Women’s Health: Then and Now

By Robert Israel
Vital Signs Editor

At the April 21 MMS Women’s Health Forum, “Hormones: Do They Define Us?,” to be held at the Waltham Conference Center at MMS Headquarters, two keynote speakers, JoAnn Manson, M.D., Dr.P.H., and Barbara L. Smith, M.D., Ph.D., will share insights into the origins and current efforts of their pioneering work as physicians and researchers — and providers who are dedicated to the care of women.

Both physicians will be honored by the MMS: Dr. Manson, an endocrinologist and chief of the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston, will be presented with the 2017 Women’s Health Research Award. Dr. Smith, director of the Breast Program and co-director of the Women’s Cancers Program at Massachusetts General Hospital, will receive the 2016 Women’s Health Award.

Dr. Manson, one of the principal investigators of the Women’s Health Initiative (WHI), has published extensively on the pendulum swings regarding menopausal hormone therapy (HT). In an in-depth analysis and overview of the WHI findings, published in the Journal of the American Medical Association in 2013, she and her colleagues demonstrated that women in early menopause (or below age 60) at the time of HT initiation had more favorable results for heart disease and all-cause mortality than those starting HT at older ages.

“The WHI spurred a seachange in how HT was prescribed by the medical community,” Dr. Manson said. “After more detailed analyses, women and their clinicians were better able to understand the benefits and risks of hormone therapy.”

In her subsequent 2016 Perspective article published in the New England Journal of Medicine, “Menopause Management: Getting Clinical Care Back on Track,” Dr. Manson advised that this improved and refined understanding of the benefits and risks of HT should be shared among practitioners and “the new generation of medical graduates and primary care providers who often lack training and core competencies in management of menopausal symptoms and prescribing of hormonal (or nonhormonal) treatments.”

Advancing Cancer Treatment

Dr. Smith’s work on surgery for women with breast cancer opened the door for improved patient outcomes with less-invasive intervention.

“Breast surgery from the 1890s through to the 1980s was very harsh, cancers were advanced, and it was accepted that mastectomy was part of the cancer treatment,” Dr. Smith said. “When I started my career in the 1980s, we were conducting lumpectomies, and this came about due to the advancement of medical science, but also because of our collaborations with our patients. It was from those early collaborations with women who demanded that we find better ways of treating the disease that we have been able to achieve better outcomes.”

Another significant advancement, Dr. Smith said, is the multidisciplinary approach to health care that has evolved over the years. This approach collects the opinions of a group of specialists who then share their findings with patients and can recommend multimodality treatment. Patients gain a new sense of confidence that all their options are being explored. This approach is coupled with the use of technological advancements that enable physicians to “tailor the amount of surgery” needed for each patient, Dr. Smith said.

“The buzzword today,” she added, “is image-guided surgery. This allows us to be even more precise in treating cancer by making tumor targets microscopically clear so we can treat them in a personalized approach.”

The activism by women patients insisting on better treatments and better outcomes continues to inspire physicians and researchers, according to Dr. Smith.

“It’s about wanting to help people,” she said, “and striving to provide better resources. It’s not only gratifying, it’s energizing, too.”

At the April 21 event, Dr. Manson will speak on “Lessons from the Women’s Health Initiative HT Trials: Evolving Data That Has Changed Clinical Practice,” at 8:45 a.m. Dr. Smith’s presentation, “Breast Surgery: Now and Then,” will be at 1:45 p.m.

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