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Editorial OCTOBER
2008
Boomers, Breast Cancer, and the Health Care
Dyad
Vivian M. Dickerson, MD
When I was young,
I used to think of breast cancer as something that was unlikely to happen to
me, but I must embrace the fact that my risk is increasing with every year
that passes. Furthermore, the fact that no one in my family has had breast
cancer doesn’t mean I have a “get out of jail free” card.
As a baby boomer, I recognize that we may have achieved a lot of things, but
we haven’t been able to slow that march toward chronic disease as we
age; we haven’t gotten rid of the acute killers that will attack us
with increasing frequency. So when we think about breast cancer, heart disease,
or autoimmune disorders, baby boomers often realize that we inevitably face
challenges and, due to our sheer numbers, that means exponentially bigger
challenges for the entire health care system. And that clock is ticking!
According to the United States Census Bureau, a baby boomer is anyone born
between 1946 and 1964. That means that by 2011, boomers will become eligible
for Medicare, and in that year, they will be turning 65 at the rate of almost
8,000 per day. More than 52% of these will be female. By the year 2030, it
is estimated that there will be 57.8 million baby boomers still living and
approximately 55% will be female, the eldest of these in their mid-eighties.
Given these demographics, it is unlikely that gynecologists will be out of
work any time soon. However, we must ask ourselves what practice will look
like and what we should do to prepare to meet the needs and expectations of
this older population. For many years ACOG has told us that while we are the
primary health care providers for women during their reproductive years and
into menopause, we tend to lose the older population when women over 65 begin
to have more of their health care needs met by internists or family physicians.
Can we really afford to allow this trend to continue? Well, luckily enough,
while we don’t wish to usurp the care for chronic disease, there will
be trends that speak to what we do know: primary prevention, risk reduction,
and health maintenance, including survivorship care. How does this play into
the demographic revolution that baby boomers are creating?
First of all, according to a recent on-line publication by the Hartman Group,
wellness will become a greater focus than ever.1 We boomers see ourselves as
active and vital people and don’t really identify with growing old if
it connotes wheelchairs, walkers, and retirement homes. Indeed, we don’t
really identify with the term “seniors” at all. ObGyns who provide
our care will need to play an integral part in helping us maintain our vitality
in very specific ways. Given the morbidity of osteoporosis, for example, boomers
will expect ObGyns not only to order the DEXAs and prescribe the drugs (using
the latest evidence-based guidelines of course), but to also know how to prevent
sports injuries, falls, and to be comfortable with alternative methods of achieving
bone health and balance such as T’ai Chi, yoga, or Pilates.
Breast cancer is another example, and as I noted previously,
an opportunity for increased involvement. It is a disease
process for which incidence increases annually until well into a patient’s
70s, but is responsible for only 4% of the annual mortalities in women; it
is therefore emerging as a chronic disease.
Aside from increasing numbers of breast cancers diagnosed and the need to screen
and detect promptly, are there other challenges or expectations among baby
boomer women? Yes, indeed. For example, can you name six risk reduction strategies?
And if you can, will patients know that you can, and come to you for that information,
or will they bypass you and seek information elsewhere? Data seem to reveal
that women of this generation are relying less and less on conventional authority
figures and will rely more on their social networks, the Web, and health care
professionals who can talk to them, not
at them.2 So this speaks not only to our degree of expertise and our willingness
to shift the focus, but also to becoming part of the health care dyad—more
an equal partner than a paternal or maternal figure.
Boomers want information more than just about anything. When
we give a woman a prescription
for her annual mammogram, we can expect more questions about safety, alternatives,
the role of MRIs, and new adjunctive imaging modalities that have yet to become
the standard of care. We can also expect requests for complete
information about relative risks, detection rates, and differential management
for high-risk patients. Since none of us has all this information at our fingertips,
we will need to develop our own robust and reliable resources for accurate
information, both electronic and written, and establish appropriate referral
patterns for timely access by our patients.
As an aside, I will add that insurance companies should get with the program
and understand that wellness matters to an increasingly older population. Some
companies are already reimbursing for the basics such as smoking cessation
and counseling on weight loss, nutrition, and exercise. A report released in
July 2008 by the Trust for America’s Health demonstrated that an investment
of $10 per person, per year in the basic preventive measures described above
would not only be effective, but would save an estimated $16 billion—Medicare
alone could save more than $5 billion and Medicaid almost $1.9 billion.3 It
is essential that this message is delivered and that the health care payors
(be they private or nationalized) come to see that it is less expensive to
pay for prevention and risk reduction than to pay for rehab or extensive hospitalization.
This kind of logic and these types of data speak volumes to the baby-boomer
generation, and I suspect they will be happy to partner as lobbyists if we
need to convince the government of the wisdom (and money!) in health maintenance
and primary prevention.
Another challenge has to do with the great controversy over the Women’s
Health Initiative (WHI) and will be a reality regardless of where you or I
stand on the findings. These boomers are the ones who dropped out of the HRT
world (many at a young age) in droves when WHI came about and they are expecting
a payoff in terms of reduced MI, stroke, and breast cancer risk. We will be
caring for women who have very strong beliefs in their abilities to manage
their own destinies through information and healthy habits.
Regardless of whether the SEER data continue to show a decrease in the numbers
of breast cancers diagnosed, and regardless of whether the increase in stroke
for women who chose to stay on HRT becomes a reality, we as health care professionals
must understand that women will
need support for the choices
they make and compassionate advice on how to deal with both the potential benefits
and the
consequences. These women made their choices, unlike their mothers or grandmothers
before them, by carefully evaluating information as it became available and
by personalizing it to their own needs. This process must be validated in an
ongoing fashion within the doctor-patient relationship.
Boomers have grown up and grown old while taking back control of their lives;
regardless of the herd mentality that intrinsically comes with being identified
as a boomer, each woman in this generation prides herself on individualism
and wants to be seen as a unique and dynamic being. She does not want to be
identified as part of a chronological cohort—even if she does “look
younger than her stated age”!
If we, as health care professionals, tap into the youthful energy of the boomer,
we will gain infinite credibility and continue to be a valued partner, consultant,
and advisor. So while no one can stop the clock, growing old is being reinterpreted
by the boomer generation. It isn’t just about geriatrics any more —it’s
another very dynamic life stage and a new era in health care for women.
back to top
Vivian M. Dickerson, MD, Editor-in-Chief
REFERENCES
- Baby boomer lifestyle traits & trends.
Hartbeat. www.hartman-group.com/hartbeat/2006-08-23.
Published August 23, 2006. Accessed September 22, 2008.
- Bringing up baby boomer. Hartbeat.
www.hartman-group.com/hartbeat/2007-03-14. Published March
14, 2007. Accessed September 22, 2008.
- Prevention for a healthier America:
Investments in disease prevention yield sig-nificant savings,
stronger communities. Trust for America’s Health.
http://healthyamericans.org/reports/prevention08/Prevention08.pdf. Published
July 2008. Accessed September 22, 2008.
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