Thursday, November 27, 2008

Worried Sick: How Vulnerable Are You Really to Heart Attack, Stroke or Breast Cancer?

By Maggie Mahar, Health Beat. Posted November 27, 2008.

Americans are bombarded with messages that death and danger are just around the corner. Reality is usually much different.

Assume that you are a 40-year-old man. What do you think the chances are that you will die of a heart attack or stroke in the next 10 years? (Please forgive the morbidity of the question; there is a purpose to this pop quiz.) The answer: just 4 out of 10,000 according to Drs. Steve Woloshin and Lisa Schwartz, authors of Know Your Chances. The chances that you will die in an accident before reaching your 50th birthday are 50 percent higher: 6 out of 10,000.

Nevertheless, many men remain convinced that they are at great risk of dying from vascular disease, particularly as they get older. In truth, even at age 60, the odds that a heart attack or stroke will end your life over the next decade are only 37 out of 10,000. Over that span, you are three times more likely to die of another cause -- with the chance of an fatal accident (5 out of 10,000) just as high as the chance of a stroke. Moreover, for reasons we do not fully understand, the incidence of heart attacks is declining.

"Fifty hears ago, heart attacks were a scourge. Everyone knew a working-age man who'd dropped dead from one," writes Dr. Nortin Hadler in his new book, Worried Sick. Today "the decline in mortality from coronary artery disease is well documented."

There is one exception: If you are a 60-year-old smoker, the chance of a fatal heart attack or stroke in the next 10 years climbs to 67 out of 10,000, and your chance of dying of lung disease rises to 59 out of 10,000.

The moral? The average man should probably worry less about his cholesterol levels and more about driving safely and avoiding tobacco.

For many women, breast cancer is the great fear. Again, let's look at the numbers. If you are a 35-year-old woman, what do you think the chances are that you will die of breast cancer before you turn 45? Just 1 out of 10,000 according to Woloshin and Schwartz. The chances that you will die in an accident over the next decade are twice as high: 2 out of 10,000.

Granted, as you grow older, your chances of dying from breast cancer rise, but so do your chances of dying from other causes. When you are 60, the odds that breast cancer will kill you over the next 10 years are 7 out of 10,000. Slim odds. The chances you will die of a heart attack are twice as high: 14 out of 10,000. Maybe you shouldn't worry quite so much about breast cancer.

I was surprised by these numbers, because I thought breast cancer was a leading cause of death among women. This is because I have heard that 1 in 9 women will "get" breast cancer if they live to 85. But as Woloshin and Schwartz point out, this is one of those health messages that is "intended to be scary, warning us that we are surrounded by danger and hinting that everything we do or neglect to do brings us one step closer to cancer, heart disease and death."

As a result, Americans are Worried Sick writes Hadler. A professor of medicine and microbiology/immunology at the University of North Carolina, Chapel Hill, Hadler points out that "far less than 1 in 9 women will die of breast cancer, or even know that they 'have' it when they die."

Unless they had a mammogram. Then they would probably find out and be treated -- whether or not they need treatment. It turns out that two-thirds of women over 55 who have breast cancer will die of something else. Here are the numbers: In order to prevent one cancer death among women over 55, 250 women have to be screened annually, beginning at age 55. But mammograms will also detect two other women with breast cancer who would not have died of the cancer. "In other words" Hadler says, "the screening will lead to the treatment of three women, for two of whom the treatment is unnecessary."


See more stories tagged with: health, risk, breast cancer, stroke, heart attack

Maggie Mahar is a fellow at the Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006).

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