Questions about coronary artery calcium CT scans

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In an issue of the Archives of Internal Medicine that published several studies pointing out the risk of cancer associated with overuse of popular CT scans, there is also a strongly worded editorial about CT scan screening for coronary artery calcium – something some journalists seem to have fallen in love with.

Dr. Patrick G. O’Malley of the Uniformed Services University of the Health Sciences wrote the editorial. Excerpts:

“Any screening for coronary artery calcification (CAC) for primary prevention of cardiovascular disease (CVD) is still an unproven strategy to improve health outcomes. … there is ample reason to be wary of screening for CAC. First, we do not know whether it results in improved outcomes. … There are members of our own profession who are not only endorsing this practice but also profiting from it. In short, screening coronary CT, as currently implemented, is a costly practice with unclear benefit and theoretical potential net harm….

Since it seems that the medical community is unwilling to self-regulate in this probably enormously wasteful endeavor, it will require policy makers to be more forceful in reining in the madness, whether it be the Food and Drug Administration or financiers of health care. To be fair, there are strong logic, rationale, and even promise for this technology, but any further resources invested in this area should first go to large randomized clinical trials to prove its clinical impact. Those trials that use change in calcification scores as a marker for atherosclerosis progression should clearly be using longer intervals than 1 year (likely at least 3 years) for repeated measurements.”

We have seen many stories – especially on TV news – that have glamorized these scans – sometimes by having reporters undergo the scans themselves as part of the story. It will be interesting to see how much attention this editorial and these new studies get.

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