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Health Related Actions: How Women Care for their Health
BREAST CANCER SCREENING
In 2002, more women died from breast cancer than from any other form of cancer. Early detection and treatment of breast cancer results in the best chance of survival, with 90% of women surviving for at least five years after detection if the cancer is localised in the breast and has not spread to other parts of the body (SEE ENDNOTE 1).
Regular examination of the breast is the most common method of detecting breast changes which may be, or may become, cancerous. Of all women aged 18 years and over, 30% reported that they had undertaken monthly breast self-examinations in 2001, with a similar proportion (27%) reporting annual doctor examinations.
Mammograms - a particularly effective way to detect cancer at an early stage - are generally only available to women aged 40 years and over, as breast tissue is too dense prior to this age (SEE ENDNOTE 2). In 2001, 51% of women aged 40 years and over reported having a mammogram for screening or diagnostic purposes at least once every two years. The proportion of women aged 40 years and over who reported ever having had a mammogram increased from 64% in 1995 to 72% in 2001.
As 70% of breast cancers occur in women over the age of 50 years, BreastScreen Australia actively seeks women aged 50-69 years for participation in its mammogram screening program (SEE ENDNOTE 2). In 2001, 74% of women aged 50-69 years reported having a mammogram at least once every two years.
In 2001, over half (52%) of women born in Australia and aged 40 years and over had mammograms every two years or more often, with women born overseas having a lower rate of mammogram examination. Women from North Africa and the Middle East were the most likely to never have had a mammogram (47%).
WOMEN REPORTING REGULAR BREAST EXAMINATIONS - 2001
PAP SMEAR TESTS
In 2001, cervical cancer caused the death of 227 Australian women, a rate of 2.1 deaths per 100,000 population (see Australian Social Trends 2004, Cancer trends, pp.72-76). It is one of the most preventable and curable of all cancers - up to 90% of cases of the most common type of cervical cancer can be prevented if cell changes are detected and treated early (SEE ENDNOTE 6).
A Pap smear test is a screening procedure in which a number of cells are collected from a woman's cervix and examined for any changes in appearance which may indicate a risk for, or the development of, cervical cancer (SEE ENDNOTE 6). The proportion of women who reported ever having had a Pap smear test remained relatively stable between 1995 and 2001 at around 90%.
According to current recommendations for Pap smear testing, all women aged between 18 years and 69 years who have ever had sex should have at least one Pap smear test every two years (SEE ENDNOTE 7). In 2001, 65% of women in this age group were meeting these recommendations. Women aged 30-39 years were the most likely to have had biennial Pap smear tests (80%), and women aged 60-69 years were the least likely (48%). The proportions of women reporting having Pap smears at least once every two years were similar across Major Cities, Inner Regional and other areas (between 64% and 69%).
Some studies have linked decreased awareness of, and participation in, Pap smear testing to language and cultural barriers experienced by recent immigrants (SEE ENDNOTE 8, ENDNOTE 9). In 2001, the proportion of women aged 18-69 years who reported having a Pap smear test at least once every two years ranged from two-thirds (67%) of women born in Australia to less than half (48%) of women born in South East Asia.
Income levels also appear to relate to how often women have Pap smear tests, with women in the higher income quintiles having higher rates of biennial Pap smears than women in the lower quintiles. In 2001, 66% of women in the highest income quintile had biennial Pap smears, compared with 61% in the middle quintile and 50% in the lowest quintile.
CONTRACEPTION AND PROTECTION
A major issue for women is being able to control their fertility, including preventing unwanted pregnancies. In 2001, the most common method of contraception used by sexually active women aged 18-49 years, was taking oral contraceptives (33%). Although very effective in preventing pregnancy when taken as directed, oral contraceptives do not provide protection against sexually transmitted diseases (STDs).
Following an increased awareness of the Human Immunodeficiency Virus (HIV) in the early 1980s, and the promotion of condoms as protection against infection, the rate of HIV infection appears to be falling (SEE ENDNOTE 10). However, there is concern that the transmission of other STDs may be rising.10 In 2001, condoms were used by 28% of sexually active women aged 18-49 years.
SEXUALLY ACTIVE WOMEN REPORTING USE OF SELECTED CONTRACEPTIVES(a) - 2001
The use of condoms declined with age from 48% of sexually active 18-24 year old women, to 12% of 45-49 year olds. Condom use may also be linked to the permanency of a woman's sexual relationship. In 2001, sexually active women aged 18-49 years who were neither married nor in a de facto relationship had a higher rate of condom use (42%) than women who were in such relationships (22%).
Lifestyle behaviours such as good nutrition and physical activity are preventative factors against cardiovascular disease, stroke, diabetes, some cancers, obesity, and osteoporosis (SEE ENDNOTE 11, ENDNOTE 12). Conversely, smoking is a recognised risk factor for several illnesses (see Australian Social Trends 2003, Health risk factors among adults, pp. 74-78).
A woman's cultural background may influence her consumption of fruit and vegetables, as different cultures have different food preferences. In 2001, women born in Australia were the most likely to usually consume four or more serves of vegetables per day (37%). Women from Southern and Eastern Europe were the most likely to eat two or more serves of fruit per day (68%). While women's levels of income did not appear to affect their daily consumption of vegetables, the usual intake of fruit was higher among women in the higher income quintiles.
It is recommended that adults undertake 30 minutes of moderate-intensity physical activity (such as brisk walking) on most days of the week (SEE ENDNOTE 11). However, in 2001, just 26% of women reported being physically active, in terms of taking moderate to high levels of deliberate exercise for recreation, sport or fitness in the previous two weeks. Between 1989-90 and 2001, the proportion of people exercising at a moderate or high level remained relatively stable (see Australian Social Trends 2003, Health risk factors among adults, pp. 74-78).
The level of deliberate exercise, taken for recreation, sport or fitness in the previous two weeks, undertaken by women aged 18 years and over varied in relation to their region of birth. A smaller proportion of women who were born in South East Asia had undertaken moderate or high levels of exercise for recreation, sport or fitness in the previous two weeks (12%), compared with women born elsewhere. The highest proportion of physically active women were from the United Kingdom and Ireland (37%), and Other North-West Europe (31%). Of women born in Australia, 27% were physically active in this way.
In 2001, over three-quarters (79%) of women were non-smokers. Women in higher income quintiles were less likely to smoke than those in lower income quintiles. Smoking status also varied in relation to region of birth, with women from South East Asia and Other Asia among the least likely to smoke (90% and 93% respectively were non-smokers).
Between 1989-90 and 2001, the proportion of women who were current smokers decreased from 24% to 21%. Over that period, women aged 18-24 years experienced the greatest reduction in smoking (in 1989-90, 36% of women in this age group were current smokers, compared with 27% in 2001). However, smoking increased among women aged 35-44 years (from 25% in 1989-90 to 27% in 2001) (see Australian Social Trends 2003, Health risk factors among adults, pp. 74-78).
1 National Breast Cancer Centre, <http://www.nbcc.org.au/pages/info/early.htm>, accessed 18 August 2003.
2 Commonwealth Department of Health and Ageing, ‘BreastScreen Australia: Who should have a mammogram?’ <http://www.breastscreen.info.au/who/index.htm>, accessed 31 October 2003.
3 Commonwealth Department of Health and Ageing, <http://www.health.gov.au/pubhlth/strateg/cancer/breast/index.htm>, accessed 4 August 2003.
4 Kong, G 1998, ‘Breast Cancer and Aboriginal and Torres Strait Islander women - a national report’, Aboriginal and Islander Health Worker Journal, vol. 22, no. 3, pp. 3-5.
5 Bailie, R et al. 1998, ‘Data for diagnosis, monitoring and treatment in Indigenous health: the case of cervical cancer’, Australian and New Zealand Journal of Public Health, vol. 22, issue 3, pp.303-306.
6 Commonwealth Department of Health and Ageing,<http://www.cervicalscreen.health.gov.au/papsmear/what.html>, accessed 3 November 2003.
7 Commonwealth Department of Health and Ageing,<http://www.cervicalscreen.health.gov.au/papsmear/who.html>, accessed 4 August 2003.
8 Rice, P (ed) 1999, Living in a new country: understanding migrants health, Ausmed publications, Ascot Vale, Australia.
9 Cheek, J et al. 1999, 'Vietnamese women and pap smears: Issues in promotion', Australian and New Zealand Journal of Public Health, vol. 23, pp. 72-76.
10 de Looper, M and Bhatia, K 2001, Australian Health Trends 2001, Australian Institute of Health and Welfare, AIHW Cat. No. PHE 24, Canberra.
11 Commonwealth Department of Health and Ageing, 1998, Developing an Active Australia: A framework for action for physical activity and health, Canberra.
12 Better Health Channel 2002, <http://www.betterhealth.vic.gov.au/bhcv2/ bhcarticles.nsf/pages/Food_requirements_ during_different_life_stages?Open Document>, accessed 16 July 2003.
13 National Health and Medical Research Council, 2003, Dietary Guidelines for Australian Adults, Canberra.