A year ago, I saw a cartoon with two people sitting across from each other at a table. One said, “I remember when we used to sit and talk about our problems over cigarettes and coffee. Now cigarettes and coffee ARE our problems.”
The TV, internet and papers bombard us day and night with the next big problem. The more sensational they can make it, the more they know we will read it.
But sifting the rumors from the facts can be daunting even for a professional. This is just the briefest of outlines to get you started.
You must use your common sense and also question the sources of information and how much this new material may impact you.
This is difficult to do especially with the Internet. The levels of authority are often problematic. We may have a blogger quoting the National Institute of Health or quoting his grandmother. Unless he or she makes it clear, it is impossible for the reader to sort out.
Health risk assessment is a complex issue where multiple factors may play a very important role. There are some factors that we can do little about, like genetics. We may be at higher risk for a particular cancer if several relatives of our family had that cancer.
There is a difference between genetic risks and familial risks. For example, we may be at higher risk for developing colon cancer because members of our family had it. This is genetics. On the other hand, we may be at risk for lung cancer or other respiratory conditions because of secondhand smoke where we grew up; this is familial. These risks are sometimes manageable while genetics is not.
At the other extreme we have diseases of lifestyle and behavior that are under our control. We can elect not to abuse alcohol or drugs. We can avoid unhealthy environments. Our risk for a disease or an injury is determined, among others, by our sex, race, family history, age, occupation, personal behavior, social environment and access to health care.
In the U.S., cigarette smoking is responsible for 90 percent of lung cancers. Despite this fact, 45 million people continue to smoke in the U.S. It is estimated that 160,000 Americans died of lung cancer in 2012. Ninety percent of these deaths were preventable, 90 percent!
The financial burden on health care for lung cancer alone is about $10 billion annually. The number of lung cancer deaths, a preventable condition, is the same as the combined deaths from colon, breast and prostate cancers.
In addition, chronic smoking causes emphysema, which is among the three respiratory diseases, asthma and chronic bronchitis being the other two, responsible for a large number of people disabled and now the fourth cause of death in the U.S. following heart disease, cancer and stroke.
We have seen a significant increase in asthma, especially among young children. The fact that this increase is more intense in large inner cities would indicate that environmental exposure is most likely one of the important causes.
One in eight women will develop breast cancer over their lifetime. But only one in 36 will die as result of breast cancer due to the benefits of modern medicine. The changes in risk, especially over time, may be due to social or environmental changes.
The death rate for lung cancer risk in females in the 1960s was less than five per 100,000. At that time the death rate for breast cancer was about 30 per 100,000. In 1987, following a remarkable change in the American society, the breast cancer risk of death remained the same but the risk of death due to lung cancer is now greater than breast cancer. Presently the risk of dying of lung cancer is twice the risk of breast cancer in women. Quoting an old commercial, “You’ve come a long way, baby.”
Risks of any type must be placed into perspective. For instance, the death risk for breast cancer is almost identical to the risk of dying of an accidental injury. The lesson here is that as much as we are concerned about mammograms we must also be concerned, for instance, about auto accidents and the most common causes of it, speeding and drunken driving.
There is a silver lining in this area. Because of regulatory efforts and the increased safety awareness by the auto industry, the year 2011 had the lowest incidence of auto accident deaths since 1949.
What we do for a living also determines our risk. Most of the time we associate risk with certain professions, men and women that put themselves daily in harm’s way, like police officers or firefighters. This is not accurate; in reality the most dangerous occupations are fishermen and women, timber cutters, pilots and construction workers.
There has been a significant emphasis on control of excessive body weight and high blood pressure. Both are of enormous importance for a healthy life.
But we must also bear in mind that unreasonable exposure to sunlight without sunscreen, the use of tanning salons, exposure to dangerous illegal drugs and abuse of “legal” pharmaceuticals also play an important role.
At the end we have to contend with the same issue with which I started this column; there are certain risks that are not within our control and some that are. It is up to all of us to minimize our risks in areas where something can be done.