Combine Spiral CT Screening for Lung and Heart Diseases

WASHINGTON—Dramatic improvements in high-resolution, or spiral, CT imaging over the past decade have created widespread and increasing demand for both lung and cardiac screening, two procedures that could and probably should be combined, according to David Yankelevitz, MD, professor of radiology at Weill Medical College of Cornell University in New York.

"As the technology improves, it's going to be very hard to think of these as separate exams," said Dr. Yankelevitz, who made his case for combining cardiac and lung CT screening at the Lung Cancer Workshop III, sponsored by the Cancer Research and Prevention Foundation (CRPF).

Interest and support for using high-resolution CT in measuring response to new therapies has grown since the CRPF held its first lung cancer workshop in 2004, said James Mulshine, MD, vice president for research at Rush University Medical Center in Chicago and a lead organizer of the workshops. With the development of CT image databases now proceeding rapidly, he said, the use of high-resolution CT in therapeutic clinical trials is "a near-term possibility."

While the use of spiral CT for drug development moves forward, its use as a screening tool also continues to evolve, according to Dr. Yankelevitz. Interest in integrating lung and cardiac screening in a single protocol springs partly from the rapid evolution of imaging technology, but there are other good reasons for combining the two, he said.

CT Screening Expanding

One of these is the increasing frequency of the procedures. On the lung side, The International Early Lung Cancer Action Program (I-ELCAP) has now screened 35,000 subjects from 40 institutions and found 400 cancers. And the program has a waiting list of sites that want to join, said Dr. Yankelevitz, one of the I-ELCAP leaders.

Cardiac CT screening is also rapidly expanding. Anecdotally, he said, cardiac screens at Cornell/New York Hospital have gone from one a day several years ago to four or five a day now. And in other hospitals in the area it is up to 10 to 15 a day, he said. Moreover, with both heart disease and lung cancer linked to smoking, the same individual often could benefit from both screens. "The risk profile of these patients is very similar if not identical," Dr. Yankelevitz said.

Arguments against the combined screening revolve around the resources involved, he said, as well as the still-controversial nature of spiral CT screening. The US Preventive Services Task Force, which issues recommendations for screening and other kinds of prevention, says there is not enough evidence to recommend high-resolution CT for any disease. "I don't think that is going to change any time soon," Dr. Yankelevitz said.

Work Together

Nevertheless, he argued, the field is moving forward, and combining lung and cardiac screening makes too much sense to ignore. "You can't really do one without the other. It's not right to image the heart and just completely ignore the lungs when you have the images and vice versa."

Dr. Yankelevitz concluded with a recommendation that radiologists and cardiologists work together on the issue. "Screening for lung cancer and tobacco-related illness will increase, I believe, despite any recommendations from the US Preventive Services Task Force. This is here to stay. . . . I think we really should look at the protocols and how to integrate them. . . . There's a lot of work to be done and a lot of opportunity."