Abstract 16624: Lung Cancer Screening With CT, Coronary Artery Calcification and Cardiovascular Events
Background: The Centers for Medicare & Medicaid Services (CMS) recently approved lung cancer screening with CT. It is unclear whether reporting coronary artery calcium (CAC) on lung screening CT could improve identification of adults at risk for cardiovascular events (CVD) and competing risk from lung cancer. Thus we determined the incidence of hard CVD (myocardial infarction, stroke or coronary/cerebrovascular death), lung cancer (diagnosis or death) and CAC in adults eligible and ineligible for lung cancer screening.
Methods: This longitudinal community-based cohort study included Framingham Heart Study Offspring Cohort participant-exams age 55-77 and free of prevalent cardiovascular disease and lung cancer from exams 3 (1984 – 1987) and 7 (1998 – 2001). Participants were divided into screening eligible and ineligible groups by CMS criteria (current or recent (≤15 years) former smokers with ≥30 pack-year history). Multivariate-adjusted cox proportional hazards models assessed the effect of screening eligibility on incident hard CVD and incident lung cancer. In participants who had CAC CT at exam 7, cross-sectional association between screening eligibility, high CAC score >300 and incident CVD was assessed. Raw incidence rates are reported; p values are adjusted for age, sex and traditional risk factors aside from smoking.
Results: Of 3085 participant-exams 20% were eligible for lung cancer screening. In mean follow up of 9.9 years, there were 281 incident CVD and 69 lung cancer events. In both groups, incident CVD was more frequent than lung cancer (eligible: 13% vs 7%, p=0.002; ineligible: 8% vs 1%, p<0.001). The screening eligible had more incident CVD (13% vs 8%, p<0.001) and lung cancer (7% vs 1%, p<0.001) than the ineligible. CAC CT was available in 107 screening eligible and 667 ineligible participants; CAC >300 was more common in the screening eligible (33% vs 23%, p=0.007).
Conclusion: In a community-based primary prevention cohort, 20% aged 55-77 were eligible for lung cancer screening CT. CMS eligibility criteria identified disease-free persons with substantially more incident hard CVD and CAC; CVD was more common than lung cancer. The results support cardiovascular prevention and reporting of CAC as part of routine lung cancer screening CT.
Author Disclosures: M.T. Lu: None. O.K. Onuma: None. J.M. Massaro: None. R.B. D’Agostino: None. C.J. O’Donnell: Employment; Significant; NHLBI/NIH. U. Hoffmann: Research Grant; Significant; Heartflow, Medis, Siemens.
- © 2015 by American Heart Association, Inc.