This Issue

Patient power

The root of the problem

Making every dollar count

ABC's of health insurance

Q & A

Inherited risks

Who’s in charge here?
You are

It is your responsibility to get the appropriate screenings at the appropriate time based on your age, gender, race, risk factors and family history. If your doctor does not offer the tests, ask for them. You’re the one who ultimately pays — in poor health.

Condition
Frequency*
Starting age*
High blood pressure
Yearly
20
High cholesterol
Every five years
20
Type 2 diabetes
Every three years
45
Breast cancer
Yearly
40
Prostate cancer
Yearly
50
Colorectal cancer
Every one to ten
50
Cervical cancer
Every one to three years
21

*Frequency and starting age will differ by risk factors. For instance, if you have prostate cancer in your family, you will probably start screening at age 40 or 45.

For more information, click here.

A detailed list of screening tests

Sources: American Cancer Society, American Heart Association,
American Congress of Obstetricians and Gynecologists

Ask the question

Looking for reliable sources of
health information?
Here are a few...
Government Agencies

• National Cancer Institute
www.cancer.gov

• MedlinePlus
medlineplus.gov

• Centers for Disease Control and Prevention
www.cdc.gov

• U.S. Department of Health & Human Services
www.healthfinder.gov

Non–profit Organizations/HMOs

• American Cancer Society
www.cancer.org

• American Heart Association
www.heart.org

• American Diabetes Association
www.diabetes.org

• Blue Cross Blue Shield of Massachusetts
www.ahealthyme.com

For a tutorial on evaluating health information on the Internet, click here.

Inherited risks

There are several diseases that run in families and are passed down from generation to generation. A family history does not guarantee an illness; it raises the odds. Examples of inherited diseases are:

• Prostate cancer

• Ovarian and breast cancer

• Colorectal and uterine cancer

• Diabetes

• Heart disease

• Stroke

• High blood pressure

• High cholesterol

• Kidney disease

• Depression and dementia

• Alcoholism and other substance abuse

• Miscarriage and stillbirth

• Birth defects and infertility

• Asthma

• Alzheimer’s disease

Reliable health information

Family history medical tree

Who's in charge here?

Risk factors
• Tobacco use

• Heavy alcohol use

• Combined tobacco and
alcohol use

• HPV infection
• Sun (cancer of the lip)

• Exposure to chemicals,
such as asbestos

• Poor diet — lacking in
fruits and vegetables
Another good reason to visit the dentist


“All you have to do is open your mouth.”

— The Head and Neck Cancer Alliance


The oral cancer examination is painless and quick … and life-saving. When cancers of the head and neck are found early, the cure rate is high. Annual screenings by a doctor or dentist should be a part of your regular physical or dental checkup. The provider:

• Inspects your face, neck, lips and mouth.

• Feels the area under your jaw and the sides of your neck, checking for unusual lumps.

• Asks you to stick out your tongue to check for swelling, color and texture.

• Using gauze, lifts your tongue and pulls it from one side, then the other.

• Checks the roof and floor of your mouth and the back of your throat.

• Feels and examines the insides of your lips and cheeks for red or white patches.

• Places one finger on the floor of your mouth and, with the other hand under your chin, presses down to check for unusual lumps or sensitivity.

Source: National Institute of Dental and Craniofacial Research

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.


Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon
617-638-8260

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
617-636-1664
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
617-573-3340
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.
781-326-4600

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
617-726-0218
Remember to call ahead to confirm
time and date
of screenings.

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The ABC’s of health insurance

HMO, PCP, PPO, POS — feel like you’re wading through alphabet soup? Read on for translations of common terms.

• Health maintenance organizations (HMO) require you to choose a primary care physician (PCP), who coordinates all of your care, including visits to specialists.

• Preferred provider organizations (PPO) let you make your own choices from a network of preferred providers (in some plans, you can pay a higher fee for out-of-network care) and may not require you to have a primary care physician.

• Point-of-service plans (POS) let you choose between receiving care from participating providers (you’ll be reimbursed more for this), or non-participating providers(you’ll be reimbursed less for this).

Some plans offer lower premiums (monthly payments) in exchange for a higher yearly deductible (the amount you must pay personally before insurance provides any coverage). Some plans require co-pays, a set fee you pay for health care visits or medications. Others ask you to pay co-insurance, which means you’re responsible for a portion (20 percent, for example) of eligible expenses charged by a provider or the amount the insurer agrees to pay for specific services.

Many plans require preauthorization or precertification for certain services, such as surgery or visits to a specialist. Some pick up the tab on preventive care services, such as flu shots, cholesterol tests, or colonoscopy. Most have formularies that list pre-approved, commonly prescribed drugs.

The root of the problem
Medical histories play an essential role in determining future lifestyles



Knowing a family medical history can sometimes reduce the risk of inherited diseases through timely screenings and lifestyle changes.
Thirty minutes had passed and Brenda Robertson had more questions than answers. She was trying to fill out her family tree — complete with medical histories — and she soon learned that the task was nearly impossible.

Many of her relatives were dead and their medical histories — to the extent they were written down — died along with them.

That didn’t deter Robertson. The information that she could collect was a good start — and changed her life.

Both of her parents died from strokes, but it was her father’s history that particularly stood out. He had two strokes, and the second one was fatal. He was 44 years old when he died.

Those genes were passed down. Already, Robertson’s older sister has had a stroke, as has one of her nephews. So far, Robertson has been spared, but she is not taking any chances.

“I want to prevent these illnesses in myself,” she said.

Knowing that strokes and diabetes run in her family, Robertson has changed her lifestyle to control those risks.

She has substituted water for sugared beverages, reduced her portion sizes and eats more vegetables. And she exercises.

“I walk a lot now,” she said.

The value of family medical histories is enormous, largely because many illnesses are passed down from generation to generation. Many diseases, such as cancer, diabetes, high blood pressure and even mental illness, have a genetic link.

So important is the family history that the Surgeon General in 2004 launched a Family History Initiative to encourage families to learn more about their inherited health risks. The Surgeon General designated Thanksgiving — a holiday when families gather — as National Family History Day. The Department of Health and Human Services has created a web-based tool at https://familyhistory.hhs.gov that allows users to enter, print out and save the information.

The family history tree is an essential tool for patient empowerment.

In the 2004 HealthyStyle survey, the Centers for Disease Control and Prevention found that 96 percent of the respondents believe that family history is important for their own health; yet a paltry 30 percent reported that they actively collected necessary information. One difference was noted, however. Those with a personal history of type 2 diabetes were more likely to have collected information from relatives.

The family medical history tree allows a doctor to assess risks for a certain disease, determine the type and time of screening tests and judge the risk of passing the conditions on to the next generation.

For instance, women who have a history of breast cancer — especially when diagnosed at a young age — may require initiation of mammograms before the age of 40 as well as a concomitant MRI.

“The biggest concerns are cancer and heart disease, especially in the young,” said Dr. Mark Drews, an internist at Whittier Street Health Center. “If you’re 40 and your brother died of cancer at 40, you should know which cancer. If it was prostate cancer, you need to start screening now. If it was lung cancer and he was a heavy smoker, there is less concern.”

An ideal family history includes at least three generations. Primary relatives — parents, children and siblings — are most important. But grandparents, aunts, uncles and cousins should not be overlooked.

What should trigger attention is a disease that occurs at an earlier age than expected, a disease in more than one close relative, a disease that is atypical for that gender — for instance breast cancer in a male — and certain combinations of diseases, such as breast and ovarian cancer.

It takes a bit of detective work to complete the history. Ask questions, review death certificates and available medical records. Determine age of diagnosis and age and cause of death. List ethnic backgrounds as well.

The history is a work in progress and should be corrected and edited as new information comes to light. Most important is to pay attention to what’s been revealed.

Lifestyle changes — healthy diet, exercise, and smoking cessation — will not change your genes, but can reduce the risk of the diseases. The fact that your family has a certain history is not a guarantee that you will likewise be afflicted.

Originally from the West Indies, Robertson readily admits she is not through with her history. “I’m going home this year,” she said. “I can get more information from my family then.”