Combined detection of coronary artery disease and lung cancer

Coronary artery disease (CAD) and lung cancer have several important features in common. First, their dramatic increases are in large part attributable to societal ills, including worsening dietary patterns, obesity, and tobacco use. Secondly, as these behaviours permeate the world, the diseases are disproportionately increasing in the poorer societies with limited resources for healthcare. Consequently, it is necessary to develop cost-effective strategies. Both disease states may be amenable to early detection by a single low radiation dose CT scan. Gated multidetector computed tomographic imaging of coronary artery calcium (CAC) is a robust strategy for the early detection of CAD in asymptomatic patients that has performed superior to risk factor-based paradigms such as the Framingham Risk Score (FRS) and the European Society of Cardiology Score.1 Notwithstanding these data, the US Preventive Services Task Force (USPSTF) in 2009 concluded that the current evidence was insufficient to assess the balance of benefits and harms of using non-traditional risk factors, including CAC scans, to screen asymptomatic men and women with no history of CAD to prevent coronary events.2 However, in 2010, CAC assessment was incorporated into ACC/AHA Guidelines with a Class IIa status (recommendation in favour of treatment or procedure being useful/effective). Measurement of CAC was considered reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk, and all diabetic patients 40 years or older.3 The ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria deemed CAC appropriate for intermediate-risk patients as well as for low-risk individuals with a family history of premature disease.4 In 2012, the European Society of Cardiology awarded a similar Class IIa recommendation, and suggested CAC for cardiovascular risk assessment in asymptomatic adults at moderate risk.5