👵🏽🏥 One Numba Fo’ Guide Yoa Health Choices (Not Yoa Age) 📊💡

⬇️ Pidgin | ⬇️ ⬇️ English

At her annual visit, da patient’s docta asks if she planning fo’ continue having regular mammograms fo’ screen fo’ breast cancer, and den reminds her dat it’s been almost 10 years since her last colonoscopy.

She’s 76. Hmmm. 😮

Da patient’s age alone may be one argument against further mammogram appointments. Da independent and influential U.S. Preventive Services Task Force, in its latest draft guidelines, recommends screening mammograms fo’ women 40 to 74, but says “da current evidence is insufficient fo’ assess da balance of benefits and harms of screening mammography in women age 75 years or older.”

Screening fo’ colorectal cancer, wit’ one colonoscopy o’ wit’ one less invasive test, becomes similarly questionable at advanced ages. Da task force gives it one C grade fo’ dose 76 to 85, meaning dere’s “at least moderate certainty dat da net benefit is small.” It should only be offered selectively, da guidelines say.

But what else is true ’bout dis hypothetical woman? Is she playing tennis twice one week? Does she get heart disease? Did her parents live well into dea 90s? Does she smoke?
Any o’ all such factors affect her life expectancy, which in turn could make future cancer screenings eida useful, pointless o’ actually harmful. Da same considerations apply to an array of health decisions at older ages, including dose involving drug regimens, surgeries, oda treatments and screenings.

“It doesn’t make sense fo’ draw dese lines by age,” said Dr. Steven Woloshin, one internist and director of da Center fo’ Medicine and Media at da Dartmouth Institute. “It’s age plus odda factors dat limit yoa life.”

Slowly, therefore, some medical associations and health advocacy groups have begun fo’ shift dea approaches, basing recommendations ’bout tests and treatments on life expectancy rada dan simply age.

“Life expectancy gives us more information dan age alone,” said Dr. Sei Lee, one geriatrician at da University of California, San Francisco. “It leads to betta decision making mo’ often.”

Some recent task force recommendations already reflect dis broada view. Fo’ older people undergoing lung cancer tests, fo’ instance, da guidelines advise considering factors like smoking history and “one health problem dat substantially limits life expectancy” in deciding when fo’ discontinue screening. Da task force’s colorectal screening guidelines call fo’ considering an older patient’s “health status (e.g., life expectancy, co-morbid conditions), pri’a screening status and individual preferences.”

Da American College of Physicians similarly incorporates life expectancy into its prostate cancer screening guidelines; so does da American Cancer Society, in its guidelines fo’ breast cancer screening fo’ women ova’ 55.

But how does dat 76-year-old woman know how long she will live? How does anybody know?

A 75-year-old has one average life expectancy of 12 years. But when Dr. Eric Widera, one geriatrician at da University of California, San Francisco, analyzed census data from 2019, he found enormous variation.

Da data shows dat da least healthy 75-year-olds, dose in da lowest 10 percent, was likely fo’ die in ’bout three years. Dose in da top 10 percent would probably live fo’ anodda 20 o’ so.

All dose predictions are based on averages and can’t pinpoint life expectancy fo’ individuals. But just as doctas constantly use risk calculators to decide, say, wheda’ fo’ prescribe drugs to prevent osteoporosis o’ heart disease, consumers can use online tools to get ballpark estimates.
For instance, Dr. Woloshin and his late wife and research partna’, Dr. Lisa Schwartz, helped da National Cancer Institute develop da Know Yoa Chances calculator, which went online in 2015. Initially, it used age, sex and race (but only two, Black o’ white, because o’ limited data) fo’ predict da odds of dying from specific common diseases and da odds of mortality overall ova’ one span of five to 20 years.

Da institute recently revised da calculator to add smoking status, one critical factor in life expectancy and one dat, unlike da odda criteria, users have some control ova’.

“Personal choices are driven by priorities and fears, but objective information can help inform dose decisions,” said Dr. Barnett Kramer, one oncologist who directed da institute’s Division of Cancer Prevention when it published da calculator.

He called it “an antidote to some of da fear-mongering campaigns dat patients see all da time on television,” courtesy of drug manufacturers, medical organizations, advocacy groups and alarmist media reports. “Da mo’ information dey can glean from dose tables, da mo’ dey can arm demselves against health care choices dat don’t help dem,” Dr. Kramer said. Unnecessary testing, he pointed out, can lead to ova’diagnosis and ova’treatment.

One number of health institutions and groups provide disease-specific online calculators. Da American College of Cardiology offers one “risk estimator” fo’ cardiovascular disease. One National Cancer Institute calculator assesses breast cancer risk, and Memorial Sloan Kettering Cancer Center provides one fo’ lung cancer.

---

NOW IN ENGLISH

📊💡👵🏽🏥 A Number That Should Guide Your Health Choices (It’s Not Your Age)

At her annual visit, the patient’s doctor asks if she plans to continue having regular mammograms to screen for breast cancer, and then reminds her that it’s been almost 10 years since her last colonoscopy.

She’s 76. Hmmm. 😮

The patient’s age alone may be an argument against further mammogram appointments. The independent and influential U.S. Preventive Services Task Force, in its latest draft guidelines, recommends screening mammograms for women 40 to 74, but says “the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women age 75 years or older.”

Screening for colorectal cancer, with a colonoscopy or with a less invasive test, becomes similarly questionable at advanced ages. The task force gives it a C grade for those 76 to 85, meaning there’s “at least moderate certainty that the net benefit is small.” It should only be offered selectively, the guidelines say.

But what else is true about this hypothetical woman? Is she playing tennis twice a week? Does she have heart disease? Did her parents live well into their 90s? Does she smoke?
Any or all such factors affect her life expectancy, which in turn could make future cancer screenings either useful, pointless or actually harmful. The same considerations apply to an array of health decisions at older ages, including those involving drug regimens, surgeries, other treatments and screenings.

“It doesn’t make sense to draw these lines by age,” said Dr. Steven Woloshin, an internist and director of the Center for Medicine and Media at the Dartmouth Institute. “It’s age plus other factors that limit your life.”

Slowly, therefore, some medical associations and health advocacy groups have begun to shift their approaches, basing recommendations about tests and treatments on life expectancy rather than simply age.

“Life expectancy gives us more information than age alone,” said Dr. Sei Lee, a geriatrician at the University of California, San Francisco. “It leads to better decision making more often.”

Some recent task force recommendations already reflect this broader view. For older people undergoing lung cancer tests, for instance, the guidelines advise considering factors like smoking history and “a health problem that substantially limits life expectancy” in deciding when to discontinue screening. The task force’s colorectal screening guidelines call for considering an older patient’s “health status (e.g., life expectancy, co-morbid conditions), prior screening status and individual preferences.”

The American College of Physicians similarly incorporates life expectancy into its prostate cancer screening guidelines; so does the American Cancer Society, in its guidelines for breast cancer screening for women over 55.

But how does that 76-year-old woman know how long she will live? How does anybody know?

A 75-year-old has an average life expectancy of 12 years. But when Dr. Eric Widera, a geriatrician at the University of California, San Francisco, analyzed census data from 2019, he found enormous variation.

The data shows that the least healthy 75-year-olds, those in the lowest 10 percent, were likely to die in about three years. Those in the top 10 percent would probably live for another 20 or so.

All these predictions are based on averages and can’t pinpoint life expectancy for individuals. But just as doctors constantly use risk calculators to decide, say, whether to prescribe drugs to prevent osteoporosis or heart disease, consumers can use online tools to get ballpark estimates.
For instance, Dr. Woloshin and his late wife and research partner, Dr. Lisa Schwartz, helped the National Cancer Institute develop the Know Your Chances calculator, which went online in 2015. Initially, it used age, sex and race (but only two, Black or white, because of limited data) to predict the odds of dying from specific common diseases and the odds of mortality overall over a span of five to 20 years.

The institute recently revised the calculator to add smoking status, a critical factor in life expectancy and one that, unlike the other criteria, users have some control over.

“Personal choices are driven by priorities and fears, but objective information can help inform those decisions,” said Dr. Barnett Kramer, an oncologist who directed the institute’s Division of Cancer Prevention when it published the calculator.

He called it “an antidote to some of the fear-mongering campaigns that patients see all the time on television,” courtesy of drug manufacturers, medical organizations, advocacy groups and alarmist media reports. “The more information they can glean from these tables, the more they can arm themselves against health care choices that don’t help them,” Dr. Kramer said. Unnecessary testing, he pointed out, can lead to overdiagnosis and overtreatment.

A number of health institutions and groups provide disease-specific online calculators. The American College of Cardiology offers a “risk estimator” for cardiovascular disease. A National Cancer Institute calculator assesses breast cancer risk, and Memorial Sloan Kettering Cancer Center provides one for lung cancer.

Calculators that look at single diseases, however, don’t usually compare the risks to those of mortality from other causes. “They don’t give you the context,” Dr. Woloshin said.

Probably the broadest online tool for estimating life expectancy in older adults is ePrognosis, developed in 2011 by Dr. Widera, Dr. Lee and several other geriatricians and researchers. Intended for use by health care professionals but also available to consumers, it offers about two dozen validated geriatric scales that estimate mortality and disability.

The calculators, some for patients living on their own and others for those in nursing homes or hospitals, incorporate considerable information about health history and current functional ability. Helpfully, there’s a “time to benefit” instrument that illustrates which screenings and interventions may remain useful at specific life expectancies.

Consider our hypothetical 76-year-old. If she’s a healthy never-smoker who is experiencing no problems with daily activities and is able, among other things, to walk a quarter mile without difficulty, a mortality scale on ePrognosis shows that her extended life expectancy makes mammography a reasonable choice, regardless of what age guidelines say.

“The risk of just using age as a cutoff means we’re sometimes undertreating” very healthy seniors, Dr. Widera said.
If she’s a former smoker with lung disease, diabetes and limited mobility, on the other hand, the calculator indicates that while she probably should continue taking a statin, she can end breast cancer screening.

“Competing mortality” — the chance that another illness will cause her death before the one being screened for — means that she will probably not live long enough to