BMJ  2004;329:1259 (27 November), doi:10.1136/bmj.38272.478438.55 (published 15 November 2004)

Paper

Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm

Paul E Norman, associate professor1, Konrad Jamrozik, professor of epidemiology2, Michael M Lawrence-Brown, vascular surgeon3, Max T Q Le, research officer4, Carole A Spencer, research officer4, Raywin J Tuohy, research assistant4, Richard W Parsons, statistician4, James A Dickinson, professor of family medicine5

1 School of Surgery and Pathology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, WA 6959, Australia, 2 School of Population Health, University of Queensland, Herston, QLD 4006, Australia, 3 Mount Medical Centre, Perth, WA 6005, Australia, 4 School of Population Health, University of Western Australia, Crawley, WA 6009, Australia, 5 Department of Family Medicine, University of Calgary, AB, Canada T2N 1M7

Correspondence to: P Norman pnorman{at}cyllene.uwa.edu.au

Objective To assess whether screening for abdominal aortic aneurysms in men reduces mortality.

Design Population based randomised controlled trial of ultrasound screening, with intention to treat analysis of age standardised mortality.

Setting Community based screening programme in Western Australia.

Participants 41 000 men aged 65-83 years randomised to intervention and control groups.

Intervention Invitation to ultrasound screening.

Main outcome measure Deaths from abdominal aortic aneurysm in the five years after the start of screening.

Results The corrected response to invitation to screening was 70%. The crude prevalence was 7.2% for aortic diameter ≥ 30 mm and 0.5% for diameter ≥ 55 mm. Twice as many men in the intervention group than in the control group underwent elective surgery for abdominal aortic aneurysm (107 v 54, P = 0.002, {chi}2 test). Between scheduled screening and the end of follow up 18 men in the intervention group and 25 in the control group died from abdominal aortic aneurysm, yielding a mortality ratio of 0.61 (95% confidence interval 0.33 to 1.11). Any benefit was almost entirely in men aged between 65 and 75 years, where the ratio was reduced to 0.19 (0.04 to 0.89).

Conclusions At a whole population level screening for abdominal aortic aneurysms was not effective in men aged 65-83 years and did not reduce overall death rates. The success of screening depends on choice of target age group and the exclusion of ineligible men. It is also important to assess the current rate of elective surgery for abdominal aortic aneurysm as in some communities this may already approach a level that reduces the potential benefit of population based screening.


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