IRISH women under 64 are more likely to die of breast cancer than any of their European Union counterparts, but less likely than any to receive preventive testing, according to a major study of the health of women in the EU.
The report, due to be published tomorrow by the Social Affairs Commissioner, Mr Padraig Flynn, exposes a yawning gulf between best preventive practice in our EU partners and those in Ireland.
Although the report records significant improvements In women's health since 1970 - including an EU wide 5 1/2 year increase in life expectancy to 89.1 years - it finds enormous variations in the level of preventive testing for women and considerable concern from women that their health needs are not sufficiently addressed.
The report was compiled for the Commission by researchers at the University of Limerick using national figures, mainly for 1996, as well as data from the World Health Organisation, the OECD, and Eurostat.
Curiously, the report shows that, while both Ireland and Denmark have widely differing standards of care - at opposite ends of the preventive testing league - they both have the lowest life expectancies among women in the EU, 77.8 and 78.6 years respectively, almost certainly a reflection of the high rates of smoking in their female populations.
Ireland and Denmark have the highest rate of tobacco related deaths among women, 3 1/2 times the EU average - 16.2 per cent of deaths of women over 35 in the case of Ireland and 15.3 for Denmark.
Irish women also appear to be healthier than most of their EU counterparts but they are in the bottom three of the EU leagues of those disabled in some way by long term illness and of attendance at doctors, and among the top three for days spent in hospital in the last year other than maternity.
Asked about their perceptions of their health, three out of four Irish women describe it as "good" or "very good", the highest in the EU.
The 3.9 per cent of Irish women reporting some restricted activity in the previous two weeks due to emotional or mental problems reflects a reality just above the European average.
Female cancers - cancers of the breast, cervix and uterus - are the main cause of death for women aged 35-64, while for older women diseases of the circulatory system are the main cause. The biggest of the cancer threats to women is breast cancer, with some 2 to 3 per cent believed likely to develop it during their lifetime.
In Ireland there has been a particularly sharp increase in the mortality in under 65s since 1970, up 17 per cent - a mystery to the medical profession as 80 per cent of those who develop it have none of the known risk factors.
The report emphasises the importance of prevention through self examination and mammography, noting that "breast cancers detected through well organised screening among 50 to 69 year olds are, on average, identified four years earlier than the clinical appearance, resulting in (gradually) reduced death rates.
"Although screening programmes with full (100 per cent) participation can cut in half the risk of dying from breast cancer, observed participation rates of around 70 per cent reduce the risk from dying by one third." Polling of women also shows strong support for national mammography testing, at 90 per cent in Ireland and the EU as a whole.
Yet Ireland has the lowest level of screening in this vulnerable age group - only 1.9 per cent had a mammogram in last year compared to Sweden's 70 per cent and the EU average of 38 per cent.
The same spread of low testing and high vulnerability among sexually active women is true of cervical smears. Yet the report says that "assessments of organised screening programmes show a significant reduction in mortality... studies from Finland report possible mortality reductions of 50-80 per cent." And, although heart checks in Ireland are close to the EU average, higher levels of testing for cholesterol, diabetes and osteoporosis are carried out in at least 12 of the other 15 member states.
While the desirability of cholesterol testing is controversial, the report argues the rise in diabetes type II, to which menopausal women are particularly vulnerable, is arrestable and it strongly recommends systematic testing of overweight women over 40.
Yet testing in Ireland of the 40 to 64 age group, at 8 per cent, is one fifth of that in Germany and a third of the EU average.
The low level of osteoporosis testing in Ireland is also worrying, with Irish women reflecting the second highest levels of concern in the EU (68 per cent) at not being well informed about HRT, the indicated treatment for osteoporosis. HRT is also of use in preventing cardiovascular disease and, according to recent research, Alzheimer's.
"Altogether these results clearly point to the need for more or better HRT information in the EU," the report argues.
Although Ireland has the third highest rate of circulatory disease deaths, more than twice that of France, it has one of the lowest rates of obesity - 17 per cent of Irish women are either overweight or severely overweight compared to some 32 per cent in Greece and 27 per cent in the UK.
Ireland has also been successful in reducing the incidence of strokes for women under 60 by 69 per cent since 1970.
The report expresses concern at the absence of reliable statistics on eating disorders, pointing out that one estimate puts mortality rates at 6 per cent for anorexia nervosa and 3 per cent for bulimia. Deaths directly attributed to such conditions are often reported as suicide or heart failure.
Research suggests, however, a close correlation between the incidence of eating disorders and obsession with body weight and appearance. A survey on weight finds young Irish women happiest with their weights - 18 per cent of 18 to 24 year olds were dissatisfied, compared to one in three in the EU and nearly one in two in the UK (45 per cent).
The report also warns that much medical knowledge - apart from that relating to conditions unique to women - "is derived from research based on the male prototype. This has overlooked the influences of gender differences in diagnoses, treatments, and health outcomes." The challenge in improving the health of women in the EU, the Commissioner for Social Affairs, Mr Flynn, will emphasise at the introduction of the report tomorrow, is not to place their needs ahead of men's, but first to acknowledge that, because of biological and social conditions, their needs are different.
