Screening men for aortic aneurysms justified

UK Authors of a study in this week's issue of THE LANCET provide compelling evidence that screening men over 65 years of age could substantially reduce death from ruptured aortic aneurysms.

Rupture of an aortic aneurysm--a swelling in the main blood vessel from the heart--is a major cause of death among men over 65 years of age. Opinion is divided as to whether ultrasound screening could be effective in preventing death from ruptured aneurysms ; death rates are high at between 65 and 80%.

The Multicentre Aneurysm Screening Study led by Alan Scott from St Richards Hospital, Chichester, UK, and colleagues compared the effect of screening for aortic aneurysms among a population of 67,800 men aged 65 years or over. Half the population were invited to attend screening--of whom 80% responded--and the other half were a control group not invited for screening. Men who had aneurysms detected by screening (swellings larger than 3cm diameter) were followed up for an average of four years, with surgical intervention when specific criteria were reached.

The relative risk of aneurysm-related death was reduced by around 50% among men who were screened, and around 40% in those who were invited for screening (65 compared with 113 deaths); the absolute risk of these men dying from aortic aneurysms was around 2 per 1000 compared with just over 3 per 1000 for men in the control group; 710 men would need to be screened to prevent one aneurysm-related death. 30-day death rates were 6% after elective surgery for an aneurysm compared with 37% after emergency surgery--a more likely outcome for the men who were not screened.

Alan Scott comments: "Our results indicate that substantial reductions in aneurysm-related mortality could be achieved by the implementation of a population-screening programme. In view of the much higher frequency of the condition among men, and the absence of evidence of effect of screening on the incidence of ruptured aneurysm

Contact: Richard Lane

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