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Dear Editor – Our C.M.O. Addresses Health Writer Susan Perry’s Issues against Life Line Screening

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.

Yours truly,

 

 

 

Andrew J. Manganaro, MD, FACC, FACS
Chief Medical Officer
Life Line Screening

References:

  1. SVS – see http://www.vascularweb.org/Media/JVS_Releases/Screening_Aids_Early_Detection_of_Vascul.html
  2. 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.
  3. Saleem MA, Sadat U, et al. Role of carotid duplex imaging in carotid screening programmes – an overview.  Cardiovascular Ultrasound 2008; 6: 34.
  4. 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
  5. NIDDS: http://www.ninds.nih.gov/disorders/stroke/stroke_needtoknow.htm
  6. SVS —  see http://www.vascularweb.org/vascularhealth/vascularscreenings/ and click on Position Statement
  7. American Diabetes Association. Peripheral Arterial Disease in People with Diabetes. Diabetes Cares 2003. 26: 3333-3341.
  8. 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.
  9. 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.
  10. 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.
  11. Zwolak R and Kent C. Screenings for Abdominal Aortic Aneurysms. Endovascular Today; Feb 2008:  51-54.
  12. 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.
  13. 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.
  14. 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.
  15. USPSTF Guidelines on Mammograms Questioned.  EMax Health, January 26, 2011.  Available at: http://www.emaxhealth.com/1024/uspstf-guidelines-mammograms-questioned
  16. 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
  17. 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.
  18. SHAPE Society Website: http://www.shapesociety.org/
  19. National Stroke Association:  http://www.stroke.org/site/PageServer?pagename=cont



Comments



3 Comments so far
  1. Plb - April 30, 2013 at 7:16 pm

    I received a screening offer and I am glad. I have read all of the blogs about why they are bad and they do not make any sense whatsoever. The more screenings and preventation the better. The idea that we would be afraid of tests that might follow a positive screening is ridiculous and a scare tactic itself. Health care is way too high and I should be able to be proactive in my own health for a reasonable price instead of controled by so-called professionals. I am not afraid of MRI or CAT scan! lol What are they talking about? I have those and other tests for little more than a headache. I am shocked that they have so little reason to discourage screening and do not recognize that the “anecdotes” are people who are someones mother, father, spouse! Leave to doctors to depersonalize lives saved or lost. Put more control back in our hands. Let me say I diagnosed myself with a parathyroid tumor online and had to talk my doctor into the test. Thank God I got it removed and got my life back! My mother was told she had TIAs for years and turned out to have a growing brain tumor! Never given a CAT scan for 8 years! Luckily, hers was benign too. We care more for ourselves, our parents, our children than doctors do. Tons of people die from this lack of screening even with symptoms!!!! Give me a break. Give us preventative care at low prices. I wish healthcare system would have thought of these things because then we wouldn’t be getting Obamacare now. God help us! PLB

  2. Carlo Bari - May 9, 2013 at 7:57 am

    The blog condemnations are self centered with bias and lies. The people most futile and hostile against these tests are reaping profits in traditional medical environments where they over charge patients. I had a Peripheral Artery Test through my doctor who very conveniently had it done in their on site lab by their tech. For this single ultrasound test HE CHARGED OVER $500.00!!!!!!!
    Its a bonanza for them that they don’t want to loose to affordable Orgs like “Life Line Screening” who charge $150.00 FOR FIVE TESTS!!!!!! Greed and corruption surround us. Wake up and ask questions to discern your best options.

  3. Richard Berg - July 15, 2014 at 10:48 am

    I am a 75 year old male. I just received the results of my screening. I have two questions. First my weight was 170 vs. 174 lbs. Second my waist is 34 vs. 44 inches. Please redo the results on pages 4 and 5.
    Comment at 6 foot and a waist of 44 inches I could not have a body mass index of 23. There must have been a miss communication in questions I asked earlier. Please redo the results. Richard Berg.


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About the Author

Joelle Reizes

I am the Communications Director at Life Line Screening with more than 15 years of experience in the field of health communications, much of it specifically working with health screening programs. Read More.

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