Lung Cancer Screening Eligibility in the Community: Cardiovascular Risk Factors, Coronary Artery Calcification, and Cardiovascular Events.

Abstract

The Centers for Medicare & Medicaid Services (CMS) recently approved lung cancer screening with computed tomography (CT); smoking is a risk factor for lung cancer and atherosclerotic cardiovascular disease (ASCVD).1 Data are needed regarding the cardiovascular risk of patients who are eligible for lung cancer screening, including implications of coronary artery calcification (CAC) visible on lung cancer screening CT. In a longitudinal primary prevention cohort study, we determined lung cancer screening eligibility in the community and its association with statin eligibility, CAC, and incident ASCVD events. A total of 3000 asymptomatic FHS (Framingham Heart Study Offspring Cohort) participants aged 55 to 77 years and free of prevalent cardiovascular disease or lung cancer were divided based on eligibility for lung cancer screening CT by CMS criteria: (1) aged 55 to 77 years (all by definition), (2) current or recent (≤15 years) former smoker, and (3) ≥30 pack-year cigarette smoking history.1 Participants were enrolled at enrolled at examinations 3 (1984-1987) and 7 (1998-2001) and followed for the primary outcome of incident ASCVD (myocardial infarction, death due to coronary heart disease, or ischemic stroke) and the secondary outcome of lung cancer. Participants were contacted annually with suspected ASCVD or lung cancer events adjudicated by a panel of 3 physicians based on review of medical records, histopathology reports, and death certificates. A subgroup of 980 from examination 7 had electrocardiography-gated calcium score multidetector CT. The institutional review boards of Boston University Medical Center and Massachusetts General Hospital approved the study. …