8^th World Conference on Women’s Health and Breast Cancer December 17-18, 2018 Abu Dhabi, UAE

Besides biology, women’s fitness or health is also influenced by the conditions such as employment, poverty and family responsibilities and therefore it can be said that the gender plays an unavoidable role in the social determination of health. Even in this 21^st century, the basic necessities of life such as health care are often restricted in many countries where women lack social and economic power.  Dr Nafsiah Mboi, Indonesia’s Minister of Health (2012-2014) and Chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria’s board, has said that “in many societies, women and young girls do not enjoy the same access to health as men, let alone the same rights or opportunities. But a society that does not cure and treat its women and young girls with love and care and with equality will never be a healthy society.”  The country, its culture, their religion, the social conditions, all becomes the culprit here.

Pregnancy, also known as gestation, is the time during which an offspring develops inside a woman. The 38 weeks of pregnancy period in a woman’s life is crucial as it may presents substantial health risks such as onset of high blood pressure, severe nausea, vomiting weight loss etc. Premature labor, maternal death etc. still remains in the list of pregnancy complications no matter how well developed the country is and how fast the technology is growing. According to World Health Organization,  830 women approximately die every day from causes related to pregnancy and child birth, yet they the considers that 99% of these deaths, the majority of which occur within 24 hours of childbirth, are preventable if the appropriate infrastructure, training, and facilities were in place. The direct causes of these maternal deaths are hemorrhage, eclampsia, obstructed labor, sepsis and unskilled abortion. In addition malaria and AIDS complicate pregnancy. Complications of pregnancy may be physical, mental, economic and social. It is estimated that 10–20 million women will develop physical or mental disability every year, resulting from complications of pregnancy or inadequate care. Consequently, international agencies have developed standards for obstetric care. Adolescent being pregnant can also lead to pregnancy and child birth complications.

Risk factors such as unsafe sex may lead to many unique health issues related to reproduction and sexuality of women. Young women and adolescents are at risk from pregnancy, STDs and unsafe abortion. Access to contraception permits women to make acquainted choices about their reproductive and sexual health, increase empowerment, and enhances choices in education, careers and participation in public life. Reproductive health also involves issues regarding other systems such as reproduction, pregnancy, childbirth and child rearing, including antenatal and perinatal care.  Many couples seek ART for infertility and many other reasons, however about a half of IVF pregnancies result in multiple-birth deliveries, which in turn are associated with an increase in both morbidity and mortality of the mother and the infant.

Ethic has an important role in women’s health which often left forgotten. Even in this 21stcentuary where we make series like “Black Mirror” which explains the fate of coming generations due to the consequences of our discoveries, for some well-educated societies, the basic rights of a woman to get medical assistance, sexual ethics, and age limit for marriage etc. becomes just sentences that are written in some white sheets. When the religion and social status empowers, ethical, legal and social issues in women’s health remains suppressed.

Being overweight or obese in women increases the relative risk of diabetes, coronary artery disease, low back pain and knee as hypertension osteoarthritis. Obesity also affects both contraception and fertility. Higher rates of high-risk obstetrics conditions such and diabetes as well as higher rates of caesarean section is linked with maternal obesity. Maternal obesity is associated with neonatal mortality, malformations, and also decreased intention, initiation and duration of breastfeeding. Obese women are at high risk of multiple cancers and obesity may also lead to depression in women.

Cardiovascular disorder (CVD) is the leading cause of death and for some chronic disease amongst women in many countries.  Women with diabetes and who smoke are more vulnerable to cardiovascular disorders than men. The major cause of CVD in women is cigarette smoking, hypertension (including isolated systolis hypertension), dylipidemia, diabetes mellitus, blood pressure, obesity, sedentary lifestyle, metabolic syndrome and poor nutrition. Even though risk factors for CVD are similar in women and men, gender differences have been reported, particularly diabetes and dyslipidemia.

Midwifery is a medical health profession that deals with nursing or assisting pregnant women before and after delivery or labor (including care of the new born), besides reproductive and sexual health of women throughout their lives. Midwifery is also known as obstetrics. Midwifery-led care has effects which includes,  a reduction in the use of epidurals, with fewer episiotomies or instrumental births, a longer mean length of labour as measured in hours, increased chances of being cared for in labour by a midwife known by the childbearing woman, increased chances of having a spontaneous vaginal birth, decreased risk of preterm birth, decreased risk of losing the baby before 24 weeks' gestation, although there appears to be no differences in the risk of losing the baby after 24 weeks or overall.

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. The cause of PCOS is uncertain, but there are some evidences that it is a genetic disorder. PCOS cannot be completely cured .Treatment may involve lifestyle changes such as weight loss and exercise. Signs and symptoms of PCOS include irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin.  Associated conditions include type 2 diabetes, obesity, obstructive sleep apnea, heart disease, mood disorders, and endometrial cancer. It can also lead to infertility, gestational diabetes or pregnancy-induced high blood pressure, miscarriage or premature birth, non-alcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver, metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease, Type 2 diabetes or prediabetes, sleep apnea, depression, anxiety and eating disorders, abnormal uterine bleeding, cancer of the uterine lining (endometrial cancer).

Osteoporosis is a disease where bone strength is reduced, which increases the risk of bone breakage. It is one of the most common diseases found in women. The bones which are mainly affected include the vertebrae in the spine, the bones of the forearm, and the hip. Chronic pain and decreased ability to carry out normal activities may occur following a broken bone. Osteoporosis may be due to lower or greater than the normal bone loss. Lower level of estrogen after menopause also leads to bone loss. Smoking, too little exercise; alcoholism, anorexia, hyperthyroidism, kidney diseases, and surgical removal of the ovaries may increase the risk of osteoporosis. Certain medications increase the rate of bone loss including chemotherapy, proton pump inhibitors, antiseizure, glucocorticosteroids and selective serotonin reuptake inhibitors. Simple and common methods like a good diet, exercise, avoiding medications, change in lifestyle etc. helps to reduce the bone loss along with hormone replacement therapy (HRT).

Women are at high risk of experiencing mental health issues such as depression anxiety  and psychosomatic complaints than men, mainly because of the change in hormonal environment. The change in hormones during puberty, menstruation, pregnancy, childbirth and the menopause can be taken as the main reasons for mental health issues in women. Most of these issues provoke suicidal tendencies and so suicide is said to be the leading cause of death for women under the age 60. Mental health issues also include dementia or Alzheimer’s disease. The occurrence of dementia in the United States is estimated to 5.1 million, and of two thirds are women. Moreover, women are likely to be the care takers of adult family members with depression, so that they bear both the risk and burdens of this disease.

Breast cancer is the cancer that develops from breast tissues. Symptoms may include a lump in the breast, change in breast shape, dimpling of skin, fluid coming from the nipple, a newly inverted nipple, or a red or scaly patch of the skin. Risks of developing the breast cancer being a female includes , obesity, lack of physical exercise, drinking alcohol, hormone replacement therapy during menopause, ionizing radiation, early age at first menstruation, having children late or not at all, older age, prior history of breast cancer, and family history. In metastasis stages of breast cancer, there may be bone pain, swollen lymph, shortness of breath, or yellow skin. Mutations in the tumour suppressing genes and oncogenes leads to development of the cancer. Breast malignant neoplastic diseases are the most common cancer diagnosed among women in both developed and developing countries. . Geographic magnetic declination in relative incidence is the opposite of that of cervical cancer, being highest in Northern US and lowest in Eastern and Middle Africa, but death rate rates are relatively constant, resulting in a wide variance in case mortality, ranging from 25% in developed regions to 37% in developing regions, and with 62% of deaths occurring in developing countries.

Palliative care can be defined as a multidisciplinary approach that may include care provided by physicians, nurses, social workers, psychologists, psychiatrists, pharmacists, spiritual care professionals, and respiratory, physical, and occupational therapists, as well as a variety of other disciplines necessary to manage symptom. Oncology nurses are critical participants in the delivery of palliative care. It is the position of oncology nurse that primary nursing should begin at the time of diagnosis and continue throughout bereavement. Physical, psychological, social, cultural, and spiritual assessments are key components to the development of a comprehensive care plan for each patient Oncology nurses must possess knowledge and skills in certain domains to deliver safe, quality palliative care, including, structure and processes of care, physical aspects of care, psychological and psychiatric aspects of care, social aspects for care, cultural aspects of care, care of the imminently dying patient, ethical and legal aspects of care and, spiritual, religious, and existential aspects of care of a cancer patient. Oncology nurses have a responsibility to engage the public and provide fact-based information about care of people with advanced serious illness to encourage advance care planning and informed choices based on the needs and values of individuals.

The treatment and the cancer itself may affect the physical functioning and energy of the body. For e.g. many breast cancer treatments decreases oestrogen in the body. This may decrease bone density. Exercise may be used to increase the bone density and help lower the risk of breast cancer reappearance and also helps to regulate treatment-related fatigue such as skin harms, neural shortages, etc., that during radiation and chemotherapy. Breast cancer recovery is favoured for the individuals who experienced lumpectomy with sentinel hub biopsy treatment, lumpectomy with axillary dismemberment surgery, mastectomy, or breast reconstructive treatment, radiation and fundamental chemotherapy.

Breast cancer is the second most common cancer diagnosed after lung cancer and is the main cause of cancer demise in women. The heterogeneity of breast cancer such as ductal carcinoma in situ, triple negative breast cancer, HER2 negative among the women makes it difficult for the doctors to provide ideal medications for the cure. The major treatment methods are chemotherapy, radiation therapy, targeted drug therapy, oncoplastic surgery etc. Recent oncology research lead to the developments in neoadjuvant therapies, have also been benefited in treatment of breast cancer. Complete cure through Ayurveda was another major breakthrough in breast cancer treatment.