Screening spots clogged arteries

April 09, 2002|By SUSAN REIMER

BREAST CANCER and mammography are getting all the headlines, I wrote in a recent column, but it is heart disease that is killing all the women.

It was then that the roof fell in.

Men and women sent letters and e-mails filled with the searing pain of losing a mother, sister or wife to breast cancer, and I wilted under the assault.

I had suggested that medicine was assigning research and public education dollars based on the emotional decibel level of a disease - breast cancer - instead of on medicine's ability to treat it - heart disease.

The letter-writers more than proved the point. Their arguments in support of funding breast cancer research were very emotional. And some wrote to blame those who suffer from heart disease for lifestyle choices that contributed to their own ill health.

But in the midst of these letters was one from Dr. William Flinn, professor and chief of vascular surgery at the University of Maryland School of Medicine, thanking me for helping him do his job.

Flinn is chairman of a task force on public education for the American Vascular Association, and his group is having a hard time getting on the radar screen of an aging American population and their general practitioners with this message: A 15-minute test using nothing more than an ultrasound wand can identify people at risk for strokes, some kinds of heart attacks, aortal aneurysms or the kind of severe peripheral artery disease that, if left untreated, can result in amputation.

This quick, cheap test can detect whether a patient - usually over the age of 55 - is in danger of a circulatory blowout that is either fatal or enormously disabling.

"These diseases are so asymptomatic but they can be so devastating," says Flinn. "These problems are under-diagnosed, and yet so simple to diagnose."

Aortal aneurysms occur when the wall of the heart's main artery balloons out, weakens and ruptures. Stroke, some kinds of heart attacks and peripheral artery disease are the result of clogged arteries. All of these things can be seen on ultrasound and treated with diet or medication or a modest, low-risk surgical procedure.

But if left untreated, "we see the results," says Flinn somberly.

During May, hospitals in 20 cities, including the University of Maryland in Baltimore, will screen a modest number of people at risk for these diseases. This first year, Flinn said, perhaps only 1,000 people will be screened nationwide. Next year, perhaps 10 times that many will undergo the sonograms.

The purpose of the campaign is twofold: to educate the public on the easy, inexpensive efficacy of this test, and to gather the data necessary to convince the federal government and Medicare that this test should join Pap smears, mammograms, blood tests for prostate cancer, colonoscopies and bone-density tests in the lexicon of preventive medicine.

An ultrasound over the neck, the ankle and just above the abdomen: "I can give you all three in 15 minutes, and you'll be telling me that you'll take a dozen of these to one colonoscopy," Flinn says.

Only recently has the technology become portable enough, fast enough and cheap enough to begin a full-blown screening. "It used to take an hour," says Flinn. "Now I can do 50 in a day."

The postwar generation of Americans is aging in enormous numbers, but it has declared that it wants to work longer and continue to be active. This is the same enormous group that is daily more vulnerable to the creeping ravages and devastating crises of vascular disease.

"This is a population that isn't afraid of dying. It is afraid of being disabled," says Flinn. "Who wants to be a stroke survivor? Why not prevent the stroke? That's what we are trying to do."

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