, 41(2), 439–445. https://doi.org/10.1016/j.ypmed.2004.11.021 

[14] IPSOS Global Advisor. “Global Views On Healthcare.” IPSOS, 2018, www.ipsos.com/sites/default/files/ct/news/documents/2018-07/global_views_on_healthcare_201 8_-_graphic_report_0.pdf. 

[15] Kent, C. (2020, September 10). Does the vaginal speculum need a redesign?. Medical Device Network. https://www.medicaldevice-network.com/features/does-the-vaginal-speculum-need-a-redesign/?c f-view. 

[16] Mayo Clinic Staff. (2023, May 24). Pelvic exam. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/pelvic-exam/about/pac-20385135.

[17] Mirin, A. A. (2021). Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health. Journal of Women’s Health, 30(7), 956–963. https://doi.org/10.1089/jwh.2020.8682

[18] National Cancer Institute. (2023, August). Cervical Cancer Screening. Cancer Trends Progress Report. https://progressreport.cancer.gov/detection/cervical_cancer.

[19] Nudson, R. (2022, June 1). Gynecology Has a Pain Problem Our discomfort is routine. what if it didn’t have to be? The Cut. Retrieved February 10, 2024, from https://www.thecut.com/2022/06/pain-in-gynecology-practice-exams.html.

[20] Oregon Health and Science University. (n.d.). Closing the Gender Pain Gap: Your Gynecologist Has Pain Control Options. Center for Women’s Health. 

https://www.ohsu.edu/womens-health/closing-gender-pain-gap-your-gynecologist-has-pain-contr ol-options. 

[21] Pardes, A. (2017, October 5). The speculum finally gets a modern redesign. Wired. Retrieved February 10, 2024, from 

https://www.wired.com/story/the-speculum-finally-gets-a-modern-redesign/#:~:text=That%20the %20speculum%20is%20old,get%20a%20good%20look%20inside. 

[22] U.S. Department of Health and Human Services. (n.d.). Not-OD-15-102: Consideration of sex as a biological variable in NIH-funded research. National Institutes of Health. https://grants.nih.gov/grants/guide/notice-files/not-od-15-102.html?itid=lk_inline_enhanced-tem plate. 

[23] Winstead, E. (2022, February 22). Why Are Many Women Overdue for Cervical Cancer Screening?. Rate of Overdue Cervical Cancer Screening Is Increasing. 

https://www.cancer.gov/news-events/cancer-currents-blog/2022/overdue-cervical-cancer-screeni ng-increasing#:~:text=Results%20on%20cervical%20screening%20from,2005%20to%2023%25 %20in%202019. 

[24] Wong, K., & Lawton, V. (2021). The Vaginal Speculum: A Review of Literature Focusing On Specula Redesigns and Improvements to the Pelvic Exam . Columbia Undergraduate Research Journal, 5(1). https://doi.org/10.52214/curj.v5i1.8084.

Whether we are talking about the people conducting and authoring research or the individuals who serve as the participants in the studies, the same fact remains true; women are disproportionately underrepresented in medical research. 

Background

This is not a new phenomenon. In fact, conditions today are much better than they used to be.  Historically, researchers have held the misguided view that females’ biology is more “variable”  than male’s due to their hormonal cycles, providing them a reason to exclude female subjects  (both humans and rats) from clinical trials.^[1] 

True Differences 

There are important differences to be noted between women and men on certain medications.  Women tend to experience higher blood drug concentrations and often take longer to eliminate a drug from their body, making it incredibly necessary to test new drugs on both men and women.^[1] In certain sectors such as cardiology, women are also found to be more likely than men to have side effects from medication at the same dose.^[2]  

The same remains true for women in the medical research workforce, with only 9% of graduates in 1970 identifying as women.³ Despite this growing to 48% in 2018, leadership positions in medicine have not reflected the same rising trend. Women remain underrepresented in full-time medical school staff, research investigators, department chairs, and deans.^[3] 

Despite progress in terms of the number of women authors of published research, the change is not reflected in positions of authority. Women are still underrepresented in senior authorship positions and significantly less likely to be named in the positions regarded as most prestigious,  first and last, when the authors are listed.^{[4, 5]} 

Harmful Exclusion  

Addressing this problem in clinical research involves first understanding the extent of harm caused by the unbalanced inclusion of participants in the scientific world. Once a study is complete,  the findings are intended to be adopted into the target population to improve outcomes.^[6] However, if the majority of male participants are included, the results will not be generalizable to the entire human population.  

This can result in major consequences for women who are recommended a regimen of medication that has only been tested on men. For clinical trials in cardiovascular disease, the leading cause of death among women, rates of female participation sit around 29%.^[2] This has huge consequences for drugs that affect the genders differently as a recent study found women obtained the optimal benefit from a heart failure drug at just 50% of the dose that men need.[2]  This isn’t just true for medications either. When it comes to implantable devices like defibrillators, women are markedly underrepresented in trials.^[2] Landmark research trials report rates as low as 14% for female participants, raising huge concerns over the efficacy of these devices in different bodies.^[2] 

Finding the Cause 

There is a range of reasons as to why women disproportionately fail to participate in trials.  Remaining beliefs surrounding the increased difficulty of studying women no doubt play a role.  Women also face unique barriers to clinical trial participation such as the logistical barriers that come with often being responsible for children in a caregiving role.^{[2, 6]} This holds true for those serving as research participants in clinical trials as well as those attempting to gain higher-ranking academic and industry positions.^[3] Women also tend to be perceived as less committed or able due to their additional life responsibilities leading to less opportunities and income.^[3] The issue of representation in research and medicine may seem benign, but in reality, it has far-reaching consequences for both women’s health and success in the workplace. Excluding women from these areas leads to medical consequences for inadequately studied pharmaceuticals as well as the perpetuation of harmful stereotypes surrounding the perception of women in medicine that only reinforces this dangerous cycle.^[7]

References

[1] Zucker, I., Prendergast, B. J., & Beery, A. K. (2022). Pervasive Neglect of Sex Differences in  Biomedical Research. Cold Spring Harbor perspectives in biology, 14(4), a039156.  https://doi.org/10.1101/cshperspect.a039156 

[2] Cho, L., Vest, A. R., O’Donoghue, M. L., Ogunniyi, M. O., Sarma, A. A., Denby, K. J., Lau,  E. S., Poole, J. E., Lindley, K. J., Mehran, R., & Cardiovascular Disease in Women Committee  Leadership Council (2021). Increasing Participation of Women in Cardiovascular Trials: JACC

Council Perspectives. Journal of the American College of Cardiology, 78(7), 737–751.  https://doi.org/10.1016/j.jacc.2021.06.022 

[3] Blumenthal, K. G., Bansal, P., Youssef, C. M., & Pappalardo, A. A. (2023). Women in  Allergy and Immunology: The Future Is Female, Let Us Soar!. The journal of allergy and  clinical immunology. In practice, 11(12), 3569–3577. https://doi.org/10.1016/j.jaip.2023.06.010 

[4] Bagga, E., Stewart, S., Gamble, G. D., Hill, J., Grey, A., & Dalbeth, N. (2021).  Representation of Women as Authors of Rheumatology Research Articles. Arthritis &  rheumatology (Hoboken, N.J.), 73(1), 162–167. https://doi.org/10.1002/art.41490 

[5] N. Pyatigorskaya & L. Di Marco. (2017). Women authorship in radiology research in France:  An analysis of the last three decades, Diagnostic and Interventional Imaging, 98(11), 769-773.  https://www.sciencedirect.com/science/article/pii/S2211568417301912 

[6] Bierer, B. E., Meloney, L. G., Ahmed, H. R., & White, S. A. (2022). Advancing the inclusion  of underrepresented women in clinical research. Cell reports. Medicine, 3(4), 100553.  https://doi.org/10.1016/j.xcrm.2022.100553 

[7] Wanted: women in research. (2010). Nature neuroscience, 13(3), 267.  https://doi.org/10.1038/nn0310-267