Our World in Data, Leading Causes of Death VS. what the Media Covers, May 29, 2019

There’s a strong argument that things we search for and gain information on encourages us to take action which prevents a further death. There are several examples where I can imagine this to be true. People who are concerned about cancer may search online for guidance on symptoms and be convinced to see their doctor. Some people with suicidal thoughts may seek help and support online which later results in an averted death from suicide. We’d therefore expect that both intended or unintended exposure to information on particular topics could prevent deaths from a given cause. Some imbalance in the relative proportions therefore makes sense. But clearly there is some bias in our concerns: most people die from heart disease (hence it should be something that concerns us) yet only a small minority seek [possibly preventative] information online.

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Mayo Clinic, Heart Scan Overview, May 29, 2019

A heart scan uses a specialized X-ray technology called multidetector row or multislice computerized tomography (CT), which creates multiple images of plaque deposits in the blood vessels. The imaging test provides an early look at levels of plaque. Plaque is made up of fats, cholesterol, calcium and other substances in the blood. It develops gradually over time, long before there are any signs or symptoms of disease. These deposits can restrict the flow of oxygen-rich blood to the muscles of the heart. Plaque also may burst, triggering a blood clot that can cause a heart attack.

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RadiologyInfo, Radiation Doses in CT & X-Ray, March 20, 2019

When radiation passes through the body, some of it gets absorbed. The x-rays that are not absorbed are used to create the image. The amount that is absorbed contributes to the patient’s radiation dose. The radiation that passes through the body does not. The scientific unit of measurement for whole body radiation dose, called “effective dose,” is the millisievert (mSv). Other radiation dose measurement units include rad, rem, roentgen, sievert, and gray.

Doctors use “effective dose” when they talk about the risk of radiation to the entire body. Risk refers to possible side effects, such as the chance of developing a cancer later in life. Effective dose takes into account how sensitive different tissues are to radiation. If you have an x-ray exam that includes tissues or organs that are more sensitive to radiation, your effective dose will be higher. Effective dose allows your doctor to evaluate your risk and compare it to common, everyday sources of exposure, such as natural background radiation.

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American Heart Association, Heart Disease and Stroke Statistics, Jan 31, 2019

This document contains a few key statistics about heart disease, stroke, other cardiovascular diseases and their risk factors, in addition to commonly cited statistics about the American Heart Association’s research program. This At-a-Glance document is based on the association’s 2019 Heart Disease and Stroke Statistics Update, which is compiled annually by the American Heart Association, the National Institutes of Health and other government sources. The years cited are the most recent available for each statistical category.

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Dicardiology, CT Calcium Scoring Efficiency, Oct. 17, 2018

“Doctors have a real dilemma sometimes,” Budoff said. “We have the Framingham Risk Score, but sometimes patients come out in the middle, in the gray zone, and we really don’t know if they are high risk and should have statins and aspirin for the rest of their life, or if they can be managed through diet and exercise. Half will go on to have a heart attack and half will not. The risk calculators we have now are only correct about 60 percent of the time. So instead of using a coin to decide if patients should get statins and aspirin, we used personalized medicine to look at each individual’s heart. We have found that calcium scoring is the best way to assess their risk.”

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Harvard Health Publishing, 5 Keys to a Longer Life, July 5, 2018

Researchers from the Harvard T.H. Chan School of Public Health conducted a massive study of the impact of health habits on life expectancy, using data from the well-known Nurses’

Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). This means that they had data on a huge number of people over a very long period of time. The NHS included over 78,000 women and followed them from 1980 to 2014. The HPFS included over 40,000 men and followed them from 1986 to 2014. This is over 120,000 participants, 34 years of data for women, and 28 years of data for men.

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Chicago Tribune, Risks of False Positives, May 18, 2018

But screening has a dark side: research shows that over three years of annual scans, 40 percent of people will have an abnormal finding that often leads to follow-up tests such as a lung biopsy, and complications of those can be fatal, said Dr. Otis Brawley, the American Cancer Society’s chief medical officer. “I’m committed to telling people the truth and letting people decide for themselves,” Brawley said, but added that if he were a candidate for screening, “I don’t think I would do it.”

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WebMD, Diagnosing Heart Disease with CT Scans, May 2, 2018

The calcium-score screening heart scan is a test used to detect calcium deposits found in atherosclerotic plaque in the coronary arteries. State-of-the-art computerized tomography methods, such as this one, are the most effective way to detect early coronary calcification from atherosclerosis(hardening of the arteries), before symptoms develop. The amount of coronary calcium has been recognized as a powerful independent predictor of future heart problems and is useful in making lifestyle changes and guiding preventive care to reduce their risk.

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National Cancer Institute, Cancer Statistics, April 27, 2018

Cancer has a major impact on society in the United States and across the world. Cancer statistics describe what happens in large groups of people and provide a picture in time of the burden of cancer on society. Statistics tell us things such as how many people are diagnosed with and die from cancer each year, the number of people who are currently living after a cancer diagnosis, the average age at diagnosis, and the numbers of people who are still alive at a given time after diagnosis.

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Dana-Farber Cancer Institute, 5 Things to Know About Early Cancer Detection, April 25, 2018

Early detection refers to measures that can be taken to diagnose cancer as early as possible, when the disease is easiest to treat. As researchers discover more about what early stages of cancer look like – under the microscope, in scans, or even on our own bodies – we can learn more about what signs or symptoms to look out for and what other measures we can take to be vigilant about recognizing cancer in its earliest forms.

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Food & Drug Administration, Should You Get a Full Body CT Scan?, Dec. 5, 2017

Should you be screened? Like any other medical procedure, there are risks involved. Before undergoing this exam, be sure to read all the sections of this web site. Consider further that the FDA has never approved CT for screening any part of the body for any specific disease, let alone for screening the whole body when there are no specific symptoms of disease at all. No manufacturer has submitted data to FDA to support the safety and efficacy of screening claims for whole-body CT screening.

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USA Today, New Cancer Drugs do Little to Help, Feb. 9, 2017

Pushed by patient advocates who want earlier access to medications, the­ Food and Drug Administration has approved a flurry of oncology drugs in recent years, giving some people with cancer a renewed sense of hope and an array of expensive new options. A few of these drugs

have been clear home runs, allowing patients with limited life expectancies to live for years. Many more drugs, however, have offered patients only marginal benefits, with no evidence that they improve survival or quality of life, said Dr. Vinay Prasad, assistant professor of medicine at the Oregon Health and Sciences University, who has written extensively about the FDA’s approval process for cancer drugs.

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ScienceDirect, History & Status of Calcium Scoring, Jan. 2017

Quantification of coronary calcium(e.g., Agatston method, calcium mass and volume) is readily detected using helical CT scanners. Large multicenter cohort studies have enabled a better understanding of the relevance of coronary calcium detection. The purpose of this review is to review the methods for quantification of coronary artery calcium, as well as to present current and future perspectives on calcium scoring for cardiovascular risk stratification.

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Psycho-Oncology, Fears about Cancer, Oct. 6, 2016

Cancer has long inspired fear. Despite advances in early diagnosis and treatment of many cancers, a third to half the general population in the United States and United Kingdom say they fear cancer more than any other disease.1, 2 Population‐based studies have consistently shown that about a quarter to half the population worry to some extent about getting cancer, with 5%–10% experiencing extreme worry.2, 3, 4On a population level, even these modest percentages equate to a great number of people experiencing significant cancer worry. Fear in itself is unpleasant and burdensome, but it may also affect behaviour, although its behavioural effects are not well understood.

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American Cancer Society, Understanding CT Scans, Nov. 30, 2015

In a way, CT scans are like standard x-ray tests. But an x-ray test aims a broad beam of radiation from only one angle. A CT scan uses a pencil-thin beam to create a series of pictures taken from different angles. . The information from each angle is fed into a computer, which then

creates a black and white picture that shows a slice of a certain area of the body – much like looking at a single slice from a loaf of bread.

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Renal & Urology News, CT Scans Preventing Early Death, July 16, 2015

The researchers found that the CAC score was highly predictive of all-cause mortality after adjustment for risk factors for coronary artery disease (P < 0.001). For CAC scores from 0 to 1,000 or greater, overall 15-year mortality rates ranged from 3 to 28% (P < 0.001). For all-cause mortality, the relative hazard ranged from 1.68 for a CAC score of 1 to 10 (P < 0.001) to 6.26 for a score of 1,000 or greater (P < 0.001). Using cut points of less than 7.5% to 22.5% or greater, the categorical net reclassification improvement was 0.21 Click here to read more.

The Guardian, Half of Cancer Patients Diagnosed too Late, Sept. 21, 2014

“Earlier diagnosis saves lives and it could save critical NHS funds. And in the face of an overstretched NHS and a projected growing number of cancers diagnosed in the years ahead, we need to do everything we can to ensure that all patients have access to the best treatment as early as possible”, he added. The Department of Health said it had invested £450m to improve earlier diagnosis, including giving GPs better access to tests such as CT and MRI scans.

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Oxford Academic, Detecting Coronary Artery Disease & Lung Cancer, Aug. 11, 2014

Coronary artery disease (CAD) and lung cancer have several important features in common. First, their dramatic increases are in large part attributable to societal ills, including worsening dietary patterns, obesity, and tobacco use. Secondly, as these behaviours permeate the

world, the diseases are disproportionately increasing in the poorer societies with limited resources for healthcare. Consequently, it is necessary to develop cost-effective strategies. Both disease states may be amenable to early detection by a single low radiation dose CT scan.

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Hindawi, Screening Ischemic Heart Disease with CT, Sept. 16, 2012

Cardiovascular disease remains the leading cause of mortality in the US and worldwide, and no widespread screening for this number one killer has been implemented. Traditional risk factor assessment does not fully account for the coronary risk and underestimates the prediction of risk even in patients with established risk factors for atherosclerosis. Coronary artery calcium (CAC) represents calcified atherosclerosis in the coronary arteries. It has been shown to be the strongest predictor of adverse future cardiovascular events and provides incremental information to the traditional risk factors. CAC consistently outperforms traditional risk factors, including models such as Framingham risk to predict future CV events.

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RSNA, Dangers of High Calcium Levels in Arteries, July 28, 2009

“The amount of calcium in the coronary vessels, as measured by CT, is of high predictive value for subsequent serious or fatal heart attack in these patients, independent of the patient’s age, sex and other coronary risk factors,” said the study’s lead author, Marcus Hacker, M.D., resident physician in the Department of Nuclear Medicine, leader of the research unit for nuclear cardiology and assistant medical director at Ludwig Maximilians University in Munich, Germany. CAD is the most common type of heart disease. According to the National Heart, Lung and Blood Institute, it is the leading cause of death in the U.S. for both men and women, killing more than 500,000 Americans each year.

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The Hospitalist, Coronary Angiography effectiveness, Jan. 2008

In patients with low pre-test probability of coronary artery disease who present for admission with chest pain, CT coronary angiography has a high negative predictive value (95%-100%) for excluding coronary stenosis as a cause. However CT angiography should not replace cardiac catheterization in high-risk patients, particularly those with prior coronary stenting.

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University of Maryland Medical Center, Cardiac Calcium Scoring, (N.D.)

A calcium score (sometimes called an Agatston score) is calculated based on the amount of plaque observed in the CT scan. It may be converted to a percentile rank based on your age and gender. The results from your cardiac scoring will be sent to your doctor. Your likelihood of having heart disease or a heart attack correlates with your calcium scoring. The lower your calcium score and percentile rank, the less likely you are to have a cardiac event compared to other men or women your age.

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World Health Organization, Screening for Early Detection, (N.D.)

Recognizing possible warning signs of cancer and taking prompt action leads to early diagnosis. Increased awareness of possible warning signs of cancer, among physicians, nurses and other health care providers as well as among the general public, can have a great impact on the disease. Some early signs of cancer include lumps, sores that fail to heal, abnormal bleeding, persistent indigestion, and chronic hoarseness. Early diagnosis is particularly relevant for cancers of the breast, cervix, mouth, larynx, colon and rectum, and skin.

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Healio, Coronary Calcium Score – No Doctor’s Order?, (N.D.)

Coronary calcium scoring (CCS) is arguably the best method to screen for coronary artery disease. The most interesting part of this test is the direct-to-consumer advertising that occurs to the public. There are not too many medical tests (especially those with radiation exposure) that anyone can purchase at an affordable price without a doctor’s order. Vascular screening is another example. Is it really appropriate for hospitals and offices to allow anyone to walk in and have a coronary calcium score performed? Hmmm … good question.

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