Why the U.S. Preventive Services Task Force Recommendation against Screening for Asymptomatic Carotid Artery Disease Should be Reconsidered

Abstract

When screening seniors with a quick carotid scan (QCS) with ultrasound, one can discover the silent carotid artery disease (CAD) that is the leading cause of strokes and Medicare expenditures and allow preemptive management and stroke prevention. This is a discussion of the U.S. Preventive Services Task Force (USPSTF) recommendation against screening for CAD. The USPSTF recommended against screening the general population, but CAD and strokes occur predominantly in seniors. An incidence of 1% for 60% to 99% stenosing CAD in seniors was used, but the yield from 22,496 scans reported by the Society for Vascular Ultrasound was 7.5%. A 1% yield requires screening 1500 seniors to prevent 1 stroke, whereas a 7.5% yield requires only 200 scans. This disparity alone invalidates the USPSTF recommendation. Contrary to reports from the NIH, the USPSTF stated that CAD causes few strokes. The QCS was reported as not accurate, but the sensitivity was 93% in our laboratory and 97% at New York University. Risks incurred from screening were given as follow-up with angiography, which is now seldom used, and the risk of surgery, which was overstated. The USPSTF recommendation against screening for CAD, like those for reducing screening for breast and cervical cancer, is ill advised and should be reconsidered.