Coronary artery calcification in lung cancer screening

Lung cancer screening has been shown in the National Lung Screening Trial (NLST) to result in a statistically significant decrease in lung cancer specific mortality. Also within that trial there was shown to be a 7% decrease in all-cause mortality. While the reasons for this benefit are not entirely clear, it may relate to the detection and treatment of other important findings. Smokers not only have a higher risk of lung cancer, but also increased risk of atherosclerosis. The latter can be detected by the discovery of aortic and/or coronary artery calcium on unenhanced CT. As coronary artery calcium scoring can be used as a screening tool to detect asymptomatic coronary artery atherosclerosis, its detection on lung cancer screening exams has the potential to provide both a teachable moment and treatment aimed at the reduction of major coronary artery events and mortality. In this review we will discuss the use of coronary artery calcium scoring for the detection of atherosclerotic disease and its potential application to lung cancer screening populations.