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Risk: Relative vs. Absolute November 22, 2009

Posted by Admin in Cancer, Health Insurance, huh?.
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What is the risk of getting cancer? There are two types of risk, absolute and relative.

If you are over 35, try out the breast cancer risk assessment tool at cancer.gov. There are also tools for colorectal cancer and melanoma.

Also from cancer.gov:

Absolute risk is the number of people who will get the disease within a certain time period. Absolute risk gives an actual number of people with that risk factor who will get the condition. You also may see this expressed as, for example, “10 out of 100 people.”

Relative risk compares the chance that a person with a certain risk factor will get cancer to the chance that a person without the same risk factor will get cancer. When you hear that someone is at “high” risk or “low” risk of getting cancer, it is referring to that person’s relative risk.

Relative risk is usually shown as a percent or ratio. The ratio is based around the value of 1. A value above 1 means a higher risk; a value below 1 means a lower risk.

There are different kinds of risk factors, they include genetic (I have a second degree relative with a cancer history-2 generations away), environmental (secondhand smoke exposure and sun), biological (gender, age, race, skin complexion), or behavioral (what I eat and drink, how much exercise I get).

When I was diagnosed with cancer, I had no risk factors. No first degree relatives, (in fact I didn’t know that I had any relatives with cancer until I was asked the family history question for the first time), no second-hand smoke exposure-unless you count flying in the 70’s) , didn’t come from an ethnic group at higher risk etc. Regular readers will recall that I do not have the BRCA 1 or BRCA 2 mutations either. Cancer was a (more…)

It’s Still a Pink Month…some history October 25, 2009

Posted by Admin in Cancer, Women.
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Six more days of Breast Cancer Awareness Month! The first time I had cancer, there were no pink ribbons,

[picapp src=”5/4/3/4/Oakland_Raiders_v_41c8.jpg?adImageId=6650056&imageId=6706065″ width=”234″ height=”148″ /]

Danskin triathlons, no tamoxifen or test for the breast cancer gene mutations, no Race for the Cure, no Susan Love books; the Susan G. Komen Foundation had been established, but I didn’t know about it.  No internet either.

No Save Second Base or the site I found last week-Save the TaTa’s!

[picapp src=”1/d/9/b/Susan_G_Koman_b934.JPG?adImageId=6647561&imageId=4981226″ width=”234″ height=”351″ /]

How did I do my research back then? (more…)

“Culture of Medicalization” October 22, 2009

Posted by Admin in Diary, Health Insurance, Health Quote of the Week.
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I just picked up a copy of : Worried Sick A Prescription for Health in an overtreated America, at my local library. It is fascinating so far. Here’s the part that prompted me to pick it up:

Hadler argues that the public is at high risk of what he calls “Type II Medical Malpractice”, or the doing of the unnecessary superbly (as opposed to “Type I Medical Malpractice”, in which necessary treatment is provided unacceptably poorly).

I am looking forward to the chapter on Breast Cancer Prevention: Screening the Evidence”. The chapter called “The Heart of the Matter”, reviews interventional cardiology and cardiovascular surgery procedures, where he labels those procedures the “cash cows of …the American health delivery system.” was startling and makes you want to make a list for the surgeons of what not to do to you.

One reason Hadler wrote the book was to empower patients to be skeptical and ask questions about their care. I don’t know if I will agree with everything, but this seems to be well worth reading in order to improve your ability to advocate for yourself when you assume the role of patient. (often involuntarily)

A Pain in My Head: Three Things I Learned October 20, 2009

Posted by Admin in Health Insurance, Women.
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Recently I had an illness, which was accompanied by the worst pain ever. I attended a talk this past weekend by a professor in what might be the leading program on pain management in the country. My question to her was what is the best way to talk to a physician about pain? I told 4 different providers that I had a headache on one side of my head and that it came as often as once per minute and that was not descriptive enough. They did ask some questions about eyesight etc. that seemed to rule out the risk or occcurrence of an aneurysm or a stroke.

Her advice was threefold:

  1. Be Specific and Descriptive: such as “a stabbing, searing recurrent pain two inches above my right eye”.  Using a “key word” such as headache, seems to lead physicians down a specific path that may not be the path you need to travel.
  2. Remember that doctors receive very little pain management training-it is not even a residency speciality like obstetrics, surgery, urology, pediatrics etc. So s not always the first tool they go for in the toolbox. In fact, sometimes the “last resort” is to send the patient to pain management. The “Interventional” Pain Management programs may be able to get you to a diagnosis more quickly.
  3. Nerves can cause pain. In my case, I probably had nerve pain related to the swelling caused by the infection. I was initially given Vicoden for the pain, as acetaminophen was not acting on the pain. That made me feel woozy, but with a searing, recurrent pain. So I was still in pain, but I couldn’t complain as loudly. One of the physicians discussed nerve pain with me, but this one was the 4th one that I had spoken to last week. Apparently Vicoden doesn’t work on nerve pain.

The DNA Test Results… October 10, 2009

Posted by Admin in Cancer, Health Insurance, Healthonymous, Women.
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Here is the news I received yesterday. To recap, I have waited about 11 years to be tested for the two known gene mutations that go with breast cancer. Why did I wait? Privacy and non-discrimination protection for genetic testing did not exist in 1998.

In an earlier post, I described what I learned about the GINA legislation, passed in May 2008.

The test results are…..drum roll… negative. Meaning that I don’t have those mutations. Whew. While my lifetime risk is still elevated (for ovarian cancer), the BRCA genes have been ruled out for now or until the test changes (it has changed twice in the last 11 years).  If I had the mutations, then I would have been asked [again] about considering oophorectomy (removal of the ovaries).

The insurance company has requested the results (which they are legally not entitled to), and the testing lab says they “have my back” on this. So not to worry, right? Nonetheless, I will worry about it a little bit. It is so rare to hear “we have your back” in the context of an insurance conversation.

NIH public domain photo

NIH public domain photo

If you want to make someone in your life feel good, tell them that you have their back!

12% Increase and How Much is Too Much September 17, 2009

Posted by Admin in Money.
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Well, I anticipated correctly. Today my company handed out the preliminary notice about open enrollment. This year’s health insurance increase will be 12%. I pay 25% of the monthly cost and the company pays the other 75%. I haven’t seen a 12% raise for a while, have you?

Also, I was at a meeting today where a speaker reminded us that some of our fellow health insurance users might be using too much health care because “well, I already paid for it”. I understand the process that might lead someone to have procedures done that might be available but not always necessary. Would I have not had my colonoscopy if I had to pay a greater share of it? Is that procedure cheaper than having cancer? Probably. Did I research that? Well, no. But I do have previous experience…Did I shop around for the cheapest colonoscopy? Well no. It was hard to even get an estimate and the insurance company wouldn’t even give me the amount that they would reimburse the clinic because they worry that the clinic will then charge that amount. Does my colonoscopy affect the double digit premium increase in the aggregate?

Here’s one reason that I went and did this right away, unlike some people I know who have postponed that procedure to age 52 or 53. I think I wanted to know if I had any risk factors for another type of cancer. I got to hear the physician tell me that no biopsy was needed.  I’ve not heard that a lot. No return procedure for ten years also great news. I agree with President Obama that colonoscopies, like mammograms, should be considered part of preventive care. But I couldn’t afford to wait for the  bill to pass! (No pun intended.)

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