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Editorial: Coronary calcium scores still not ready for prime time

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On his Cardobrief blog, Larry Husten captures the latest chapter in the promotion of coronary calcium screening. There’s a new study in JAMA that says the technique can improve the classification of heart risk.

Husten writes:

“Once again a study has turned up results that appear to favor widespread application of calcium screening. And once again an editorial has pointed out that the technique is still not ready for prime time. (And we predict that once again the proponents of calcium scans will trumpet the study as absolute justification for widespread adoption of calcium screening.)

An accompanying editorial by John Ioannidis and Ioanna Tzoulaki points out that the statistical improvement in risk prognostication, even if validated in different populations and studies, does not necessarily mean the technique should be put into widespread use: it has not yet been “demonstrated that the added accuracy in risk stratification can actually aid clinicians in better treating patients or improving their clinical outcomes.”

“Moreover,” they write, “cost and harms may be major issues. Computed tomography costs $200 to $600 and routine implementation at the population level can be very expensive. The lifetime excess cancer risk due to radiation exposure from a single examination at age 40 years is 9 cancers per 100 000 men and 28 cancers per 100 000 women. This risk should be taken into account in formal risk-benefit analyses.”

Addendum:

See also the thorough reporting by MedPageToday.com.

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