In the second episode in our heart health series of WomenTalk, we’ll learn all about the link between heart disease, stroke and diabetes. Cardiologist Payal Kohli, M.D., explains what factors increase our risk of disease and how to lower your risk.Watch more WomenTalk episodes

Español Monica Austin-Cox remembers well the day a routine pelvic exam changed her life forever. Her gynecologist felt a lump that was initially believed to be related to Austin-Cox’s ovaries. But further testing revealed it was actually a mass in her bladder. She was quickly referred to a urologist, who performed a cystoscopy, a procedure that involves examining the inside of the bladder with a camera. The results confirmed her worst fears — Austin-Cox had bladder cancer. The news was shocking: “I had never heard of bladder cancer,” said Austin-Cox, who was 30 at the time of her diagnosis and had never been a cigarette smoker but had been exposed to secondhand smoke much of her life. “The signs and symptoms, like blood in the urine, were things I had experienced, but I had attributed it to the repeated urinary tract infections (UTIs) I’d been getting. I’d always taken the antibiotics prescribed by my doctor and they would just go away. So, I thought nothing much of it.” Read: Living with Bladder Cancer >> Her cancer was quickly diagnosed as stage 1, non-muscle invasive, an aggressive form of cancer that required close monitoring and repeated treatments. Over the next four years, Austin-Cox found herself in a nightmarish medical battle that included having surgery to remove the mass in her bladder and follow-up cystoscopies every three months. Each time, she’d learn that the cancer had returned. “There was constant anxiety of wondering if the cancer would come back,” she recalled of the all-too-brief periods in between her checkups. “It was overwhelming.” ​How bladder cancer differs for Black womenAdding to Austin-Cox’s anguish, she found little in terms of support groups and resources available for women battling bladder cancer, especially for Black women like her, near where she lived in North Chesterfield, Virginia. And she wasn’t able to find much information on the internet about how women experience the disease either. “It’s not just ‘a white man’s disease,’” she said, referring to a widespread myth. “Black women get bladder cancer too and we deserve the support and resources we need to fight this horrible disease.”Men are more likely to develop bladder cancer than women and white people are about twice as likely to develop bladder cancer as Black and Hispanic people. However, a growing body of research confirms that Black women are battling the disease more and more, and they are often being diagnosed at later stages, facing poorer outcomes as a result.Studies have also found: Black women have the highest proportion of advanced and aggressive tumors when compared to Black men and white men and women.Compared to white women, Black women make up a larger percentage of bladder cancer incidence and face disparities in treatment, regardless of insurance status, education, the presence of other health conditions at diagnosis or the stage when the disease is found.Black women with bladder cancer tend to be at higher risk for the cancer cells spreading from the bladder into their bones. Houston researcher Heather Honoré Goltz, Ph.D., an expert in cancer survivorship and disparities, a licensed clinical social worker, and a professor of social work at the University of Houston-Downtown, said women are often misdiagnosed, partly due to symptoms like frequent urination or blood in the urine being mistaken for menopause or UTIs, like Austin-Cox experienced. According to Goltz, Black women often face elevated risks for the disease related to exposure to harmful chemicals in certain professions, such as exposure to hair dyes while working as a hairdresser, environmental toxins where they live and the long-term effects of smoking, a leading cause of bladder cancer.“Like your liver, the job of your kidneys is to filter harmful toxins from your bloodstream and move them into your bladder,” explained Goltz. “That’s why being exposed to certain chemicals may increase a person’s risk for bladder cancer.” She attributes the poorer outcomes Black women with bladder cancer face to long-standing issues of bias within the healthcare industry. “A significant problem is the way healthcare systems interact with women, particularly Black women,” said Goltz, noting that studies show that even with health insurance, private and public, Black patients tend to receive lower quality of care compared to their white counterparts.“There’s an assumption that if you have access to quality care, that you’re going to receive the gold standard of care, but that’s not always true. What we’re finding is that a large percentage of Black patients, and particularly Black women, aren’t getting the highest standard of care.”Read: Why Sex and Race Matter More in Bladder Cancer Treatment >>​Steps Black women with bladder cancer can take for a better prognosisSelf-advocacy is vital in detecting and diagnosing bladder cancer in the earlier stages, when it’s more treatable.“Be vigilant about any changes you’re experiencing in your body and any concerning symptoms, such as painful urination or frequent urination,” Goltz said. “Don’t automatically dismiss it as related to aging or menopause. Discuss your symptoms with your primary care doctor and request follow-up testing or even a referral to a urologist to be sure.”Austin-Cox can relate to the quality of care concerns Goltz raised. Early in her diagnosis, she felt dismissed and neglected by her urologist, including receiving repeated requests from his office to reschedule follow-up exams, despite the severity of her case.“The nurse would call and say, ‘He’s not going to be able to see you this week, would you like to reschedule?’” And I was like, ‘No, because the cancer keeps coming back,’” she recalled.Frustrated, she eventually took control of her healthcare and sought a new urologist who provided more attentive care and initiated a more aggressive treatment, marking a turning point in her treatment. “Never be afraid to advocate for yourself,” she said. Five years after her diagnosis, Austin-Cox was declared cancer-free. Now she visits with her urologist annually to check for any signs of the disease. As for the lack of support and resources available for women battling bladder cancer, Austin-Cox, now 50, said that has improved slightly in the two decades since her diagnosis, but there’s still a great need today. She is grateful for a supportive husband, family and friends who helped her through her cancer journey. To this day, she pays it forward to others by volunteering and participating in advocacy efforts with the Bethesda, Maryland–based, Bladder Cancer Advocacy Network (BCAN). Added Austin-Cox, “We all have to do our part to raise awareness about the fact that women do get bladder cancer — and our lives matter too.”This educational resource was created with support from Daiichi Sankyo and Merck.

English Mónica Austin-Cox recuerda bien el día que una examinación pélvica rutinaria cambió su vida para siempre. Su ginecólogo detectó una masa que inicialmente se asumió que tenía una relación con los ovarios de Austin-Cox. Pero más pruebas revelaron que de hecho era una masa en su vejiga. La refirieron rápidamente a un urólogo, quien realizó una cistoscopía, un procedimiento que implica examinar el interior de la vejiga con una cámara. Los resultados confirmaron sus peores temores, Austin-Cox tenía cáncer de vejiga. Las noticias fueron impactantes: “Nunca había escuchado del cáncer de vejiga”, dijo Austin-Cox, quien tenía 30 años cuando recibió su diagnóstico y nunca había fumado un solo cigarrillo, pero había tenido exposición a tabaquismo pasivo durante una gran parte de su vida. “Señales y síntomas, tales como sangre en la orina, fueron cosas que había experimentado, pero las atribuí a infecciones urinarias (IU) repetitivas que tenía. Siempre tomaba los antibióticos que me recetaba mi doctor y simplemente desaparecían. Así que no pensé mucho en eso”. Lee: Vivir con cáncer de vejiga >> Su cáncer fue clasificado rápidamente como invasivo no muscular de etapa 1, una forma agresiva de cáncer que requirió un monitoreo cuidadoso y tratamientos repetitivos. Los siguientes cuatro años, Austin-Cox estuvo envuelta en una batalla médica espeluznante que implicó una cirugía para remover la masa en su vejiga y cistoscopías de seguimiento cada tres meses. Cada vez se enteraba que el cáncer había reaparecido. “Tenía angustia porque me preguntaba constantemente si el cáncer había reaparecido”, recordó de los muy breves periodos de tiempo entre sus examinaciones de seguimiento. “Era abrumador”. En qué forma el cáncer de vejiga es diferente para las mujeres de raza negra Para empeorar la angustia de Austin-Cox, encontró poco en lo que se refiere a grupos y recursos de apoyo disponibles para mujeres que viven con cáncer de vejiga, especialmente para mujeres de raza negra como ella, cerca del lugar en el que vivía en North Chesterfield, Virginia. Y tampoco pudo encontrar mucha información en el Internet acerca de la forma en que las mujeres experimentan la enfermedad. “No solo es una enfermedad de hombres blancos”, dijo, refiriéndose a un mito generalizado. “Las mujeres de raza negra también desarrollan cáncer de vejiga y merecemos el apoyo y los recursos necesarios para luchar contra esta enfermedad horrible”. Los hombres son más propensos a desarrollar cáncer de vejiga que las mujeres y las personas de raza blanca tienen dos veces más posibilidades de desarrollar cáncer de vejiga que personas de raza negra e hispanas. Sin embargo, cada vez más investigaciones confirman que mujeres de raza negra viven con la enfermedad, lo cual se está volviendo más común con el tiempo y frecuentemente reciben sus diagnósticos en etapas posteriores enfrentando peores desenlaces clínicos como consecuencia. Estudios también identificaron que: Las mujeres de raza negra tienen la mayor proporción de tumores agresivos y en etapas avanzadas en comparación con hombres de raza negra y personas de raza blanca. En comparación con las mujeres de raza blanca, las mujeres de raza negra tienen una mayor incidencia porcentual de cáncer de vejiga y enfrentan desigualdades en los tratamientos, independientemente de su seguro médico, educación y la presencia de otras condiciones médicas o de la etapa de la enfermedad cuando se recibió el diagnóstico. Las mujeres de raza negra con cáncer de vejiga tienden a tener un mayor riesgo de que las células cancerosas se propaguen de la vejiga a sus huesos.Una investigadora de Houston, Heather Honoré Goltz, Ph.D., experta en supervivencia y desigualdades relacionadas con el cáncer, trabajadora social clínica certificada y profesora de trabajos sociales en la Universidad de Houston-Downtown, dijo que las mujeres frecuentemente reciben diagnósticos erróneos, debido en parte a síntomas tales como micción frecuente o sangre en la orina que crean confusiones porque se atribuyen a la menopausia o a IU, tal como lo que le pasó a Austin-Cox. Según Goltz las mujeres de raza negra frecuentemente enfrentan mayores riesgos de la enfermedad relacionados con exposición a químicos dañinos en ciertas profesiones, tal como la exposición a tintes para el cabello en trabajos de estilistas, toxinas medioambientales en los lugares en los que viven y los efectos a largo plazo del cigarrillo, una causa principal de cáncer de vejiga. “Al igual que tu hígado, la función de tus riñones es filtrar toxinas dañinas de tu torrente sanguíneo y trasladarlas a tu vejiga”, explicó Goltz. “Esa es la razón por la cual tener exposición a ciertos químicos podría incrementar el riesgo de cáncer de vejiga”. Atribuye los peores desenlaces clínicos a los que se enfrentan las mujeres de raza negra con cáncer de vejiga a problemas persistentes relacionados con prejuicios de la industria médica. “Un problema significativo es la forma en que los sistemas de atención médica interactúan con las mujeres, particularmente con las mujeres de raza negra”, dijo Goltz, indicando que estudios demuestran que incluso con seguro médico privado y público, los pacientes de raza negra tienden a recibir una menor calidad de atención en comparación con sus contrapartes de raza blanca.“Se asume que si tienes acceso a atención de alta calidad, recibirás el estándar dorado de atención, pero eso no siempre es verdad. Lo que estamos descubriendo es que un porcentaje alto de pacientes de raza negra, y particularmente de mujeres de raza negra, no están obteniendo atención con los estándares más altos”.Lee: Por qué el género y la raza son más importantes en lo que se refiere al tratamiento de cáncer de vejiga >>Pasos que las mujeres de raza negra con cáncer de vejiga pueden tomar para una mejor prognosisDefender tus derechos es vital para la detección y el diagnóstico de cáncer de vejiga en etapas más tempranas, cuando puede tratarse más.“Mantente atenta de cualquier cambio que experimentes en tu cuerpo y de cualquier síntoma preocupante, tal como dolor al orinar o micción frecuente”, dijo Goltz. “No asumas automáticamente que es producto de la vejez o la menopausia. Habla de tus síntomas con tu doctor de cabecera y solicita pruebas de seguimiento o incluso una referencia a un urólogo por precaución”.Austin-Cox conoce bien los problemas relacionados con la calidad de la atención que mencionó Goltz. En las primeras etapas de su proceso de diagnóstico, se sintió ignorada y descuidada por su urólogo, recibiendo incluso varias solicitudes de su consultorio para posponer examinaciones de seguimiento, a pesar de la gravedad de su caso.“La enfermera llamaba y decía, ‘él no va a poder atenderte esta semana, ¿te gustaría reagendar la consulta?” Y yo decía, ‘no porque el cáncer sigue reapareciendo’”, recordó.Frustrada, eventualmente tomó el control de su atención médica y buscó un nuevo urólogo quien proporcionó una atención más esmerada e implementó un tratamiento más agresivo, lo cual marcó la diferencia en su tratamiento. “Nunca tengas miedo de defender tus derechos”, dijo. Cinco años después de su diagnóstico, se declaró que Austin-Cox ya no tenía cáncer. Ahora tiene consultas con su urólogo anualmente para revisar si hay señales de la enfermedad. En lo que se refiere a la falta de apoyo y recursos disponibles para mujeres que viven con cáncer de vejiga, Austin-Cox, quien ahora tiene 50 años, dijo que eso ha mejorado ligeramente en las dos décadas que han pasado desde que recibió su diagnóstico, pero todavía hay una gran necesidad de mejora actualmente. Está agradecida de tener un esposo, familiares y amigos que la apoyan y que la ayudaron durante su proceso del cáncer. Actualmente, retribuye eso ayudando a otras personas con trabajo de voluntariado y participando en iniciativas de concientización con Bladder Cancer Advocacy Network [Red de concientización del cáncer de vejiga] (BCAN) con oficinas principales en Bethesda, Maryland. “Todos tenemos que contribuir para informar al público en general que las mujeres también pueden desarrollar cáncer de vejiga y que nuestras vidas también son importantes”, agregó Austin-Cox. Este recurso educativo se preparó con el apoyo de Daiichi Sankyo y Merck.

During this three-part series of WomenTalk, we’re partnering with the National Association of Nurse Practitioners in Women’s Health to explore the role nurse practitioners play in contraceptive, maternal and menopause care. In the third episode in our Women Talk: “The Role of Nurse Practitioners in Women’s Health” series, we’ll be exploring the role nurse practitioners play in women’s health, particularly in menopause. We’ll discuss options to manage symptoms and simple tips on what you can do to support yourself through the big change. Watch more WomenTalk episodes

As told to Jacquelyne Froeber November is National Family Caregivers Month. My mom was my biggest fan. After I published my first novel, she came to all my author talks. At the end of each session, I’d ask if anyone in the crowd had questions, and she was always the first one to raise her hand. “I’m Vicki, your mother,” she’d say standing up. Everyone would laugh. “My daughter is a brilliant writer — this is a brilliant book.” People thought my mom was adorable, but I was so embarrassed. I said, “Mom, you cannot announce to everyone how great your daughter is and then ask me questions at every reading.” She said OK and then ignored me. That was just who my mom was — she radiated positivity and joy, and she was passionate about supporting women — including, and most especially, her daughter. After my father passed away in 2014, my mom moved to Los Angeles. She lived in a 55 and older community about five minutes from my house. Although she was independent, she was living with a brain tumor. It wasn’t cancerous but it limited her vision in one eye and caused balance issues. Still, my mom was able to do mostly everything on her own: go to the supermarket, get her nails done, take a memoir writing class. Then the fender bender happened. My primary care doctor, who was also my mom’s doctor, told us she didn’t think mom should drive anymore — her eyesight was too bad. I knew giving up her car was a big deal for her — driving was her independence. But I quickly realized it was a big change for all of us. I became mom’s primary caregiver after that, but I still had two of my three kids at home that I was driving to doctor’s appointments, school, soccer practice, martial arts and all the other places they needed to be. I started to feel like I was drowning in demands. On an average day, I would go pick up mom for an appointment or to go to the grocery store and my phone would buzz the entire time. “I need the reservation number for the plane tickets.” — Daughter“I need a ride home after practice.” — Son“I need money for lunch.” — Youngest“Did you respond to the text about the reservation?” — Husband“I need a walk.” — Family dog OK, our dog never made demands over text, but I still felt guilty. I was always running around trying to balance the needs of my kids and my mom. There were also the emotional needs and teenage angst that came with everyday life. And my mom had emotional needs, too. I tried to stay present in the moment when I was with her, but I was often distracted. I felt like I was falling behind as a daughter, mom and wife. Robin and her dog, Shiloh, 2024 Some days, I wanted to pull the car over and cry. I was so overwhelmed physically and mentally. But frankly, I didn’t have time. In October 2019, things got worse. My mom fell and hit her eye — the good one. The injury took her eyesight and then she was almost completely blind. She needed in-home care and therapy, and it was up to me to find the best care team to help with all her new challenges. Then Covid started and everything went dark. The in-home care plans stopped. Everything was closed and planned doctor’s visits and therapy just went away.We were terrified. Everyone was terrified. To make matters worse, our home was not safe for my mom. My husband’s a physician so he was in and out of the hospital every day during the pandemic. We were terrified we were going to pass the virus to her. And I couldn’t go to her place. The elder community was very strict because they were trying to protect their vulnerable residents. So, weeks went by before I was able to see my mom in person. When I was finally able to visit I was shocked by how downhill she’d gone in such a short time. She was confused and disoriented. The isolation and loneliness and lack of services had taken an irreversible toll on her. We did everything we could to lift her spirits and health overall, but Mom died not long after that. The guilt was insurmountable. As her caregiver, I felt responsible for her. The blame and regret played on a loop in my brain: I made the wrong choices … I should have made different choices … if only I’d known my mom was at the end of her life … but how could I have known … I could have moved her in with me … but I was trying to protect her … but did I protect her? These questions plagued me.The loss and the grief of losing a parent is something many people experience. But grief is a different shade when you’re their primary caregiver. There’s an extra layer of guilt and remorse — even though there’s nothing more you could have done. Because it’s not just grief, there’s a sense of responsibility and that’s very hard to handle. Mentally, I was in a very dark place for a long time. I’d spent so much time worrying about my mom when she was alone and now that she was gone, I was worried about how she died. About a year later, when the world opened back up, two of my three kids were off at school. My youngest started driving everywhere and didn’t need me like before the pandemic. Suddenly I was this rudderless person. I had these two starring roles in my life — mother and daughter — which may have been difficult at times but they gave me a sense of purpose. So, who was I without my children and my mother? I needed help moving forward, so I started seeing a grief therapist. She changed my life. She helped me see that I’d been a fierce advocate for my loved ones all my life and there was nothing I could’ve done to change what happened to my mom. In addition to therapy, I began a regular writing practice where I shared my grief and loss each week on my blog. It was the best way for me to connect to myself and share my grief journey with others. After a year of writing, I went back and reread what I’d written. It remains a powerful map of what I’ve been through and how far I’ve come. It’s been four years since my mom died. Since that time, I’ve moved from feeling her absence to feeling her presence in everything I do. I called upon her many times for help when I was writing my second book, “Heart. Soul. Pen.: Find Your Voice on the Page and in Your Life.” I still look for her hand in the crowd during author talks, but, even though I don’t see it, I feel it. I know she’s still right here with me.Have a Real Women, Real Stories of your own you want to share? Let us know.Our Real Women, Real Stories are the authentic experiences of real-life women. The views, opinions and experiences shared in these stories are not endorsed by HealthyWomen and do not necessarily reflect the official policy or position of HealthyWomen.