Breast Cancer HealthRisk Assessment

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Medically Reviewed By: Expert-24 Medical Review Board on March 27, 2014 | References | Terms of Use & Privacy

HEALTHTOOLS™ (HEALTHRISK™ AND HEALTHAGE™) DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Expert Review Panel – Expert-24 Ltd

Terms of reference

The aim of the Expert Review Panel is to ensure that all Expert-24 clinical and epidemiological content is robust, independent and up to date.

Qualifications

Medical Director and Editor

Dr. Timothy Dudley

Chairman of the Expert Review Panel

Dr. Robin Christie

Current authors and reviewers for the Health Risk Assessment

Dr. Martin Dawes

Dr. Jonathan Mant

Emeritus authors and reviewers for the Health Risk Assessment

The following individuals were deeply involved in the creation of the health risk assessment at its inception, but are no longer active reviewers on the panel:

Dr. John Fletcher

Dr. Emma Boulton

Professor Larry Ramsay

Professor Klim McPherson



Patient-centered health risk using an Evidence Based Medicine approach

Who created it and how often is it reviewed and updated?

This health risk assessment is brought to you by Expert-24 Limited. Expert-24 Ltd has full editorial control over content and strives to ensure that the content is: 

  • Robust - All information used is derived from reputable, referenced sources and subject to rigorous expert review. The content is written by the medical staff of Expert-24 and reviewed by an independent Expert Review Panel. All content is subject to regular review and updated to incorporate the latest evidence. Oxford Health Consulting was commissioned to conduct independent research to determine the model for disease and mortality-specific risks, the contents and its assumptions. The research and statistical modeling behind the risk assessment has been led by Dr. John Fletcher. Dr. Fletcher is deputy editor of the Canadian Medical Association Journal. He holds a Masters degree in Public Health Quantitative Methods and is a member of the Royal College of General Practitioners. 
  • Independent - The content on the site is provided by Expert-24 Limited, an independent UK company providing knowledge automation and decision support tools to improve health and wellbeing. No member of the Expert Review Panel has any financial stake in Expert-24 Ltd. Content creation and ongoing Quality Assurance is provided by Expert-24 Ltd and its Expert Review Panel. 
  • Up to date - All clinical material is subject to review by Expert-24 and its Expert Review Panel at least annually.

Why is this health risk assessment different than others?

Most health risk assessments say if a person is at high, medium or low risk of either dying from or developing a given medical condition. Most also indicate what lifestyle factors contribute to this risk. What they do not say is the magnitude of each risk for an individual and how much that person’s risk will decrease if they change their lifestyle. For example, if one is at moderate risk of two diseases, say bowel cancer and heart disease, most people would be unaware that their risk of heart disease is still five times higher than their risk of bowel cancer. 

In order to construct an electronic risk assessment tool for health and disease states, it is necessary to provide supporting research evidence and a method of encapsulating the best estimate of relative risk. For each medical condition, it is necessary to present credible estimates of risk, based on evidence from relevant, peer reviewed medical research. Important features of the risk assessment tool are: 
  • The tool gives numerical estimates of risk, rather than an imprecise statement such as "increased risk" or "reduced risk". 
  • The tool has the capability for interaction, allowing users to explore the impact on their personal risk of changing individual risk factors. 
  • The tool utilizes best available medical evidence 

The aim of this project is to provide healthy people with a quantitative assessment of their personal risk of developing some important diseases and some of the factors that influence their risk. This is an ambitious task and we would not claim to have produced the definitive approach. Although we believe this is the most informative collection of disease prediction equations available at the present time they do have limitations. The ones we are aware of are outlined below.

What exactly does a given percentage risk mean?

Someone looking at their risk of lung cancer until the age of 50 should read this model as saying, "Assuming survival to age 50 the chance of developing lung cancer during that time would be (some predicted value)". This approach has the appeal that changing risk factors will have the expected impact on cumulative risk and the mathematics remains transparent. We chose the risk of developing a certain condition rather than the risk of dying from it because for many people the fear of living and dealing with a disabling disease is as frightening as dying from it. 

This is different than lifetime risk calculations, which generally calculate the risk of dying from a given condition. Lifetime risk must take account of the fact that we all die of something in the end and calculating the relative contribution of common competing causes of death at various ages is difficult. Not only that, but the interpretation by users is complex. For example, a user of an interactive model predicting lifetime risk of lung cancer would see their individual risk of lung cancer fall with increasing cigarette consumption, because they would be dying of heart disease and chronic lung disease before they could get lung cancer.


How accurate are these percentages?

These models are good for illustrating the change in risk due to the presence or absence of single risk factors for prediction times of up to 5 years. They are likely to be reasonably good for 15 or 20 years and for combinations of several risk factors. For longer prediction times and varying more than, say, four risk factors the results should be regarded as illustrative rather than precise. The absolute level of risk for an individual may also be wide of the mark because the majority of overall risk remains unexplained in most research studies. This is why "confidence intervals" have not been included. That said these prediction equations do calculate the best estimate of risk that can be provided on the data given. 

Is this useful in the end? We believe it is. We believe that putting some quantification on risk allows users to explore the possible impact on their health of altering what they do. We find this approach more informative than a bland statement of "high risk" that is often value laden or that a certain action will "cut down" a risk without any indication of by how much.

Is risk really reversible?

This is a difficult question to answer, but in many cases the answer seems to be, "yes". This is good news for people with high risks who are older. Intuition might tell you that you are constantly doing damage to your body that accumulates over time, and in many cases that may be true. An example of this is in skin cancer, where the earlier and more often you are badly burned in life, the higher your risk of skin cancer. Staying out of the sun when you are old cannot reverse this risk. 
However, there is good evidence that for heart disease, for example, your risks can be significantly reduced no matter what your age. Cholesterol reduction by medications called "statins" reduces the risk of heart attack, angina or sudden death from heart problems by up to 30%, and this is entirely independent of age. Similarly, blood pressure reduction by drugs reduces the risk of stroke and heart disease by 25% - again entirely independent of age. Because in general it is older people who have the highest risks, they actually stand to benefit the most from treatment. 

The risk for developing heart disease in tobacco users has been shown to decline to a level comparable with a person who has never smoked within 2-3 years of giving up. Furthermore, the risk of having a stroke is reversed after 5-10 years of stopping. Studies have also shown that life expectancy improves even in people who stop smoking later in life (i.e. at 65 years or older). 

The reduction of risk that can be obtained from changing lifestyle habits such as diet, alcohol consumption and exercise is largely unknown. Therefore, the amount of risk reduction that can be expected from optimizing these habits needs to be viewed with caution. Certainly they should not take the place of blood pressure control, cholesterol control, and smoking cessation as goals.


How good is the evidence?

Our aim in searching for evidence was to identify up to ten high quality, relevant research studies for each topic. We used Medline to search using free text, MeSH terms and thesaurus search terms specific to each medical condition. To narrow the documents we used filters using "risk" and study design type; cohorts, case control, longitudinal, follow up. Searches were limited to studies published in English language and human studies. Although a comprehensive systematic review of the literature on each disease was not possible due to the scope of this project, we feel that the evidence used represents a reasonable cross-section of high-quality literature on the subjects in question. 
What we have done is to seek out plausible values of relative risk to use in the prediction equations. We have used an approach that searches for high quality research studies and have then applied our judgment tempered by Austin Bradford Hill's criteria for causation when selecting which risks to use. Hill's criteria are: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experimental evidence and analogy. 

If this sometimes appears somewhat subjective then that is because at times it is a matter of judgment. The judgments have seldom altered the relative risk by more than a small amount. For each risk factor we had to choose a value to use in the model and have been faced at times with a range from which to choose. While a meta-analysis may provide the best point estimate, one is not always available and would be spurious to conduct on the sample of studies we have used for each condition. Given the level of uncertainty surrounding an individual's absolute personal risk we are comfortable with a comparatively lesser degree of uncertainty regarding a risk factor's relative risk.

What is the mathematical model that is used?

The actual mathematical and statistical models and risk coefficients that are used to determine risk are proprietary at this time, but have been validated by the authors and reviewers to be appropriate for use in this setting. 

References: Breast Cancer

Most recently reviewed:

  1. Gonzalez CA and Riboli E. Diet and Cancer Prevention: Contributions from the European Prospective Investigation into Cancer and Nutrition Study. Euro J Cancer 46 (2010) 2555 –2562.
  2. Chen, WY et al. Moderate Alcohol Consumption During Adult Life, Drinking Patterns, and Breast Cancer Risk. JAMA 2011; 306(17): 1884-1890.
  3. Petracci E, Gail M, et al. Risk Factor Modification and Projections of Absolute Breast Cancer Risk. J Natl Cancer Inst 2011; 03:1037-1048.
  4. World Cancer Research Fund and the American Institute for Cancer Prevention. Recommendations based on the Second Expert Report. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. 2007 http://www.dietandcancerreport.org/expert_report/index.php

Guidelines reviewed annually:

  1. American Cancer Society Guidelines for the early detection of cancer at http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guid...
  2. NHS Cancer screening programmes at http://www.cancerscreening.nhs.uk/
  3. National Institute for Health and Clinical Excellence at www.nice.org.uk
  4. Risk of breast cancer at http://www.cancer.gov/bcrisktool/
  5. United States Preventive Services Task Force at http://www.ahrq.gov/clinic/uspstfix.htm

Selected articles from previous reviews:

  1. Duffy, SW et al. Absolute numbers of lives saved and over diagnosis in breast cancer screening, from a randomized trial and from the Breast Screening Programme in England. J. Med. Screen 2010; 17:25-30
  2. Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk, April 2009 at http://www.otru.org/pdf/special/expert_panel_tobacco_breast_cancer.pdf
  3. Schreer, I. Dense breast tissue as an important risk factor for breast cancer and implications for early detection. Breast Care 2009; 4(2): 89-92. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931066/
  4. Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD001877.
  5. Tosteson AN, Stout NK, Fryback DG, for the DMIST Investigators. Cost-effectiveness of digital mammography breast cancer screening. Ann Intern Med 2008;148(1):1-10.
  6. Sweeney C, Baumgartner KB, Byers T, Giuliano AR, Herrick JS, Murtaugh MA, et al. Reproductive history in relation to breast cancer risk among Hispanic and non-Hispanic white women. Cancer Causes Control. 2008 May ;19(4):391-401.
  7. International Menopause Society concensus statement on HRT and risk of cancer at: http://www.imsociety.org/pdf_files/comments_and_press_statements/ims_press_statement_13_05_08.pdf
  8. Benetou, V. et al. Conformity to traditional Mediterranean diet and cancer incidence: Greek EPIC cohort. British J. Ca. (1 July, 2008) 99, 191-195
  9. Kushi, L.H. et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity CA Cancer J. Clin. 2006; 56 (5):254-281
  10. Chlebowski RT, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. J Natl Cancer Inst. 2006 Dec 20;98(24):1767-76.
  11. Breast Cancer Management - alcohol consumption. Clinical Knowledge Summaries. Minor update May 2007 at: http://cks.library.nhs.uk/breast_cancer_managing_fh/management/detailed_answers/what_advice_can_i_gi...#
  12. Takkouche B, et al. "Personal use of hair dyes and risk of cancer: a meta-analysis." JAMA May 25, 2005, 293(20):2516-252.
  13. Duijts SF, et al. "The association between stressful life events and breast cancer risk: a meta-analysis." Int J Cancer Dec. 20, 2003, 107(6):1023-9
  14. Boyd NF, et al. "Dietary fat and breast cancer risk revisited: a meta-analysis of the published literature." Br J Cancer Nov 2003, 89(9):1672-85
  15. McTiernan A, et al. "Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women's Health Initiative Cohort Study." JAMA 10/09/
  16. Calle EE, et al. "Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults." N Engl J Med Apr 24, 2003, 348(17):1625-38
  17. Rossouw JE et al. "Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial." JAMA 2002 Jul 17 288(3):321-33.
  18. Ellison RC et al. "Exploring the relation of alcohol consumption to risk of breast cancer" Am J Epidemiol. Oct 15, 2001; 154(8):740-7.
  19. Key, T.J. et al, "Epidemiology of breast cancer." Lancet Oncology 01 Mar 2001; 2(3): 133-40
  20. Hamajima, N. et al, "Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease." British Journal of Cancer, 18 Nov 2002; 87(11): 1234-45
  21. Bianchini, F., "Overweight, obesity, and cancer risk." Lancet Oncology 01Sep 2002; 3(9): 565-74
  22. Lahmann, P.H., "A prospective study of adiposity and postmenopausal breast cancer risk: The Malmö diet and cancer study." International Journal of Cancer 10 Jan 2003; 103(2): 246-52
  23. Boyd, N.F., "Heritability of mammographic density, a risk factor for breast cancer." New England Journal of Medicine 19 Sep 2002; 347(12): 886-94
  24. Lillberg, K., "Stressful life events and risk of breast cancer in 10,808 women: a cohort study." American Journal of Epidemiology 1 Mar 2003; 157(5): 415-23
  25. Kropp, S., "Active and passive smoking and risk of breast cancer by age 50 years among German women." American Journal of Epidemiology 1 Oct 2002; 156(7): 616-26
  26. Egan, K.M., "Active and passive smoking in breast cancer: prospective results from the Nurses' Health Study." Epidemiology 01 Mar 2002; 13(2): 138-45
  27. Band, P.R., "Carcinogenic and endocrine disrupting effects of cigarette smoke and risk of breast cancer." Lancet 5 Oct 2002; 360(9339): 1044-9
  28. Layde, P.M., "The independent associations of parity, age at first full term pregnancy, and duration of breastfeeding with the risk of breast cancer. Cancer and Steroid Hormone Study Group." Journal of Clinical Epidemiology 01 Jan 1989; 42(10): 963-73
  29. Lipworth, L., "History of breast-feeding in relation to breast cancer risk: a review of the epidemiologic literature." Journal of the National Cancer Institute, 16 Feb 2000; 92(4): 302-12
  30. Little, M.P., "Comparison of breast cancer incidence in the Massachusetts tuberculosis fluoroscopy cohort and in the Japanese atomic bomb survivors." Radiation Research, 01 Feb 1999; 151(2): 218-24
  31. Doody, M.M., "Mortality among United States radiologic technologists, 1926-90." Cancer Causes Control, 01 Jan 1998; 9(1): 67-75
  32. Evans, J.S., "The influence of diagnostic radiography on the incidence of breast cancer and leukemia." New England Journal of Medicine 25 Sep 1986; 315(13): 810-5
  33. Eunyoung, C., et al, "Premenopausal Fat Intake and Risk of Breast Cancer" Journal of the National Cancer Institute, Vol. 95, No. 14, 1079-1085, July 16, 2003
  34. Clavel-Chapelon, F., "Differential effects of reproductive factors on the risk of pre- and postmenopausal breast cancer. Results from a large cohort of French women." British Journal of Cancer 4 Mar 2002; 86(5): 723-7
  35. Holmes MD, et al. "Physical activity and survival after breast cancer diagnosis". JAMA 5 May 2005; 293(20):2479-86
  36. Key TJ, et al. "Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women" J Natl Cancer Inst. 20 Aug. 2003; 95(16):1218-26
  37. Duijts SF, et al. "The association between stressful life events and breast cancer risk: a meta-analysis." Int J Cancer 20 December 2003; 107(6):1023-9
  38. Collaborative group on hormonal factors in breast cancer, "Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies", Lancet, 1996 347:1713-1727
  39. Colditz, et al, "Family History, Age and Risk of Breast Cancer; Prospective data from the Nurses Health Study", JAMA 1993 270: 338-343
  40. Schairer, et al, "Menopausal Estrogen and Progestin-Estrogen Replacement therapy and Breast Cancer Risk", JAMA 2000 283: 485-491

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The HealthTools™ assessment is an educational tool made available to you at no charge.  It is designed for adults 18 years and older living in the United States.  It was developed using current national standard guidelines.

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YOU AGREE TO WAIVE ANY AND ALL LAWS THAT MAY LIMIT THE EFFICACY OF ANY RELEASES CONTAINED IN THESE TERMS, INCLUDING THE PROVISIONS OF CALIFORNIA CIVIL CODE SECTION 1542.

Copyright Violations

If you believe that your copyrighted work has been copied and is accessible through our Services in a way that constitutes copyright infringement, please notify our designated copyright agent. The notice must include all of the information required by the Online Copyright Infringement Liability Limitation Act of the Digital Millennium Copyright Act, 17 U.S.C. § 512 (“Copyright Act”). As of the date of the posting of this Agreement, the information that you must provide includes: identification of the copyrighted work that allegedly has been infringed; identification of the material on our Services that you believe infringes the copyright (with sufficient specificity to allow us to locate it); a statement that you believe in good faith that the use is not authorized by the copyright owner, its agent or the law; a statement that the information you have provided is accurate and, under penalty of perjury, that you are the owner of the copyright involved or are otherwise authorized to act for the owner; your physical or electronic signature or the signature of a person authorized to act on behalf of the owner of the allegedly infringed right; and your contact information. Please keep in mind that under Section 512(f) of the Copyright Act, any person who knowingly materially misrepresents that material or activity is infringing may be subject to liability. Any claims of copyright infringement concerning our Services should be sent to copyright@hcahealthcare.com. We will respond to each complaint quickly and diligently. Only copyright complaints should be sent to the above agent. No other communications will be accepted.

Forward-Looking Statements

Some statements made available by our Services are not historical facts and therefore are considered forward-looking statements within the meaning of Section 21E of the Securities and Exchange Act of 1934. These forward looking statements are subject to risks and uncertainties as which could cause our actual results to differ materially from those expressed in or implied by the content of our Services. Forward-looking statements made available by our Services are made as of the date of the initial publication and we undertake no obligation to update any of these forward-looking statements as actual events unfold.

Third Party Payments

We are not responsible for any charges or fees associated with financial transactions that occur on or through third party websites. Any payments you may make for services you have found through use of our Services or through any Portal (such as enrolling in a class) are made exclusively through an affiliated third party website the separate privacy policy of which applies, and not through our Services or Portal. We encourage you to read the privacy statements of each and every website that collects personally identifiable information.

Privacy

We are sensitive to the expectation of privacy by those who access and use our Services. For a complete statement of our policies related to online privacy, please read our Privacy Policy, available at our Website homepage.

Choice of Law and Venue

This agreement is entered into and performed in the State of Tennessee and you agree this agreement is governed by the laws of the State of Tennessee, without consideration to the principles of the conflicts of law. Your continued use of our Services, confirms you consent and submit to the personal jurisdiction in the State of Tennessee and venue of the County of Davidson for any state or federal action arising out of the use of our Services or these Terms. This agreement does not constitute doing business in any other state than the State of Tennessee.

You agree that regardless of any statute or law to the contrary, any claim or cause of action arising out of or related to our Services, the Terms or the Privacy Policy must be filed within one year after such claim or cause of action arose or such claim or cause is barred.

Invalidity and Waiver

If any provision of these Terms is found to be invalid by any court having competent jurisdiction, the invalidity of such provision shall not affect the validity of the remaining provisions of these Terms, which shall remain in full force and effect. No waiver of any of these Terms will be deemed a further or continuing waiver of such term or condition or any other term or condition.

Section Titles

The section titles of the Terms are merely for convenience and will not have any effect on the substantive meaning of these Terms.

Entire Agreement

Except as expressly provided in a particular "legal notice" on our Services, these Terms constitute the entire agreement between us and you, respectively, with respect to the use of our Services and content contained therein.

Additional Terms for Use of Text Message Notifications

Text Message Terms

We have developed a mobile alert and messaging service that may allow you to receive confirmation or reminders for billing purposes, medical appointments at our facilities, and other communication we may send. In addition to the mobile alert services, you may also receive additional notifications from us. By providing a mobile number that allows you to receive text message or short message reminders and information, you are opting to participate in our mobile alert and messaging service and you agree to be bound by the following terms and conditions related to our SMS text notification services.

How we Protect our Patients’ Private Information

We are dedicated to maintaining information confidentiality and complying with regulatory requirements by – among other things – limiting access to only those users that have a legitimate need to view it, and regularly educating employees on information protection.

We are committed to the care and improvement of human life, and that includes protecting your private information.

Website Privacy Policies

These are the policies regarding the usage of the El Camino Hospital website.

El Camino Hospital is committed to respecting the privacy of all those who visit the El Camino owned and operated web site, which excludes linked and framed external web sites, (the "El Camino Owned Site") and use our online services and will endeavor to implement measures designed to protect the privacy of those using our services. Note, however, that we do collect and use information from visitors to the El Camino Owned Site and to web sites that are external to www.elcaminohospital.org, that are accessible through links and frames within the El Camino Owned Site (the "El Camino Web Site"). This Web Site Privacy Policy is part of the Terms of Use Agreement, which sets forth our practices and the terms relating to the collection and use of information from you in connection with your visit to the El Camino Owned Site and use of our online services. Please note that by visiting and using the El Camino Owned Site you are agreeing to the terms and conditions of this Privacy Policy. If you do not agree to such terms and conditions, please discontinue use and exit the El Camino Owned Site.

Please be aware that the El Camino Hospital reviews its privacy practices from time to time, and that those practices and this policy are, therefore, subject to change. We ask that you bookmark and periodically review this page to ensure continuing familiarity with the most current version of our Web Site Privacy Policy. We may provide notice of any such changes by posting an updated Web Site Privacy Policy with the date of the update set forth below. To contact El Camino Hospital about privacy issues related to the El Camino Owned Site or to report a violation of our Web Site Privacy Policy, please e-mail us at ECH_Webmaster@elcaminohospital.org with your request. We treat all information in accordance with the Web Site Privacy Policy in effect at that time.

IMPORTANT! Note that the El Camino Hospital Notice of Privacy Practices is a separate document that governs how certain health information about you may be used and disclosed by El Camino Hospital. Please take a moment to review this policy as well, located in our Patient Services section.

Except as set forth within this Web Site Privacy Policy, the El Camino Hospital Notice of Privacy Practices and our Terms of Use Agreement, or as required or permitted by law, we do not release personally identifiable information about the El Camino Owned Site visitors without their permission.

What Information Does El Camino Hospital Collect From You in Connection with the El Camino Hospital Web Site?

Personally Identifiable Information

El Camino Hospital and its third-party service providers collect and store certain personally identifiable information that you voluntarily provide or otherwise convey through your use of the El Camino Web Site, such as web pages that allow you to register for classes, provide us with input on our El Camino Owned Site, participate in on-line surveys, apply for open positions or correspond with certain departments within the hospital (such as the billing department). Such information may include your name, address, e-mail address, social security number, credit card information (when applicable) and similar types of information. Additionally, some features of the El Camino Web Site may ask you to provide certain health information in addition to your name, address and email. Although certain areas of the El Camino Web Site may require that you provide us or third-party service providers with such personally identifiable information in order, for example, to complete certain on-line forms, you are free to use the remainder of the El Camino Web Site without providing such personally identifiable information and may exit such forms at any time.

We do not knowingly collect personally identifiable information from children (defined herein as minors younger than thirteen years of age). If you are under the age of thirteen, please do not submit any personally identifiable information via the El Camino Owned Site. Before using the El Camino Web Site, persons under the age of eighteen must have their parents or legal guardians read our Terms of Use Agreement and this Web Site Privacy Policy and consent to the terms on their behalf.

Non-Personally Identifiable Information

El Camino Hospital and third-party service providers also collect non-personally identifiable information such as web site usage, traffic patterns, site performance and related statistics based on our tracking of your visits to the El Camino Web Site. Although such information may not be personally identifiable, we can determine from an IP address a visitor's Internet Service Provider and the geographic location of his or her point of connectivity. We also use small text files placed on a user's computer hard drive ("Cookies") to help us determine the type of content and sites to which a visitor to the El Camino Web Site links, the length of time each visitor spends at any particular area of the El Camino Web Site and the El Camino Hospital services visitors choose to use. Cookies allow El Camino Hospital to serve you better and more efficiently, and to personalize your experience at the El Camino Web Site. Nevertheless, you should be able to control how and whether Cookies will be accepted by your web browser. For more information on how to do so, please refer to the documentation accompanying your browser.

How We Use (and Do Not Use) the Information We Gather in Connection with the El Camino Hospital Web Site

Please take some time to familiarize yourself with the different ways El Camino Hospital and third-party service providers use the information that each gathers through the El Camino Web Site. Keep in mind that, while El Camino Hospital encourages all third parties with access to our visitor information – including but not limited to its affiliates and advertisers – to adhere to the El Camino Hospital policies regarding the privacy of our visitors and to otherwise handle personally identifiable information in a responsible manner, we cannot and do not assume any responsibility for any actions or omissions of third parties, including the manner in which they use information received either from El Camino Hospital or independently through frames on or links within the El Camino Web Site. Nevertheless, in the event that you encounter any third party associated with, or who claims association with, El Camino Hospital who you feel is improperly collecting or using information about you, please contact ECH_Webmaster@elcaminohospital.org with your request; we will be happy to forward your message to the third party.

Personally Identifiable Information

El Camino Hospital may use personally identifiable information that we or third-party service providers receive or collect from you to provide and improve our products and services, send announcements, marketing materials or other communications, process your requests, or otherwise administer our business. El Camino Hospital will use much of the personally identifiable information that you provide primarily for the purposes for which it was collected. For example, we will use information submitted for class registration to administer the classes and to notify you about class schedules and class information, information provided for billing inquiries will be used to respond to such inquiries, and information provided by on-line survey participants may be used to compile statistics regarding user preferences by geographic location. The personally identifiable information collected by El Camino Hospital and third-party service providers may also be used to improve the content of the El Camino Web Site and to better address the needs and interests of El Camino Web Site visitors. For example, El Camino Hospital may send its own e-mail solicitations to visitors who have not "opted out" of receiving such communications. The solicitations are limited in that they, among other things, will clearly indicate the originator of the e-mail and provide the customer with a method of "opting out" of receiving future communications of a similar nature.

If you do not want your personally identifiable information to be used for marketing purposes, you may contact El Camino Hospital at ECH_Webmaster@elcaminohospital.org.

Although El Camino Hospital does not sell personally identifiable information about El Camino Web Site visitors to third parties, we may, in certain circumstances, share personally identifiable information with third parties and provide you with the opportunity to provide personally identifiable information to third-party service providers directly through linked and framed web sites. For example, El Camino Hospital may use third-party service providers to facilitate our services and provide operations for one or more aspects available through the El Camino Web Site. Such third-party service providers may, in certain circumstances, require a visitor's personally identifiable information in order to facilitate certain services and provide such operations. For instance, El Camino Hospital uses a third-party service provider for processing certain billing, credit card and donation transactions and to administer applications for open positions. Any credit card information submitted by you to El Camino Hospital, therefore, will be submitted directly to our credit card processing service provider through a frame on the El Camino Web Site. Also, if you do not "opt out" of receiving promotional materials from El Camino Hospital's affiliates, advertisers or third-party service providers, El Camino Hospital reserves the right to release personally identifiable information regarding you to third parties who provide goods or services that we believe may be of interest to you. If you decide that you would like to discontinue receiving promotional information from such third parties, please contact those third parties directly, or contact El Camino Hospital at ECH_Webmaster@elcaminohospital.org.

Notwithstanding anything herein to the contrary, we reserve the right to release information collected from a visitor (whether or not personally identifiable), including information contained within our access logs, when that visitor is in violation of, or to enforce, our Terms of Use Agreement or other published guidelines, or engages (or is reasonably suspected of engaging) in any illegal activity, or to protect our rights and the El Camino Web Site, even without a subpoena, warrant or other court order, and to release such information in response to requests from law enforcement, court and governmental orders, civil subpoenas, discovery requests and as otherwise required by law, rule, regulation or other legal process. We cooperate with law enforcement agencies in identifying those who may be using our servers or services for illegal activities. We also reserve the right to report any suspected illegal activity to law enforcement individuals or entities for investigation or prosecution.

(For California Residents) California Privacy Rights under California Civil Code Sections 1798.83-1798.84

California Civil Code sections 1798.83-1798.84 give California residents the right to ask El Camino Hospital for a notice describing the categories of personally identifiable information it shares with third parties or corporate affiliates for their direct marketing purposes. The notice will identify the categories of information shared and will include a list of the third parties and corporate affiliates with which it has been shared, along with their names and addresses. If you are a California resident and would like a copy of this notice, please submit a written request to ECH_Webmaster@elcaminohospital.org or the following address: El Camino Hospital, 2500 Grant Road, Mountain View, CA 94040, Attn: El Camino Hospital Privacy Officer. Please allow 30 days for a response.

Non-Personally Identifiable Information

El Camino Hospital will use the non-personally identifiable information it collects in connection with your El Camino Web Site usage for making changes or enhancements to the El Camino Web Site and to better address the needs and interests of the El Camino Web Site visitors, as well as for other internal administrative purposes. We also may use data regarding El Camino Web Site usage to determine which pages of the El Camino Web Site are most helpful to visitors and to improve the information available through such pages. Further, we may provide statistical information and other non-personally identifiable information to advertisers, affiliates and other current and potential third-party service providers. We may also use aggregate data to inform these third-party service providers as to the number of people who have seen and clicked on links to their web sites.

We allow third-party companies, including AddThis, to collect certain anonymous information when you visit our website. These companies may use non-personally identifiable information during your visits to this and other websites in order to provide advertisements about goods and services likely to be of greater interest to you. These companies typically use a cookie or a third party web beacon to collect this information. To learn more about this behavioral advertising practice, you can visit www.networkadvertising.org.

What About Third Party-Privacy Policies?

The El Camino Web Site contains links to other Internet web sites, which may direct you to an external web site or which may be displayed within a frame on the El Camino Owned Site, including co-branded or other affiliated sites which may or may not be owned or operated by El Camino Hospital. Links to the El Camino Web Site may also be featured on independent third-party web sites. El Camino Hospital has no control, and is not responsible for, the privacy practices of other web sites that may host links to the El Camino Web Site or that you may visit through links or frames on the El Camino Owned Site, including such sites' use of any information (such as IP number, browser type, or usage history) collected when visitors to the El Camino Owned Site click through links to such sites or access such sites through frames. We recommend that you review individual site privacy policies before providing any information on such web sites.

Changing or Deleting Personally Identifiable Information; Business Transfers

El Camino Hospital strives to keep your information accurate, complete and current. If you would like to update, correct or have personally identifiable information that you provide or convey through your use of the El Camino Owned Site removed from El Camino Hospital's database, please contact us at ECH_Webmaster@elcaminohospital.org with your request, and we will use reasonable efforts to comply with your request. Upon receipt of a request to delete personally identifiable information, we will delete the applicable personally identifiable information from our active databases, but note that the deletion of the applicable personally identifiable information may prevent you from using certain functions on the El Camino Owned Site. Keep in mind, however, that there will be residual information that will remain within El Camino Hospital databases, access logs and other records, which may or may not contain such personally identifiable information. The residual information will not be used for commercial purposes; however, El Camino Hospital reserves the right, from time to time, to recontact former customers or users of the El Camino Web Site. In addition, we may sell or transfer assets or portions of our business as we continue to improve our product and service offerings. In such transactions, user or visitor information (whether non-personally identifiable or personally identifiable) may constitute one of the transferred business assets.

Protecting Personally Identifiable Information

El Camino Hospital uses reasonable security measures to protect the personally identifiable information that we collect via the El Camino Owned Site. However, while we take reasonable steps to protect your personally identifiable information, we cannot guarantee and do not warrant or represent, that all information will be protected against loss, misuse, or unauthorized access by third parties. By your use of the El Camino Web Site, you agree and stipulate that your use of the Internet and the El Camino Web Site is at your own risk, that no Internet data transmission can be guaranteed as secure from such incidents, and that you will not hold us responsible for any breach of security that is not solely caused by our negligence.

How Do I Find Out About Changes to this Web Site Privacy Policy?

If El Camino Hospital changes its privacy policy for the El Camino Owned Site, we will post those changes here so that you will always know what information we gather, how we might use that information and whether we will disclose it to anyone.

Contact Us

Questions, comments or complaints regarding this Web Site Privacy Policy or our information practices should be directed to El Camino Hospital at ECH_Webmaster@elcaminohospital.org or, if by U.S. mail, at El Camino Hospital, 2500 Grant Road, Mountain View, CA 94040, Attn: El Camino Hospital Privacy Officer.

License

Subject to the terms and conditions of these Terms of Use & Privacy Policy, Hospital grants you a non-exclusive, non-transferable license to access and use the HealthTools assessment and any reports provided to you via the HealthTools assessment solely for your personal information purposes.  Hospital and its licensors retain all intellectual property rights in the HealthTools assessment, including any reports, and any enhancements to it.  Hospital, in its sole discretion, may terminate your license to access and use the HealthTools assessment at any time, for any reason and without any prior notice; provided, that, you may continue to access and use any reports in accordance with this license that you saved outside of the HealthTools assessment.   

Reservation of Rights

Hospital and its licensors are the exclusive suppliers of the HealthTools assessment and the exclusive owners of all right, title and interest in and to the HealthTools assessment, including reports, and all intellectual property related to the HealthTools assessment, any enhancements thereto, and any materials provided to you in connection with the HealthTools assessment.  You may not use the HealthTools assessment, including reports, except pursuant to the limited rights expressly granted in these Terms of Use & Privacy Policy.

Warranties Disclaimer

Hospital provides the HealthTools assessment and reports to you via the HealthTools assessment on an “AS IS “BASIS WITHOUT ANY WARRANTIES OF ANY KIND.  TO THE FULLEST EXTENT PERMITTED BY LAW, HOSPITAL DISCLAIMS ALL IMPLIED WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, NONINFRINGEMENT AND FITNESS FOR A PARTICULAR PURPOSE.  HOSPITAL MAKES NO WARRANTIES ABOUT (i) THE ACCURACY, RELIABILITY, ACCESSIBILITY, COMPLETENESS, OR TIMELINESS OF ANY INFORMATION SUPPLIED TO YOU VIA THE HEALTHTOOLS assessment.

Limitation of Liability

IN NO EVENT SHALL HOSPITAL OR ITS AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, AGENTS OR LICENSORS BE LIABLE TO YOU FOR INCIDENTAL AND CONSEQUENTIAL DAMAGES, RESULTING FROM YOUR USE OR INABILITY TO USE THE HEALTHTOOLS assessment OR ANY REPORTS OR OTHER INFORMATION PROVIDED VIA THE HEALTHTOOLS assessment, OR FOR ANY DAMAGES WHATSOEVER, WHETHER SUCH LIABILITY IS BASED ON WARRANTY, CONTRACT, TORT, NEGLIGENCE OR ANY OTHER LEGAL THEORY, AND WHETHER OR NOT HOSPITAL OR ITS LICNESORS ARE ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

Responsibility for Safety

The HealthTools assessment may advocate or involve physical activity.  You hereby expressly assume all risk associated with any physical activity you undertake in connection the HealthTools assessment or any reports or other information provided via the HealthTools assessment. It is your responsibility to consult with a physician to determine your fitness to engage in any physical activities. It is also your responsibility to use appropriate equipment, clothing and techniques.

Governing Law

THIS USER AGREEMENT, AND YOUR USE AND ACCESS OF THE ASSESSMENT IS GOVERNED BY THE LAWS OF THE STATE OF COLORADO, WITHOUT REGARD TO ITS CONFLICT OF LAWS RULES. JURISDICTION AND VENUE FOR ANY CAUSE OF ACTION ARISING UNDER THIS AGREEMENT SHALL BE IN DENVER, COLORADO. “HOSPITAL” makes no representation that the Assessment is appropriate or available for use in locations outside the United States of America. You agree not to access the Assessment from any country or jurisdiction where its content is illegal or prohibited. If you choose to access the Assessment from outside the United States, you do so on your own initiative and you are responsible for compliance with local laws.

Entire Agreement

You agree that these Terms of Use & Privacy Policy set forth the entire understanding between you and Hospital with respect to the HealthTools assessment. You further agree that if any provision of these Terms of Use & Privacy Policy is held invalid, the remaining provisions shall continue in full force and effect.

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