Rita Redberg, in an early release editorial in Archives of Internal Medicine writes that she “was troubled to read” that during his recent physical examination President Obama had received an EBCT coronary calcium scan. Redberg writes: “this screening test likely exposed Mr Obama to significant radiation unnecessarily, increasing his risk of future cancer. A single electron beam CT scan is estimated to result in a lifetime excess cancer risk of 9 (range, 3-42) additional cancers per 100 000 persons for men. In light of this radiation risk,and the lack of proven benefit in low-risk persons, the US Preventive Services Task Force (USPSTF) recommends against this test in men such as Mr Obama. In addition, the leading professional cardiology societies do not recommend coronary calcium screening for such men.”
Redberg argues that the best measure Obama could take to reduce his cardiac risk would be to quit smoking. “The relevance of Mr Obama’s coronary calcium score, no matter how low, pales in comparison,” she writes. Redberg also points out that Obama should not have had a virtual colonoscopy, as he has not yet reached 50 and virtual colonoscopies are not yet recommended for screening.
The value of coronary calcium screens has been heavily debated of late. Earlier today, as we reported, a study in JACC found a low rate of “conversions” from a zero calcium score in the first few years, though the implications of the finding are debatable. Exactly a month ago a very different study in JACC found significant lesions in one-fifth of high risk patients with calcium scores of zero. In an accompanying editorial, Redberg then wrote: “Calcium screening may yet have its place in the clinician’s arsenal for evaluation of patients with chest pain, but until its benefits are clearly established, we must take great care when subjecting patients to it.”