The Dubious Value of Coronary Calcium Scoring on Lung Cancer Screening CT.
J Am Coll Radiol. 2017 Mar;14(3):343-344. doi: 10.1016/j.jacr.2016.08.011. Epub 2016 Oct 4.
Bernheim A1, Auffermann WF2, Stillman AE2.
Coronary artery disease is responsible for approximately 620,000 new acute myocardial infarctions each year in the United States and accounts for approximately 380,000 annual deaths . On the basis of data released from the National Lung Screening Trial, CMS ruled in February of 2015 that it will cover annual lung cancer screening with low-dose CT for asymptomatic individuals aged 55-77 with a tobacco smoking history of at least 30 pack-years who are currently smoking or who had quit within the past 15 years . Even within this segment of the population that is at substantively increased risk of lung cancer (the number one cancer killer in both men and women), heart disease is still the most likely cause of death . Therefore, there have been a number of proponents suggesting that coronary calcium scoring, whether performed quantitatively or qualitatively, could and/or should be reported on lung cancer screening CT reports . The thought of coupling screening of lung cancer with coronary arterial calcium assessment, thus simultaneously assessing two leading causes of death, has been enticing. However, upon further examination, it may be best to temper enthusiasm for the value of coronary artery calcification. In the overwhelming majority of lung cancer screening patients, little value will be added that will actually effect any change in management because most of these patients will already be either in the “high-risk” category and recommended to be on statin therapy or in the “intermediate-risk” group for which treatment should be considered.