Written by by Jane Seltzer, Special to CNN
In 1974, there was only one coronary calcium scan available to help determine if a patient needed coronary intervention, such as stenting. Subsequent advances in technology combined with medical advances have improved the patient-specific calcium scan , making it a realistic tool for helping doctors select intervention for patients with coronary calcification.
For example, coronary calcium scan results may also be used to help determine prognosis. For years, clinicians have relied on the calcified plaque to diagnose patients with atherosclerosis and help them decide if patients with a poor prognosis — especially with risk factors such as high cholesterol and diabetes — should undergo stenting.
Within just a few years of the first coronary calcium scan, calcium scans have become popular. Glucose and lung scans can determine how a patient feels in the following days. Gallium and your breast can help diagnose breast cancer.
In these advanced technologies, you are looking to the structure of organs, and not at the patient. Nevertheless, there are few questions patients — and doctors — are asking each other today.
In a recent study, tissue analysis researchers at The Ohio State University Comprehensive Heart and Vascular Center compared coronary calcium test results with lung and kidney cancer (LNBC) scans in patients with lung disease and found that fewer lung patients had coronary heart disease (CHD) results that would have qualified them for a noninvasive treatment option.
This study results, along with others, have shown that coronary calcium scan results are not independently predictive of disease progression, and that it may be an additional cost burden for patients.
As society has become more aware of the potential benefits of coronary calcium scans, use of this test has increased dramatically in the past few years. Most companies, as well as the CMS, are highly optimistic about the use of coronary calcium scans, as a predictor of future events and mortality. However, concerns about reimbursement, access to resources, the cost of scopes and the increasing demand for scans also give some pause.
First, the risk-benefit ratio must be determined. Perhaps the most obvious red flag is cancer!
Results of the study from Ohio State University highlighted that between the time when researchers decided that prostate cancer patients would be included in the coronary calcium scan study and the time these scans were actually performed, no difference in cancer outcome occurred.
Statistical evidence has shown that in healthy men, a PET scan is more powerful predictor of disease development and progression, and may even be better at predicting death. Although the National Cancer Institute notes that “more or less,” a PET scan is more beneficial in men with prostate cancer.
But whether a PET scan or coronary calcium scan are beneficial or not, it is important to consider the population that is selected for the scan.
The current clinical community acknowledges the use of coronary calcium scans in otherwise healthy patients who have significant risk factors for having their CHD progressed to a worse state.
If the current CMS reimbursement model were to take effect, it would discourage people from taking the test.
The potential cost of providing the scan could cause many who would likely benefit from the test to decline the scan due to costs. Not to mention, many who may not know what their genetic risk is or even understand it.
Second, even if a scan were to be a safe, effective and inexpensive option for identifying a significant heart disease risk factor, it may not be the appropriate type of scan to use.
Although there is some disagreement regarding whether you should have a CT scan, my personal preference is that a coronary calcium scan should be performed when a patient is considered at high risk. It’s the only available screening tool and on my list of best evidence-based options for today’s physicians.
Opinions on coronary calcium scans are also mixed among physicians and patients alike. This study added another barrier to everyone conducting cardiac screening.
It is important for both patients and doctors to have open dialogue and to discuss their wants and needs. In the context of conversations in healthcare, most want to have their primary care physician speak with them and be more involved in the process.
Ultimately, the medical decisions are made by the individual doctor and patient, and there are various alternative screening tools. The complexity of multiple diseases in today’s culture makes patients uncomfortable and may avoid discussing treatment options.
Ultimately, there is a time for prayer and and time for facts. One should not fear the unknown and prefer uncertainty, but knowledge is power. I urge all patients to bring their questions to their primary care physician, who will help them understand the best answer for their individual needs.