Physical Health Issues 515(see Newton et al., 2000). Women tend to develop heart dis-
ease 10 years later in life on average than do men and
are more likely to have chronic, comorbid risk factors (e.g.,
diabetes and hypertension), which can make diagnosis,
detection, and treatment of heart disease extremely dif“cult
(Of“ce on Women•s Health [OWH], 2000). Studies con-
ducted with men have indicated that modi“cation of risk
factors (e.g., lipid levels, blood pressure, smoking) helps
decrease mortality and morbidity (Ness, 2000). Although
alteration of these risk factors in women would yield the
same results, research in this area remains sparse and there-
fore inconclusive.
Heart attack symptoms in women often differ from those
in men, resulting in women not seeking medical attention
promptly or having their symptoms misdiagnosed (Malacrida
et al., 1998). The results of the Worcester Heart Study, a large
population-based investigation, found that women more
commonly experience neck, back, jaw pain, and nausea than
men, whereas chest and arm pain are experienced at similar
rates (Goldberg et al., 1998). Further research is needed to
examine gender differences in symptom presentation to pre-
vent the delay of a CHD diagnosis in women to the later
stages of the disease when prognosis is poor, or from having
the disease go completely undetected.
Research has indicated that sex and ethnic racial status can
determine the course of treatment for patients with CHD. For
example, Schulman et al. (1999) found that the sex and eth-
nic racial status of a patient in”uenced whether a physician
referred patients with chest pain for cardiac catheterization.
In this study, different actors portrayed patients with identical
histories, and researchers controlled for personality charac-
teristics. Regardless of patients• clinical presentation, these
physicians were less likely to recommend cardiac catheteri-
zation for women; this was particularly true for African
American women.
Likewise, Steingart et al. (1991) found that physicians
tend to be less aggressive in their management approach to
CHD in women than in men. Women with CHD were less
likely to undergo cardiac catheterization and coronary bypass
surgery than men. The results could not be accounted for by
coronary risk factors or cardiovascular medications, two
reasons a physician may use a less aggressive approach.
Women reported more cardiac disability than men but were
less likely to undergo aggressive procedures to address their
symptoms or improve functioning. Similarly, women who
are hospitalized for CHD undergo fewer diagnostic and ther-
apeutic procedures than men (Ayanian & Epstein 1991;
D•Hoore, Sicotte, & Tilquin, 1994). Ayanian and Epstein
found that hospitalized men with diagnosed or suspected
CHD were more likely to undergo coronary angiography and
revascularization procedures even when they adjusted for
possible clinical and demographic confounding variables.
However, researchers are careful to note that further research
should be done in this area to explore the reasons for this un-
derutilization because it is possible that certain procedures
may not be appropriate for women.
In summary, women with CHD often display different
symptomatology than men with CHD, which may help ex-
plain why women delay seeking treatment. Subsequently,
prevention efforts should focus on educating women and
health care practitioners about the typical symptoms of CHD
among females to facilitate women in seeking prompt med-
ical attention when CHD symptoms arise. In addition, pre-
vention efforts should focus on publicizing risk factors for
CHD in women and developing strategies to reduce and man-
age risk factors, especially among African American women,
who have the highest risk of developing CHD and the worst
prognosis after myocardial infarction. Furthermore, studies
indicate physicians are less likely to perform aggressive
coronary techniques (e.g., cardiac catheterization and coro-
nary bypass surgery) on women than men, and further re-
search is warranted to assess whether this underutilization is
appropriate. Although CHD mortality rates are higher for
women than men, practically all studies on risk factors, inter-
ventions, and treatments have focused on men. Like other
areas of medical research, women have been excluded or
underrepresented in cardiovascular research •because they
are either of childbearing age or are elderly with coexisting
illnessŽ (Sechzer, Denmark, & Rabinowitz, 1994). Because
women often experience greater disability after myocardial
infarction, it is imperative that future research efforts include
women in suf“cient numbers to examine gender dif ferences
in symptom presentation, risk factors, and treatment options.
These factors can help inform the development of psychoso-
cial interventions. For example, clinical health psychologists
may be consulted to help with patient adherence to diet, exer-
cise regimen, and stress management to help promote healthy
functioning in women with CHD.CancerLung CancerAccording to the American Cancer Society (ACS; 2000),
cancer is the second leading killer of American women, with
lung cancer being the leading cause of cancer death among
women in the United States. Lung cancer has the third high-
est incidence rate for women (after breast and colon cancers;
Anderson, Golden-Kreutz, & DiLillo, 2001). It is estimated
that 157,400 deaths will occur from lung cancer in 2001