Why Woman Wait

American women understandably fear dying from breast cancer, given the numbers who will contract the disease at some point. Breast cancer can be a devastating illness, striking women with no apparent risk factors, often in the prime of life.

Many will be subjected to disfiguring surgery, long-term chemotherapy and perhaps weeks of radiation treatment. Their physical scars often pale in comparison with damage to self-image and sexuality, coupled with fear of recurrence or a painful death.

My mother learned in 1986 that she had localized breast cancer, a diagnosis that sent my family into a brief tailspin. Happily, she has been disease-free since that time.

Speaking to my mother recently made me understand one of the reasons women so fear dying from breast cancer. It is the timing of the disease, striking in midlife, just as they are starting to reap the benefits of years of hard work.

While the risk of breast cancer is never far from her mind, my mother has no such concern about heart disease because, she believes, it kills older women, and it does so in a relatively ''humane'' fashion.

It comes as a surprise to many women -- and to many of their physicians as well -- that coronary heart disease, not breast cancer, is the No. 1 killer of American women.

Although about 36 percent of American women will die from heart disease, only 4 percent fear it as their leading cause of death, according to a recent Gallup survey. The National Center for Health Statistics reported that 40 percent of women feared dying from breast cancer, even though only 4 percent of them actually do.

More interesting, while heart disease and breast cancer are the leading causes of death in patients over 65, in nearly every age group, more American women die from heart disease than breast cancer.

In all, about 375,000 American women die from heart disease each year, compared with 44,000 who die from breast cancer.

The relative disparity of attention toward women's risk of heart disease extends to the health care system as well. Our paradigms for the diagnosis and management of heart disease have developed around the framework of the male patient.

According to the American Heart Association,