ACC 2019: Importance of reporting coronary calcium when staging cancer on CT
Computed tomography (CT) scans for cancer staging can also reveal coronary artery calcification (CAC), a risk indicator of cardiovascular disease. Because cancer patients who undergo potentially cardiotoxic treatments have higher risk of developing cardiovascular disease, it is important for radiologists to report this finding. Unfortunately, this information is not always reported and is rarely acted upon in current practice, according to research presented at the American College of Cardiology annual meeting held in March in New Orleans.
Researchers from the Cardiovascular Division of the University of Minnesota in Minneapolis surveyed cancer patients to determine how often CAC on cancer staging CT scans was clinically reported, and how often the information was acted upon to help prevent cardiovascular disease. The study included 1,001 consecutive patients 45 years and older who had a CT scan prior to chemotherapy treatment with antracycline or trastuzumab. The majority of patients had either breast cancer (28%), lymphoma (22%) or sarcoma (12%). Their mean age was 62 years, and 62%)were women.
The researchers first reviewed the patients’ CT scans to determine the presence or absence of CAC. When identifying CAC, they checked the patient’s medical records to determine if CAC was reported and if any clinical action was taken. They collected information on the rates of cardiology evaluation for primary prevention of cardiovascular disease and whether statins and/or an aspirin regimen were prescribed.
Scientific session presenter Matthew C. Hooks, MD, reported that CAC was reported in only half of the 349 patients diagnosed with the condition. Fifty-six patients, or 16%, had previously been diagnosed with coronary artery disease (CAD), 46% were taking a statin, and 44% were on an aspirin regimen prior to the CT scan, but Dr. Hooks did not specify if any of these patients were among the 178 whose CAC was reported by radiologists. Only 24 of the 178 patients with reported CAC were referred to cardiologists, of whom 10 patients were referred for prevention of cardiovascular disease.
“It would be particularly helpful to know if a patient has evidence of early coronary artery disease before starting cancer treatment that can potentially harm the heart,” said Dr. Hooks. “As cancer treatments have improved and more patients are surviving cancer, we have become more aware of how these therapies might affect patients’ heart health in the long term. We hope to find out whether we can use CAC as a predictive tool to identify patients who many have poor cardiac outcomes and potentially guide the type of chemotherapy they are prescribed or guide whether preventative measures should be implemented prior to starting chemotherapy.”
Dr. Hooks said identifying plaque buildup in coronary arteries is “essentially free information, because the patients are undergoing the CT scans anyway.” He said that while further research is necessary to determine whether identifying CAC before cancer therapy can help improve long-term outcomes, the study underscores CT scans as an underutilized resource that could offer an important first step toward reducing the toll of heart disease in cancer patients.