A new study takes CT screening on the road in rural Appalachia, showing how a mobile van outfitted with a CT scanner can screen at-risk individuals for both lung cancer and cardiovascular disease in one visit.
Recent studies have demonstrated the effectiveness of CT lung cancer screening not only among the overall population, but particularly among disadvantaged communities with lower healthcare access.
- Such limited access is common in rural areas of Appalachia, which also have some of the highest rates of smoking and cardiovascular disease in the U.S.
Researchers from West Virginia University wanted to tackle two challenges at once with LUCAS, a mobile van outfitted with a CT scanner for lung cancer screening.
- They noted that CT lung scans can also be used to acquire data on coronary artery calcium (CAC), a known risk factor for cardiovascular disease.
LUCAS was launched in September 2021, so WVU researchers analyzed data acquired for 526 low-dose CT screenings of high-risk people conducted through December 2022.
- They used the CT lung scans to calculate CAC scores based on Agatson criteria, in which a score of 101-400 indicates moderate risk of cardiovascular disease and >400 is classified as high risk; individuals with scores ≥100 should be referred to aspirin or statin therapy.
They found that LUCAS scans revealed …
- Over 54% of patients had coronary calcification on LDCT scans
- 31% of patients had CAC scores ≥100
- 14% had CAC scores ≥400
- Elevated CAC scores correlated with lung cancer risk based on Lung-RADS scores as well as smoking history based on pack-years
- Of the patients with CAC scores ≥1 and who weren’t already on statin or aspirin therapy, 6.2% started statins and 3.3% started aspirin
Despite the firm link between CAC scores and lung cancer risk, the researchers expressed disappointment that so few patients started prevention therapy like statins or aspirin after their exams.
- Indeed, researchers noted that few patients from the study got additional cardiac testing or follow-up referrals for cardiovascular prevention after their screenings.
The Takeaway
The new study not only confirms recent research showing that opportunistic screening can enhance the value of CT lung cancer scans, but also the role that lung exams can play in reducing healthcare disparities. On the down side, it shows that all the screening in the world won’t make a difference if patients don’t get appropriate follow-up.
