Are You at Risk?

To some degree, everyone is at risk for something. Where health issues are concerned, it seems like there are risks around every corner -- at least according to media reports.

For example, you may hear on the news one night: "A new study finds that people who don't exercise have three times the risk of getting cancer!" Does this mean that if you don't exercise, you have a three times greater risk of getting cancer than your neighbor who jogs daily? The answer, it seems, is not that simple. How do you translate a report about cancer or other health risks?

What Is a Risk Factor?

To understand risk, one must know what a risk factor is. As it applies to health, a risk factor is something that people are exposed to or something they do. People can also be born with risk factors. Risk factors increase the chances of people becoming sick or getting a disease.

A risk factor could be:

• A toxin, such as cigarette smoke, which increases the risk for lung cancer.

• A lifestyle habit, such as a lack of exercise, which increases the risk for heart disease. An unhealthful diet, another lifestyle habit, increases the risk for many diseases.

• A hereditary risk factor that "runs in the family." For example, if you are a woman and your mother had breast cancer, your risk for breast cancer may be greater.

Remember that having one or more risk factors does not necessarily mean that you will get cancer. However, knowing your risk factors will help you and your doctor evaluate what you can do to prevent a cancer from developing or to find it at an early stage.

Making Sense of the Numbers

These are some terms you may hear when talking about risk:

Incidence -- the number of people who have a disease during a certain time period compared to a number of people in the population.

Example: the incidence rate for breast cancer in women is about 22 cases per 100,000 women.

Relative Risk -- this is a ratio of how strong the link is between an exposure or risk factor and an outcome, such as cancer. It compares the incidence of disease in a group of people having a risk factor to the incidence of disease in the group without the risk factor

Example: women who have an immediate family member with breast cancer have two times the relative risk of getting breast cancer compared to women without a family member having the disease.

Lifetime Risk -- the chances that a person will develop cancer over the course of a lifetime.

Example: one in two men have a lifetime risk of getting cancer.

Relative Survival Rate -- the percentage of people alive in a certain time period after the diagnosis of a disease, such as cancer. The number is adjusted to exclude causes of death other than cancer. It is usually stated as a five-year survival rate.

Example: eighty-five percent of women survive for five years after a diagnosis of breast cancer.

Although you may hear these numbers referred to in studies, they may or may not apply to your own condition. As you will see, there are many factors that affect one's personal risk.

Applying Risk to a Population Versus a Person

Linda Jacobs, PhD, CRNP, AOCN, clinical assistant professor and nurse coordinator at the University of Pennsylvania Cancer Center recently published a report on the concept of risk. "When you hear statistics about health risks, those numbers are averages for general populations," she says. "For example, a study may say that people with a certain risk factor have twice the chance of getting this disease or that condition. That risk number is not figured for any one particular person."

Consider that if you are a forty-year old woman, you have a one in 233 chance of getting breast cancer, according to the National Cancer Institute. But this is an average estimate for the American female population. And many women have heard the statistic that 1 in 8 women will get breast cancer. That number is for women over a lifetime if she lives to 85. These numbers do not include individual factors such as race, family history, reproductive history, smoking habits, and many other factors that can raise or lower your risk of cancer.

Jacob says, "People see things on television or in magazines about a health risk and automatically personalize it, thinking they must be at risk." She says people should use the information with caution and understand that it doesn't necessarily apply to them.

"It's important to explore any concerns with your health care provider. Someone's level of risk for one thing really depends on so many other factors in the person's life. The statistics you hear about are not as relevant when rating your own personal risk. You need to discuss it with your doctor who knows your situation."

Jacobs says to keep in mind that doctors are also reading from statistics that are based on large groups or populations. "Doctors can give you a ballpark figure for your risk of something, but it won't be exact."

How to Use Risk Information

Jacobs says that people should look at risk information closely before acting on it. She explains, "Studies reported on television are often unclear. Reporters don't say exactly what population or group of people the study applies to. When you only have two minutes to describe a complicated research study, something likely gets lost in the translation."

It is also important to find a balance. After all, some risks come with benefits. Women over forty are told to have yearly mammograms, which present a very low risk of cancer from the radiation used. However, experts feel the benefit of screening and finding cancer outweighs the low risk of mammograms.

Jacobs suggests that risk numbers can be useful as general guidelines. But to apply the numbers personally, discuss the following questions with your doctor:

• What group(s) of people does a particular study apply to?

• What is my personal health history?

• What is my family history of disease?

• What personal risk factors and risk-taking behaviors can I control? Smoking? Diet? Exercise? Sexual activity?

• What are the benefits, if any, to be weighed against the risk?

• Should I be worried about this risk?

• What can/should I do about this risk if it might apply to me?

People may react in extremes when hearing about risk. Some believe they are at such high risk for a disease that they can't do anything to prevent it -- and continue with high-risk behaviors. On the other end, some can become so nervous that they run out to get screened for every possible illness.

The better response lies somewhere in the middle. Understanding what risks apply most in your life involves talking with your doctor and carefully weighing the questions above.

Health Risks That Can Be Controlled Linda Jacobs found in her research that there are risks some people choose to take. "Many diseases are to some extent brought about by our own behaviors. People take risks despite knowing the problems that can result from them." Estimates from the American Cancer Society support this idea. They report that smoking is the most preventable cause of death. However, thirty percent of all cancer deaths and eighty-seven percent of lung cancer deaths are caused by tobacco use. Scientists note other controllable behaviors that may lower the risk of cancer, such as diet and exercise. Yet, each year one-third of cancer deaths are related to nutrition factors, including obesity, and almost one-third of Americans report not participating in regular exercise. People have the power to control some of the risk factors for cancer but may not. Yet, other risks gain more attention and concern, particularly those that are unfamiliar or that cannot be controlled. Examples are concerns about pesticides and toxic waste, which studies have not yet shown to be significant causes of cancer cases. On the other hand, several studies have shown smoking or eating a high-fat diet to cause certain cancers. "It's a personal decision that people make, often shaped by what they've learned is acceptable in their culture," says Jacobs.