Integrating Cardiovascular Screening in Lung Cancer Screening

Area of Science:

• Cardiology
• Pulmonology
• Radiology

Background:

• Individuals eligible for lung cancer screening (LCS) often have high cardiovascular risk.
• Cardiovascular disease is a leading cause of death, competing with lung cancer mortality.
• Low-dose computed tomography (LDCT) for LCS can simultaneously assess coronary artery calcium (CAC) without extra radiation or cost.

Purpose of the Study:

• To evaluate the integration of cardiovascular risk assessment, specifically CAC scoring, into LCS.
• To determine the feasibility and potential benefits of using LDCT for both lung cancer and cardiovascular risk screening.

Main Methods:

• Review of existing literature on CAC detection during LDCT for LCS.
• Analysis of long-term follow-up data from a randomized LCS trial regarding CAC reporting and cardiovascular outcomes.
• Discussion of implementation strategies for simultaneous screening, including standardized reporting and care pathways.

Main Results:

• CAC detected on non-gated chest CT has prognostic value for cardiovascular events.
• A long-term LCS trial follow-up showed CAC reporting was linked to reduced cardiovascular mortality.
• This association is likely due to enhanced risk recognition and increased preventive care utilization.

Conclusions:

• Simultaneous LCS and CAC screening is a pragmatic approach to address competing risks of morbidity and mortality.
• Standardized reporting, clear preventive care pathways, and prospective evaluation are crucial for implementation.
• Artificial intelligence holds potential for standardizing CAC assessment and supporting integrated thoracic and cardiovascular prevention.