How to Calibrate Your Anxiety to the Degree of *Actual* Risk 🩺
Working on our anxiety by itself can’t guarantee health.
Apparently, last week’s post about Managing Health Anxiety struck a chord. It’s clear that many of you live with low-grade, simmering anxiety about a variety of silent, serious diseases.
Take, for example, this reader’s reply to last week’s post:
I have a fear of ovarian cancer because it is a silent disease whose symptoms can mask something innocuous. I had a relative die from this. I have had this checked and am fine but every twinge near there causes worry. I wonder if other women worry about this and if this would make for a good article from you ie. what to do to guard against these silent but serious illnesses?
This reader’s concern echoes what I hear from many other people, patients, friends and people in the comments. It makes complete sense. It’s normal to worry about health. It’s also difficult to access good primary care doctors who have time to listen, explain evidence-based recommendations, and address their patients’ concerns. The internet capitalizes on people’s vulnerabilities, spiking anxiety with junk science and unfiltered information.
In my experience, there are a handful of diagnoses that people tend to worry about. Ovarian cancer, pancreatic cancer, Alzheimer’s disease, brain tumors, and ALS are high-profile diseases with generally unfavorable—and often fatal—outcomes. They also aren’t easy to screen for.
Which is why they are perfect fodder for an anxious mind. And why people without symptoms often report feeling dismissed by doctors when they voice their concerns. While medical reassurance is often appropriate (and is not the same as dismissing a patient’s concerns), when patients feel dismissed, it tends to fuel their anxiety and can breed distrust of physicians.
The inherent problem is that working on our anxiety by itself can’t guarantee health. So, the question isn’t how to stomp out health anxiety altogether; it’s: How do you calibrate your anxiety to your degree of actual risk?
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The short answer is: Start with the facts.
First, it’s important to recognize that every serious disease—whether it’s ovarian cancer or Alzheimer's—has some known risk factors. And while some of these risk factors are fixed, some are dynamic. In other words, some things that predispose us to developing the disease are knowable. Some are even within our control.
Take, for example, the risk of ovarian cancer. The lifetime risk of developing ovarian cancer is 1.3 percent, and it increases with age. An increased risk of ovarian cancer is associated with several ovarian cancer susceptibility genes, primarily BRCA1, BRCA2, as well as other genes associated with Lynch syndrome, a genetic disorder that is the most common cause of inherited colorectal cancer. This means that women with a family history of ovarian, breast, or colorectal cancer may have an increased risk. This risk is higher if close relatives (such as a mother, sister, or daughter) have had ovarian cancer.
What else increases a woman’s risk for ovarian cancer? Advancing age, infertility, endometriosis, polycystic ovarian syndrome, and cigarette smoking. Some studies suggest that obesity and the use of talcum powder may be associated with an increased risk.
My advice? Talk to the women in your family. Quit smoking if you’re able. Take a list of your known risk factors to your doctor and talk about your risk. Discuss your need for added screenings which can include genetic testing, pelvic sonograms, or blood testing, if appropriate. Make sure you are seen, heard, and provided with data when you have symptoms that worry you. Not every woman needs specific genetic, radiographic or lab screening for ovarian cancer. But every woman deserves a conversation about her risk.
Next let’s talk about Alzheimer’s disease (AD). Alzheimer’s is the most common cause of dementia and one of the leading sources of morbidity and mortality in the aging population. Age and genetics are the top two risk factors for developing AD. (I will write another post later on the genetics and the testing landscape for AD.)
Of course we cannot control our age and genetic makeup. However we can try to control some of the risk factors that predispose us to AD. Factors that increase the risk include vascular risk factors (such as hypertension, high cholesterol, cerebrovascular disease, altered glucose metabolism, and diabetes), trauma to the brain, and certain medications (such as benzodiazepines like Alprazolam and Clonazepam). The significance of these risk factors appears to be most pronounced when they develop during midlife.
My advice? To mitigate anxiety about your risk of Alzheimer’s disease, know your family history. Know your other environmental, social/behavioral, and cardiovascular risk factors—and know which ones are potentially reversible. See your doctor and make a plan for screening if appropriate. Get moving. Limit alcohol, sugar, and processed food. Quit smoking. Limit medications, like benzodiazepines, that may negatively affect cognition. Estimates suggest that up to one-third of Alzheimer’s cases around the world could be attributed to modifiable risk factors such as diabetes, midlife hypertension, and physical inactivity!
And last, try to work on the anxiety itself. Anxiety loves uncertainty; it festers in the what ifs? We can sleep better at night—and we can be healthier in general—when we have a better understanding of the medical facts. Learning which facts are fixed and which are dynamic is key. When we learn to accept the things we cannot control, we free up our limited brain space to have agency over the things we can change.
As always, I welcome your thoughts in the comments!
Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
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