Page 26 - Delaware Medical Journal - November/December 2019
P. 26
“The opportunity for early diagnosis of additional chronic conditions through LDCT (low-dose CT) screening, especially among older Delawareans, will further reduce overall morbidity and mortality and generate substantial cost savings for the state.” In
my opinion, that statement is an unrealistic
to see how screening would “generate substantial cost savings for the state.” Are there economic models that show this? The unattainable ideal screening protocol has no overdiagnosis, no false positives, and rare from that paragon, the more the uneasiness among physicians who are in a position to support a screening study. It is the turning
of asymptomatic screening subjects into patients that generates so much criticism of many screening protocols.
smoking-related conditions that may be detected incidentally on screening
scans: emphysema and coronary artery
diseases that may contribute to morbidity and mortality in Delawareans. It is also of interest to note that the leading cause of death in the NLST was a cardiovascular event, with deaths. Is a lung cancer screening study a valid substitute for a formal coronary artery calcium (CAC) scoring study — perhaps?
Or it may just as well be an ersatz study that contributes to further non-invasive cardiac tests and specialist referrals that may greatly increase costs to the state. The issue is unsettled.
There is no consensus among lung cancer screening centers about reporting CAC; however, the Society of Thoracic Radiology recommends reporting CAC on all non- contrast chest CT scans. Some centers only centers give a detailed vessel-by-vessel description that approaches Agatston scoring.
CAC screening has generated considerable debate and controversy among cardiologists. Many investigators have shown that CAC predicts cardiovascular events beyond what is shown by traditional Framingham Risk factors.10 As well,
some have used CAC burden as a guide to therapy — statins — or to no therapy in those with zero CAC. Despite increasing research on the clinical utility of CAC, there are no randomized trials that demonstrate that CAC screening decreases mortality.11
Some cardiologists believe that CAC
risk assessment; however, the United States Preventive Services Task Force concluded that the change is too modest to recommend CAC screening.12 It is reasonable for radiologists to report moderate or heavy CAC when reporting lung-cancer screening studies; such information can be used to encourage
leading the way
in healthcare professional development
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