Joelle Reizes - June 14, 2012
Some criticism of our work at Life Line Screening comes from an article by health writer Susan Perry on the MINNPOST website, interestingly sponsored by a Minnesota health care insurance provider called UCare. Below, we’ve included a letter written to MINNPOST from our Chief Medical Officer, Dr. Andrew Manganaro. We hope you’ll read it and decide for yourself if health screening companies such as Life Line Screening are valuable or not. You can also read what our many satisfied customers have to say on our Testimonials page –we’re clearly doing something right according to them!
Subject: From the office of Andrew Manganaro, MD, FACC, FACS, Chief Medical Officer, Life Line Screening
Andrew J. Manganaro, MD
Member, International Society for Endovascular Surgery
Fellow, American College of Cardiology
Member, Society for Vascular Medicine
Fellow, American College of Chest Physicians
Member, Society for Vascular Surgery
Fellow, American College of Surgeons
Member, Society for Vascular Ultrasonography
Fellow, International College of Surgeons
Fellow, International Society for Cardiovascular Surgery
Member, Society of Thoracic Surgeons
Dear MinnPost.com and Ms. Susan Perry:
I am writing in response to the article posted on 3.21.12 entitled “Buyer beware of direct-to-consumer health screenings.” I wish to refute your claims that the screening tests are ‘pointless, a waste of time and money.” This is objectively not true and you do your readers harm by not discussing both sides of the debate and discussion. In addition to my letter, I am attaching some recent research of which you may not be aware.
As a clinical vascular surgeon for 30 years, I have seen many strokes and ruptured Abdominal Aortic Aneurysms (AAA) which could have been easily prevented had the patient only known of their presence. So much death and terrible disability could be avoided by identification of previously unknown disease and successful preventive measures.
Indeed, to put this personal experience into context, we must remember that there are nearly 800,000 strokes a year in this nation. What we as a nation are doing isn’t working. It isn’t enough. We need to do something to reduce these numbers. Everyone who read your article knows someone who has had a stroke or a heart attack. These conditions are simply that prevalent.
This is where health screenings come in, as well as the new evidence-base that supports it. Preventive vascular screening aims to identify those with subclinical disease at a time when lifestyle changes and medical management can make a difference. Its focus is on creating a teachable moment between doctors and patients during which advice such as eating well, exercising and not smoking can actually result in behavior change. Medical management such as aspirin therapy or statins can also be implemented and possibly avert a serious health event or surgery. For those in whom surgery is necessary, the usual response is one of gratitude for finding a potentially life-threatening condition. Community-based vascular screenings for carotid disease have been reviewed by researchers in the UK and found to be cost effective and life-saving. (References1, 2 below) Research in the U.S. has found consistent findings. (3)
In addition, the risk factors for cardiovascular disease are incredibly prevalent. The latest statistical research reveals that 94% of the United States population has at least one serious risk factor for cardiovascular disease. Thirty-eight percent have at least three serious risk factors. (4) Stroke risk doubles every decade after age 55. (5) These facts are clear – we are a nation at risk.
Many groups recommend vascular screening for at-risk individuals. Groups such as the Society for Vascular Surgery and the American Diabetes Association, for example, which recommends Peripheral Arterial Disease screening for every diabetic age 50 and over. (6, 7) PAD screening is also recommended for better cardiovascular risk prediction, as documented in a paper published in the Journal of the American Medical Association (JAMA) by Jaff and colleagues from the University of Massachusetts. AAA screening is already recommended for male smokers. Newer research also reveals that women are at higher risk than previously thought. (8, 9, 10)
Vascular surgeons, Drs. Kent and Zwolak, highlight the importance of vascular screening and the necessity to do more of it, when they cited Life Line Screening as an example of a successful company in the field of AAA and vascular screening in a paper in Endovascular Today, writing “The most successful of these organizations is Life Line Screening, which has screened more than 6 million individuals for vascular disease since 1993. Despite the progress made by Life Line and other companies, this is still only a fraction of the individuals at risk. (11)
A common criticism, albeit misguided, is that LLSA offers screenings not recommended by the United States Preventive Services Task Force (USPSTF). The focus of these criticisms usually revolves around the Task Force report on carotid artery screenings. The USPSTF statement on carotid artery stenosis screening is widely misunderstood. The statement recommends against hospital-based screening of asymptomatic individuals for the purposes of treating with carotid endarterectomy. They do not examine community-based screening for the purposes of early identification and treatment with lifestyle coaching and medical management, which is what Life Line Screening does. Others agree, as Dr. Lavenson, of the prestigious Uniformed Services, states in his article on this topic, “The USPSTF recommendation against screening for CAD (carotid artery disease)…is ill advised and should be reconsidered.”(12)
The lack of warning signs associated with vascular disease, coupled with the sheer prevalence of cardiovascular disease risk factors has led the Society for Heart Attack Prevention and Eradication (SHAPE) to promote screening in the asymptomatic population. SHAPE guidelines are supportive of screening using both ultrasound for carotid artery stenosis and ankle-brachial index. The reasoning for recommending screening in “at-risk asymptomatic population for subclinical atherosclerosis is to more accurately identify and treat patients at high risk for acute ischemic events, as well as to identify those at lower risk who may be treated more conservatively.”(17, 18)
I also draw to your attention the National Stroke Association website which clearly outlines the underlying disease states that lead to stroke, all of which are conditions for which Life Line Screening tests. (19) These diseases are listed as “Controllable Risk Factors” but, as noted in the website, are often silent and go undetected. Screening is a method of detection and can help individuals get on a path to wellness before something unfortunate and serious happens. The goal is to always share the screening results with a doctor, who can help determine which steps are right for that individual.
Thank you for the opportunity to discuss our program with you in more detail.
Andrew J. Manganaro, MD, FACC, FACS
Chief Medical Officer
Life Line Screening
- SVS – see http://www.vascularweb.org/Media/JVS_Releases/Screening_Aids_Early_Detection_of_Vascul.html
- Wyman RA, Fraizer MC, et. Al. Ultrasound-detected carotid plaque as a screening tool for advanced subclinical atherosclerosis. Am Heart J. 2005 Nov; 150(5): 1081-5.
- Saleem MA, Sadat U, et al. Role of carotid duplex imaging in carotid screening programmes – an overview. Cardiovascular Ultrasound 2008; 6: 34.
- Heart Disease and Stroke Statistics – 2012 Update: A Report from the American Heart Association. http://circ.ahajournals.org/content/early/2011/12/15/CIR.0b013e31823ac046
- NIDDS: http://www.ninds.nih.gov/disorders/stroke/stroke_needtoknow.htm
- SVS — see http://www.vascularweb.org/vascularhealth/vascularscreenings/ and click on Position Statement
- American Diabetes Association. Peripheral Arterial Disease in People with Diabetes. Diabetes Cares 2003. 26: 3333-3341.
- Ankle Brachial Index Collaboration. Ankle Brachial Index Combined With Framingham Risk Score to Predict Cardiovascular Events and Mortality: A Meta-Analysis. JAMA. 2008l 300 (2): 197-208.
- Beckman JA, Jaff MR, Creager MA. The United States Preventive Services Task Force Recommendation Statement on Screening for Peripheral Arterial Disease: More Harm Than Benefit?” Circulation, 2006; 114: 861-866.
- DeRubertis BG, Trocciola SM, Ryer EJ, et al. Abdominal aortic aneurysm in women: Prevalence, risk factors, and implications for screenings. J Vasc Surg 2007; 46: 630-5.
- Zwolak R and Kent C. Screenings for Abdominal Aortic Aneurysms. Endovascular Today; Feb 2008: 51-54.
- Lavenson GS. Why the U.S. Preventive Services Task Force Recommendation against Screening for Asymptomatic Carotid Artery Disease Should be Reconsidered. J Vasc Ultrasound, 36(10: 26-30, 2012.
- Most Stroke Patients Do Not Get A Warning: A Population-Based Cohort Study. Hackham DG, Kapral MK, Wang JT, Fang J, Hachinski V. Neurology 2009; 73: 1074-1076.
- Kent CK, Zwolak RM, Egorova NN, et al. Analysis of risk factors for abdominal aortic aneurisms in a cohort of more than 3 million individuals. J Vasc Surg 2010; 52: 539-48.
- USPSTF Guidelines on Mammograms Questioned. EMax Health, January 26, 2011. Available at: http://www.emaxhealth.com/1024/uspstf-guidelines-mammograms-questioned
- New U.S. Analysis Backs Annual Breast Screening. Reuters, January 26, 2011. Available at: http://www.reuters.com/article/2011/01/26/us-cancer-breast-screening-sb-idUSTRE70P0MO20110126
- Naghavi M, Falk E, et. al. From Vulnerable Plaque to Vulnerable Patient – Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report. Am J Cardiol 2006; 98[suppl]: 2H-15H.
- SHAPE Society Website: http://www.shapesociety.org/
- National Stroke Association: http://www.stroke.org/site/PageServer?pagename=cont
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