ACC backs AMA resolution to boost lung cancer and heart disease screenings in smokers with low-dose CT scans

The goal of the resolution is to gain AMA support for efforts to expand lung cancer screenings that combine CAC testing either as low-cost or free exams to catch more disease earlier in the hopes of initiating treatment before progression. Earlier interventions can also lower healthcare costs and improve patient outcomes.

Financial barriers to prevention screening

Williams noted that, while guidelines from the ACC and American Heart Association recommend coronary calcium scoring as a key part of cardiovascular risk stratification, cost remains a significant barrier. Outside of a few states such as Connecticut, Texas and New Mexico, patients typically pay out of pocket—anywhere from $50 to $200 for the test, putting it out of reach for many low-income individuals.

"Unfortunately, for my people on the west end of Louisville and the south side of Chicago, that's rent and food. They can't afford it. And so we're trying to find other ways to do this," Williams explained.  

However, LDCT lung screening for people who have smoked for more than 20 years and are over 50 years old can be paid for by insurance, he said. Since payments of calcium scoring CT are not usually covered, ACC and SCCT want to take advantage of the opportunistic screenings lung CTs offer. Coronary calcium can easily be seen in these scans, even if they are ungated without ECG, and rated as low, medium or high, Williams said. While not as refined as gated CAC scans that enable the assessment of each coronary artery, lung scans, or any CT scans of the chest for that matter, can easily offer ballpark cardiac risk assessments.

The resolution states lung cancer screening remains very underutilized, with only 4.5% of the eligible U.S. population receiving screening in 2022. If screening numbers could be increased with CAC scores tacked on, it could be a big win-win for patients and healthcare systems

CT could be a one-stop shop for early disease detection

“The advantage of the lung screening is it goes from the apex to the diaphragm, so it is a one-stop shop where we get a lot out of a CT scan," Williams said.

In addition to imaging the heart and looking for cancer, these scans often include a portion of the liver to look for hepatic diseases as well. 

"At the University of Louisville, unfortunately, in addition to the cancer issues, we have a lot of steatosis of the liver from obesity, and we have a lot of alcoholic liver disease. And you can actually get a good handle on how good the liver is doing, believe it or not, from the coronary calcium score or the lung cancer screening, because you get the tip of the liver. And that's all you need to be able to go in there and measure how much fat there is," he explained. 

Williams added that opportunistic imaging where additional clinical data is extracted from routine scans is becoming more feasible with the rise of artificial intelligence (AI). AI can now automatically detect issues like coronary calcium, liver steatosis or lung nodules, improving diagnostic accuracy and enabling early interventions.

AI opportunistic imaging is a growing trend discussed at radiology conferences, and numerous companies have or are working toward regulatory clearance for these algorithms.

Tackling inequity in CT screening access

Williams said these CT screening tests often are not offered in low-income communities because the hospitals know many residents there cannot pay for them. However, one solution is to offer these tests for free to use up unscheduled CT slots. This has been a business approach by some health systems as a long-term investment in downstream care. Patients who are found to have lung nodules or high calcium scores are then referred for care within the system, which is where the return on investment comes in.

In one such program at University Hospitals in Cleveland, offering free scans led to drastic increase in screening among minority patients. It also generated follow-up care revenue for the hospitals from detected conditions that required treatment or surveillance.