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| Uncovering Your Health Risks | Prepared Patient Archives |
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At various points in our lives, we’re curious about our health risks, wondering about our susceptibility for everything from high cholesterol to a deadly inherited disease. We might want to learn more about our risks when we reach a certain age or experience a bout of bad health; when we hear about a friend or co-worker coping with a dreaded illness; or read the latest headlines about disease research. People can choose many paths to find out more about their personal risk(s) of disease, including community health screenings, health assessments provided by a doctor or an employer, or online calculators offered by hospitals, insurance providers and nonprofit health groups.
Entering the Realm of Risk Health risk usually refers to the chance of getting a certain disease during a certain time frame. You’re most likely to hear about risks in numbers: a 20 percent chance of developing cancer, or a one in five chance of having a heart attack before age 65. These are estimates based on what is known about the rate or the number of various conditions occurring across groups of people. Sometimes these estimates are broken down by gender, by geographic location and certainly by age. Numerous studies show that most people—even doctors—have a difficult time understanding risk. It’s a task that involves many skills, from understanding mathematical probability to knowing how to evaluate information sources, say Dartmouth researchers Steven Woloshin, M.D., Lisa Schwartz, M.D. and Gilbert Welch, M.D. (see sidebar) Researchers have found that we tend to overestimate the risks of dying from a rare illness, while downplaying our risks of death from common diseases. This bias can lead to fretting about unlikely causes of illness and potential cures, while ignoring controllable behaviors such as diet, exercise and proper medication that have been proven to reduce the overall risk of disease and poor health. Health Screenings, Calculators and More You may be concerned about a specific risk, like the chances that you might be likely to have heart disease, in which case you may ask your doctor for a certain test, or seek out that test or screening in a venue like a community health fair. You might search online for more information, or take advantage of a health evaluation program offered by your employer. While some people seek specific risk information through these channels, it’s important to note that these are also the places where you might accidentally turn up risk information that wasn’t on your radar. When Barry Wilhelm signed up for an assessment offered by his workplace, he hoped it would motivate him to change some unhealthy behaviors and put his family’s poor health history in perspective. But blood tests offered as part of the plan turned up some startling news: he had hemochromatosis, an iron overload disorder that can lead to organ damage if untreated. Until the assessment, Wilhelm had no idea that he was walking around with a serious condition. After the blood tests, he scheduled a visit to his regular doctor and began to plan the care that would allow him to lead a normal life. “If you have a test and something like that pops out,” he cautions, “you don’t want to just let it sit there.” Online tools that calculate risk —from well-known sites such as RealAge to those offered by groups like the American Heart Association—may offer a glimpse of your health future. Most of these calculators ask a few short questions about your current health status, your tendency toward any known risk factors for a particular disease, and sometimes your family history of disease. Like any other online source of information, it’s best to choose a calculator from a reputable source, such as a well-known nonprofit or an established hospital. Beyond calculators, people may use health risk assessments offered by their workplaces or available for purchase, or get information about health risks from community health screenings or a visit to a doctor. These assessments can be more comprehensive than an online calculator, although they may ask similar questions. In many cases, your risk is calculated by comparing your answers to certain health questions or screening results to what’s known from research about the characteristics of the people who have the disease and scientifically established disease risk factors, including any genetic data. But it’s important to know exactly where these comparison data are coming from, said Erika Waters, Ph.D., an assistant professor at the Washington University School of Medicine who has studied the content of online risk calculators.
Even if the calculator appears to be based on good studies, the findings from those studies or the people that were studied may not be relevant to you, Waters cautions. For instance, a heart disease calculator could give an overall assessment of risk based on excellent studies of men over 65 years old, but their risk factors and health status are different than those for a 40–year- old woman. It’s also helpful if the risk assessment can put your risk into perspective by noting how common the disease is, and by comparing the calculated risk to the risk of other conditions. Oncologist Robert Miller uses several online cancer risk calculators with his patients. “For people concerned about cancer, these are good motivators to encourage good health behavior,” he says. “For those with cancer, these calculators are quite helpful to allow people to make more informed and better decisions.” Miller recommends the National Cancer Institute (NCI) of the National Institutes of Health as a resource. The NCI website section on Cancer Causes and Risk Factors offers a wide range of reliable information about cancer risk including calculators. Ready for Action Some health risk assessments have expanded the definition of risk to include the complete health care experience, from a person’s social support network to how well you feel your doctor listens to your concerns. John Wasson, M.D. a geriatrics researcher at Dartmouth Medical School, helped create the How’s Your Health? assessment to include these items and more. How’s Your Health? allows users to look at their health in a broad way that includes follow up and specially tailored advice for different age groups. The focus on follow-up and positive strategies to minimize risk should be a key part of any health assessment, Wasson says. “People usually hate the idea of health risk assessment,” he says. “They don’t like being told, yet again, that they’re overweight. They like to get patted on the head, but most of the time they get kicked in the butt.” The best risk assessments offer further information or other resources to help users follow up, says Waters at Washington University. Without strategies to reduce your risk, “you’re kind of at a loss.” Barry Wilhelm took his assessment to his next visit with his doctor to help them together figure out how to proceed in treating his hemochromatitis. He sees the assessment as “a tool for people who want to take some responsibility for their health,” but not a replacement for a good relationship with a regular doctor. Wasson wants people to realize that a questionnaire can be your entry to the realm of risk, but it’s only the first step. “We want people to be curious about their health, but we also want them to understand that change in anything we do is a journey, not a one-time completion of anything.”
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When you read in the newspaper that a new ulcer drug increases the risk of stomach bleeding by 30 percent, does that seem like news you can use, or do you end up feeling like it's all a roll of the dice? To help decipher these alarming and yet potentially useful stories, Dartmouth researchers Stephen Woloshin, Lisa Schwartz and Gilbert Welch published a book called Know Your Chances to help people decipher the language of risk. “We wrote the primer because while people are bombarded with messages about health risks and treatment benefits,” Woloshin says, “little is done to prepare them to understand those messages.” Know Your Chances is a great read, but you can also find some of the same information online. Check out the “risk” resources in the Prepared Patient Forum’s 411 directory.
Published by Designed by The Health Behavior News Service, of The Center for Advancing Health, does not provide medical advice or consultation. The Prepared Patient is a new series intended to help people make informed choices about their health care. REPRINTS: CFAH welcomes reproduction of Prepared Patient features, in whole, for educational purposes and feedback only (not for profit), with credit to the “Health Behavior News Service, part of the Center for Advancing Health.” Any changes or additions to this feature must be pre-approved by HBNS/CFAH. © 2010, All Rights Reserved
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But the information and usefulness of these sources can vary, and may leave you with more questions than answers. For some, these first forays into sorting out personal risks can be more distressing than helpful. 
“One thing I like to see is if there is an indication on the Web site that explains where they got their information,” she says, “like a note that explains that the risk assessment calculator was developed based on these 15 scientific articles.”