Women's Health Research Progress, Pitfalls, and Promise (2010) / Chapter Skim
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6 Synthesis, Findings, and Recommendations
6 Synthesis, Findings, and Recommendations
Pages 273-292
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From page 273... ...
Numerous conditions could be included in such a list. The committee could not review all such conditions and, therefore, highlights a number of such conditions as examples that are specific to women because of differences in prevalence, severity, preferred treatment, or understanding or because the condition is prominent in women or there is a research need regarding women, whether or not there are sex differences.
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From page 274... ...
Many intervention programs show promise, but most have not been well tested, and the health effects of smoking, such as cardiovascular disease and lung cancer, are still the leading killers of women. Similarly, interventions to improve eating habits, increase physical activity, decrease sexual risk behavior, and decrease substance abuse have not been as successful as they need to be to improve women's health.
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From page 275... ...
Some of the research findings and the progress that has been made against a number of conditions are summarized briefly below. Conditions on Which Research Has Contributed to Major Progress Through its review of the literature, the committee identified three conditions in which scientific research led to major progress with respect to improvements in prevention, diagnosis, or treatment that resulted in substantial reductions in inci dence or mortality: breast cancer, cardiovascular disease, and cervical cancer.
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From page 276... ...
The WHI demonstrated that a given drug or treatment -- in this case, con jugated equine estrogen with or without progestin -- could have adverse effects on some conditions (for example, breast cancer, stroke, embolism, and gall bladder disease) while having beneficial effects on others (for example, reducing the risk of bone fracture)
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From page 277... ...
Sex differences in the underlying physiology and manifestation of cardiovascular disease have been documented. Data from women-only studies have contributed to the knowledge base of cardiovascular disease in women.
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From page 278... ...
Conditions on Which Little Progress Has Been Made The committee identified a number of conditions on which little progress has been made in reducing incidence, morbidity, or mortality. Unintended pregnancy and autoimmune disease are highlighted below as examples of conditions on which there has been little progress.
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From page 279... ...
For example, there has been little progress in lung cancer despite a large amount of research, including some research on sex differences. The committee identified a number of potential reasons for the lack of progress, including degree of attention from government agencies, consumer advocate groups, and Congress and resulting research funding; availability of interested researchers trained in a given field; adequacy of understanding of the underlying pathophysiology and natural history of a condition; adequacy of understanding of behavioral factors associated with decreased risk; availability of sensitive and specific diagnostic tests and screening programs to identify individuals who are at risk for or have a condition; and nonmedical barriers associated with political or social concerns.
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From page 280... ...
The postmenopausal hormone therapy and the calcium and vitamin D components of the WHI were randomized clinical trials that were based on the findings from such observational research. In addition, the observational studies led to animal and in vitro studies aimed at elucidating the pathophysiology of conditions and identifying potential treatments.
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From page 281... ...
As outlined in NIH guidelines, clinical research should take advantage of previous epidemiologic studies, smaller human studies, and available incidence, preva lence, and mortality data to identify where sex, racial, and ethnic differences have been documented (NIH, 2001)
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From page 282... ...
Social and cultural factors can be barriers to the translation of scientific findings regardless of scientific consensus, especially in connection with sexual mores, as occurred with a vaccine against HPV that has the potential to prevent most cases of cervical cancer. Socioeconomic status, immigration status, and
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From page 283... ...
Lessons learned from the WHI, mammography, and cardiovascular disease highlight both the challenges to and the successes in the translation and com munication of research findings. The results of the WHI were disseminated to women, both study participants and the general public, through the mass media and health-care providers.
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From page 284... ...
Research on prevention of and treatment for Alzheimer's disease, obesity, and diabetes has rarely examined sex differences. There is little information on autoimmune diseases that affect women disproportionately, such as rheumatoid arthritis, lupus, and other potentially related immune system disorders.
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From page 285... ...
Large-scale studies -- such as the WHI, which included both observational and experimental arms and considered multiple end points -- provided some of the needed data from that perspective. Its overall history demonstrates the limitations of using only observational studies even if they are based on a good understanding of the molecular and cellular basis of sex differences, and also shows their synergistic value in developing targeted prevention and treatment strategies Genetic and pathophysiologic studies are increasingly providing information on risk factors for conditions and potential treatment options on an individual level.
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From page 286... ...
Finding 1 Investment in women's health research has afforded substantial progress and led to improvements in women's health with respect to such important conditions as some cancers and heart disease. Greater progress in women's health has oc curred in conditions characterized by multipronged research involving molecular, animal, and cellular data; in observational studies to identify effects in the overall population; and in clinical trials or intervention studies from which evidencebased conclusions on treatment effectiveness can be drawn.
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From page 287... ...
Finding 3 The incidence, prevalence, morbidity, or mortality associated with a number of conditions -- for example, unintended pregnancy, maternal mortality and morbid ity, nonmalignant gynecologic disorders, alcohol- and drug-addiction disorders, autoimmune diseases, and lung, ovarian, and endometrial cancer -- have not improved. Most of those conditions substantially affect the quality of life of those who experience them.
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From page 288... ...
Finding 5 Limitations in the design, analysis, and scientific reporting of health research have slowed progress in women's health. Inadequate enforcement of recruitment of women and of reporting data by sex has fostered suboptimal analysis and reporting of data on women from clinical trials and other research.
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From page 289... ...
Recommendation 6 Research should be conducted on how to translate research findings on women's health into clinical practice and public-health policies rapidly. Research findings should be incorporated at the practitioner level and at the overall public-health systems level through, for example, the use of educa tion programs targeted to practitioners and the development of guidelines.
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From page 290... ...
Relevant knowledge from studies of communication often is not used by researchers, funders, providers, and public-health professionals to target health messages and information to women. Recommendation 7 The Department of Health and Human Services should appoint a task force to develop evidence-based strategies to communicate and market health messages that are based on research results to women.
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From page 291... ...
2007. Recent trends in breast cancer incidence rates by age and tumor characteristics among US women.
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From page 292... ...
2005. Rethinking gender differences in health: Why we need to integrate social and biological perspectives.
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