Assignment 6

Discussion

You are discussing the health risks of cigarette smoking with Doris Puffer, a married, slender, 52 year old post-menopausal female patient of yours who is a current smoker. She has had three children, and has no exciting medical problems in the past. Both of her parents lived to be over 80 years old without serious medical trouble. A recent cholesterol level was in the third quintile for her age, and she ``exercises regularly" (by doing her own shopping, it turns out). Under your care, she has received regular Pap smears and blood pressure checks, all of which have been normal. However, she has refused your advice, and has not taken menopausal estrogens.

You estimate that the 10-year risk of lung cancer in a patient like her who does not smoke is about 0.1%, and you guess that the 10-year risk of lung cancer for her (as a current smoker) is about 1%. You estimate that the 10-year risk of coronary heart disease (CHD) in a non-smoker otherwise similar to her is about 8% and you think that her 10-year CHD risk is around 20%.

Mrs. Puffer reminds you that cigarette smoking is protective against endometrial cancer, a problem a friend of hers was just hospitalized for. Since Mrs. Puffer is slender and not taking estrogens, you estimate the 10-year endometrial cancer risk of a non-smoking women otherwise similar to her is about 1%, but she - as a smoker - has a risk of about 0.5%.

1. Summarize in a quantitative manner the relationship between smoking and lung cancer, CHD, and endometrial cancer.
2. Smoking has 2 detrimental effects, and 1 benefit. Is the net effect positive or negative? Can you estimate the net effect? What assumptions do you have to make in order to reach this estimate?

Homework assignments for Thursday October 13

Read Chapter 3 Risks, Risk Factors, and their measurements from Dr. Baron's notes.

To be handed in Thursday.

1. The relative risk of current cigarette smoking (vs never smoking) for coronary artery disease is about 3.
2. The relative risk of bladder cancer among smokers is 30%.
3. The mortality after open radical prostatectomy is 5% among men 70 to 75 years old.
4. The 5-year risk of graft thrombosis after saphenous vein coronary artery bypass is 15%.
5. The mortality rate during bone marrow transplant for disseminated breast cancer is approximately 10%.
6. The mortality rate for coronary artery disease in 65 year-old men is approximately 10%
7. The failure rate among Harvard undergraduates is 10%
8. The lifetime risk of breast cancer for an American woman is 11%.

Journal Assignment for Thursday October 13

Comment in your journal on how you might be able to use Dr. Baron's discussion of evaluating health risks in your own decisions relating to health risks.