Point-of-Care Guides

Estimating 10-Year Mortality Risk

Am Fam Physician. 2007 Mar 15;75(6):885-887.

Clinical Question

What is a patient's risk of dying from vascular disease, cancer, infection, an accident, or any cause within the next 10 years?

Evidence Summary

Accurate estimates of patient risk or prognosis can be helpful to a primary care physician. For example, patients may resist participation in a screening program because they underestimate their risk. Also, women may overestimate their risk of breast cancer1 and downplay other important health risks. Comparing the risk of cancer or heart disease between smokers and nonsmokers can be useful when counseling patients about smoking cessation.

Research has shown that information about risk can be clearly communicated to patients using absolute numbers and frequencies (e.g., 12 in 1,000 patients), whereas percentages, probabilities, and likelihood ratios should be avoided.2 A group of researchers has developed a set of charts (Figures 1 through 43) to help physicians communicate the 10-year mortality risk from vascular disease, cancer, infection, an accident, and any cause.3 The charts are separated based on sex and smoking status. Mortality rates were calculated using data from the 1998 National Center for Health Statistics Multiple Cause of Death Public Use File.4

10-Year Mortality Risk: Male Smokers

Figure 1.

Chart for determining 10-year mortality in men who smoke. The chart indicates the number of men per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 men. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:803.

View Large

10-Year Mortality Risk: Male Smokers


Figure 1.

Chart for determining 10-year mortality in men who smoke. The chart indicates the number of men per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 men. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:803.

10-Year Mortality Risk: Male Smokers


Figure 1.

Chart for determining 10-year mortality in men who smoke. The chart indicates the number of men per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 men. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:803.

10-Year Mortality Risk: Male Never Smokers

Figure 2.

Chart for determining 10-year mortality in men who have never smoked. The chart indicates the number of men per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 men. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:801.

View Large

10-Year Mortality Risk: Male Never Smokers


Figure 2.

Chart for determining 10-year mortality in men who have never smoked. The chart indicates the number of men per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 men. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:801.

10-Year Mortality Risk: Male Never Smokers


Figure 2.

Chart for determining 10-year mortality in men who have never smoked. The chart indicates the number of men per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 men. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:801.

10-Year Mortality Risk: Female Smokers

Figure 3.

Chart for determining 10-year mortality in women who smoke. The chart indicates the number of women per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 women. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:802.

View Large

10-Year Mortality Risk: Female Smokers


Figure 3.

Chart for determining 10-year mortality in women who smoke. The chart indicates the number of women per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 women. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:802.

10-Year Mortality Risk: Female Smokers


Figure 3.

Chart for determining 10-year mortality in women who smoke. The chart indicates the number of women per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 women. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:802.

10-Year Mortality Risk: Female Never Smokers

Figure 4.

Chart for determining the 10-year mortality in women who have never smoked. The chart indicates the number of women per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 women. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:800.

View Large

10-Year Mortality Risk: Female Never Smokers


Figure 4.

Chart for determining the 10-year mortality in women who have never smoked. The chart indicates the number of women per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 women. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:800.

10-Year Mortality Risk: Female Never Smokers


Figure 4.

Chart for determining the 10-year mortality in women who have never smoked. The chart indicates the number of women per 1,000 who will die from various diseases or any cause during the next 10 years, beginning at the indicated age. The shaded area indicates age and cause-of-death combinations with less than one dead per 1,000 women. (AIDS = acquired immunodeficiency syndrome.)

Reprinted with permission from Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst 2002;94:800.

Applying the Evidence

A 60-year-old female smoker is extremely worried about her risk of breast cancer because two of her friends have been diagnosed with the disease in the past 10 years. She has no risk factors for breast cancer, but she has asked you to refer her for breast magnetic resonance imaging (she read that this was the latest and most accurate screening test). What is the best way to convince her that smoking cessation to prevent lung cancer would be more beneficial to her than breast cancer screening?

Answer: You determine that her risk of dying from breast cancer in the next 10 years is seven in 1,000. However, her risk of dying from lung cancer in that same period is 65 in 1,000, compared with five in 1,000 if she were a never smoker. Similarly, her risk of dying from heart disease or stroke in the next 10 years is 61 in 1,000, compared with 18 in 1,000 if she were a never smoker. Her overall risk of dying in the next 10 years is nearly twice as high as it would be if she were a never smoker (199 versus 105 in 1,000). The risk for smokers who quit is presumably somewhere between that for current and never smokers.

Address correspondence to Mark H. Ebell, M.D., M.S., at ebell@msu.edu. Reprints are not available from the author.

REFERENCES

1. Evans DG, Burnell LD, Hopwood P, Howell A. Perception of risk in women with a family history of breast cancer. Br J Cancer. 1993;67:612–4.

2. Gigerenzer G. The psychology of good judgment: frequency formats and simple algorithms. Med Decis Making. 1996;16:273–80.

3. Woloshin S, Schwartz LM, Welch HG. Risk charts: putting cancer in context. J Natl Cancer Inst. 2002;94:799–804.

4. U.S. Department of Health and Human Services. 1998 Multiple Cause-of-Death Public Use File. National Center for Health Statistics CD-ROM Series 20, No.10H. Issued December 2000.

This guide is one in a series that offers evidence-based tools to assist family physicians in improving their decision making at the point of care.


Copyright © 2007 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

More in Pubmed

Navigate this Article