October Awareness Month - The Other Killer of Women

October is Breast Cancer Awareness month. I don't think anyone living anywhere near the mainstream of society has missed that fact. Pink ribbons can now be found on just about everything. Clever slogans regarding breast cancer can also be found in abundance, including:

• Save the Ta Tas
• Check Your Bumps for Lumps
• Big or Small, Save Them All!
• Real Men Wear Pink

Another women-related issue also shares the month of October. "There is another issue?" you ask. Yes, but it is not typically spoken of in society, the way breast cancer is. In fact, the subject is avoided as much as possible. The very fact most people have no idea what I'm talking about is a clear indication this is true.

What is it? According to the National Coalition Against Domestic Violence and a Presidential Proclamation, October is also National Domestic Violence Awareness Month.

But, isn't breast cancer much more important? It must be since we are so aware of it; Or does it just have better marketing?

Domestic/Intimate Partner Violence in Perspective

Let's see if you know the answer to a few questions:

1. According to statistics, 39,510 women will die from breast cancer this year. What is the number of women estimated to die from domestic/intimate partner violence this year?

A. 1,000 B. 5,000 C. 10,000 D. More than 15,000.

The answer?

D. It is estimated that 16,800 murders will occur as a result of domestic/intimate partner violence. In a report from New York, 44 percent of murdered women were killed by their partners.

2. Which of these carries a higher probability to occur during a woman's life?

A. Breast cancer. B. Domestic/intimate partner violence.

The answer?

B. According to statistics, women have a probability of one in eight for developing breast cancer during her lifetime. In the United States, the probability of a woman suffering from domestic/intimate partner violence is one in four.

3. Which is higher, the number of women living with breast cancer or the number of women living in a violent environment?

A. Breast cancer. B. Domestic/intimate partner violence.

The answer?

B. Approximately 2.6 million women were alive with a history of breast cancer in January 2008. An estimated 5.3 million victimizations occur each year. These result in 2 million injuries, of which 550,000 will require medical treatment. And, as noted above, nearly 17,000 murders.

Domestic/intimate partner violence should be considered a serious health concern among women. More than 95 percent of cases involve women. Certainly, it can be proven it is as serious in the lives of women, day-to-day, as breast cancer. The issue is that we are not "aware" of it.

This is just the good news. The bad news is that while the United States numbers are not good, we are not the worst; not by a long shot. The World Health Organization and others estimate that in some locations, up to 70 percent of the women have suffered domestic/intimate partner violence at some point during their lives, and up to 70 percent of female murder victims were killed by an intimate partner. To put it in perspective, if this were true in the United States, of the estimated 157 million women, 110 million women would have suffered from domestic/intimate partner violence. Nearly every woman you know would have been abused at some point during her life. And don't even get me started on the fact that an estimated 2.8 million children live in households touched by violent crime.

Billions of dollars are spent each year diagnosing, evaluating and treating women afflicted with breast cancer. With domestic/intimate partner violence, not only are there no large national programs at multiple medical centers to study and help these victims, there are no real, high profile programs to even begin an open discussion similar to that seen with breast cancer.

I am not saying we should in any way lose sight of breast cancer as a significant health issue for women; However, there are other real, and potentially more severe and ever present women's health issues. I believe we should be aware of all the issues women face.

Three Things Radiologists Can Do to Raise Awareness:

1. We can become aware of the fact that we see evidence of domestic/intimate partner violence nearly every day, in every practice, and we don't even recognize when it has occurred. In pediatrics for example, with every case we review, we look for the subtle and overt signs of abuse. We need to do the same thing with every women's imaging case we see.

2. When we see signs of potential abuse, we need to raise the question with the patient’s clinician or emergency room physician. Again, in pediatrics, when we have even the slightest suspicion of abuse, we immediately sound the alarm. This needs to be done with domestic/intimate partner violence as well.

3. Finally, we can work more closely with the emergency room team when they suspect abuse. In pediatric cases, we frequently get a heads up about that potential. With women's imaging I have rarely in my 21 years as a radiologist been alerted to the possibility we were imaging a patient with suspected domestic/intimate partner violence.

A great case in point can be found this week on the Case of the Week file from Virtual Radiology, where domestic/intimate partner violence was initially suspected by the radiologist reading the case.

What Can You Do?

I encourage victims, their loved ones and anyone concerned about this issue to learn more by calling the National Domestic Violence Hotline at 1-800-799-SAFE, or visiting www.TheHotline.org.

If you do nothing else during October to be aware of the issue of domestic/intimate partner violence, visit the Remember My Name Online Memorial to see some of the names of those who have had their lives taken from them as a result of these senseless acts of violence.

References
Cancer facts & figures 2012

National Coalition Against Domestic Violence domestic violence facts

Medscape: Domestic Violence

CDC: Costs of Intimate Partner Violence Against Women in the United States