Coronary calcium score zero

[Stavia]

Phew.
Just had it a few mins ago.
Decided to do it here and not in the US with you guys cos I didn't want a lung report. (False positives high chance)
Slow my beating heart.

[Julie G]

Happy dance... and a little jelly . Congrats, my sister!

[Surfrank57]

I always say celebrate with pizza, but you don't know pizza in New Zealand ...lol
Hahaha...... just kidding, but really take one cheat meal, not going to hurt your heart.!!!!!!!!!
F

[SusanJ]

So happy for you!!!

Now let's hope we have more good results to celebrate in August...

[Stavia]

I had chocolate and some bread Frank
Tomorrow I start seriously sorting my shit out

[Lucy5]

Wonderful news, Stavia, and what a relief that must be!! Think I may just have a (very) small glass of wine to help you celebrate!

[Stavia]

I thought I'd take the opportunity to explain why I had it done here and not in the US. Non-medical people often assume a test result is a binary outcome - yes or no - but it's far more complex than that for many tests.

Apart from not waiting and just getting it over with, the USA scan includes a limited lung reading. I did not want this.
It's got to do with test results which are NEVER 100% accurate. There is always an error rate ie false positives and false negatives. Which have different impacts on the interpretation of the result depending on pretest probability of the disease being present.
Look up the concepts of this and sensitivity and specificity on Wikipedia. And then positive predictive and negative predictive values. Remember I'm always on about context? For instance a zero calcium score in one of us has a high negative predictive value ie likely to be a true negative by a huge percent. But a zero calcium score in an 80 year old with angina is likely to be a false negative.
Coronary calcium scores are most accurate in a person under say 65 or 70 without angina.

Here's another example of a situation where false positive rates are orders of magnitude higher than true positive rates - HIV screening in a low risk population say a monogamous heterosexual faithful couple who have never had a blood transfusion, tattoo or needlestick injury. We just never do it.

Here's what I emailed Julie about why I didn't want a lung reading. And I didn't want to take a chance I'd be emailed a lung reading even if I asked not to have it.

Every test has an error rate. every single test. There are false positives and false negatives and this translates into sensitivity and specificity.
Say the lung scan has a false positive rate of 1% ie 1 in a hundred scans will be reported as having a mass that either isn't there or is a scar or something completely irrelevant.
99% is pretty damn good and I doubt its as high as that. Its a subjective interpretation not an objective cacium value.
This will obviously cause enormous anxiety and will require more scanning perhaps an MRI, (not radiation but hideously expensive) will probably kneejerk a reaction to scan again in 6 months (more radiation). Unfortunately this is the result of asymptomatic inappropriate widespread screening.

Now my pre-test probability of having something serious like a cancer in my lung is far far far lower than 1 in a hundred. It’s probably one in thousands. I never smoked*. And my lungs are full of scars from my whooping cough as a kid, my multiple pneumonias. I know I have central bronchiectasis. SO....my expected false positive lung cancer test result exceeds my expected true positive rate by orders of magnitude. I SO don’t want to hear what some defensive (worried about being sued) radiologist in the US will say about my lungs.

[Stavia]

*....Well mebbe a handful of non-tobacco roll-your-owns in my youth....

Also you might not know that the "normal" range of most blood tests is set at 2 standard deviations. This means that 5% of normal people will fall outside the range. So doctors ignore slightly out of range bloods if the clinical pre-test probability of disease is low. The more bloods you order the higher the probability that some will be outside the stated range but in fact you are normal. (Or its an error as in my post above). This causes anxiety and is why I am not in favour of shotgun untargeted widespread screening without a sound clinical reason.
This may be a different paradigm to the one you are used to in the USA, but I've just checked the WHO site and my country spends 63% less per capita on healthcare but has a life expectancy 1.37 years longer. I'm not criticising the wonderful things your country does, just introducing a different paradigm.
(We also earn 42% less money!)

[Surfrank57]

Stavia first of all, chocolate and bread, is a nice treat, grats again ....secondly we all have choices on what we will test and more importantly why we test. You gave a beautiful explanation that I hope everybody reads. It is something that the medical field and good docs understand and patients just see black or white. I feel the exact same way as you do and would have done the same. Because in good conscious if they said you had a neoplasm or some mass, you would have done further testing, even though you know the probability is so low that it was a real problem. Just how we are trained. Or your son would have said, oh just do an MRI and rule it out.

You choose not to have the lung portion based on percentages, past history of scarring, and zero clinical manifestations of an illness and your explanation was very transparent and honest. Very refreshing....My mom when she was alive had some old compression fractures in her spine and ribs with scarring and every single standard X-ray came back with a radiological report of potential mass. Put her and our family through so much stress, finally I told the her lung doc, we are not doing anymore follow up scans and if she dies of lung cancer, don't worry I won't sue you. Never had lung cancer even with terrible COPD.. I respect your decision and keep doing what your doing because in your case it is not a false negative, it's just good news mate.

Frank

[Tincup]

Great news! Happy Dance!

Turns out the husband of a couple who are friends of mine who got the EBT scan in Boulder got a positive lung report. From what I understand, they did suggest a repeat scan after a year or so, assuming if no change it is nothing to worry about. The wife does have a calcium score that puts her in the 90+ percentile for her age and sex. Certainly worth knowing about.