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You ask Mrs. Heart more questions...

Dr. You: Have you ever thought that your pain could be due to heart problems?

Mrs. Heart: Never! I thought that heart disease occurred only in men... my son experienced angina, but I don’t think that my pain was like his.

1.What do you think of this woman's beliefs?

Mrs. Heart: I have always feared breast cancer, since my mother died of cancer 10 years ago and I never thought that I should worry for my heart...

In a report from the Heart and Stroke Foundation National Omnibus Survey, it was documented that 60% of women felt breast cancer was the leading cause of death among women in Canada, whereas 17% identified heart disease as the major cause of mortality in Canadian women [1]. Likewise, in a national telephone survey in United States 58% of women believed they were as likely, or more likely, to die of breast cancer than coronary artery disease. In the same survey, 50% of women over 45 years of age reported that their doctor had never talked to them about heart disease[2]. Awareness of CVD in women has increased, although a significant gap between perceived and actual risk of CVD remains.[4] As physicians, we can be better at recognizing the frequency and importance of coronary artery disease in women and talking about it with those we care for.

1.What are the possible reasons for this diagnosis bias?
2.What are the consequences for women's health?


1. HSFO- (2003) Facts and Stats Online- Document #1040- Women, Heart Disease and Stroke. Available at URL:

2. Legato, M.J., Padus, E., Slaughter E. (1997) Women's Perceptions of their General Health, with Special Reference of their Risk of Coronary Heart Disease: Results of National Telephone Survey. Journal of Women's Health, 6: 189-198.

4. Mosca L, et al. Tracking women's awareness of heart disease. Circulation. 2004;109:573-579.

All references for this section