Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
A carefully targetted screening is the answer
- Kofi O Ofuafor (13 May 2004)
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No room for blunders
- Neville W Goodman (14 May 2004)
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Delays in Treatment
- George K Molyneaux (7 September 2006)
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National screening programme for aortic aneurysm
- Nazar R DESSOUKI (9 September 2006)
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Kofi O Ofuafor, Senior SHO Gastroenterology Weston General Hospital, Weston super mare
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True arterial aneurysms are defined as 50% increase in the normal diameter of a vessel. By this definition a prevalence of 5% in men over the age of 65 years has been reported(David Spurgeon et at). This is a very common problem with a chilling mortality of 90% in the community if it rupures.
It is therefore a big relief, to know that this problem can virtually be wiped out if a national screening programme can be become a reality, but as always there is a small matter of how to finance this, as resources are always limited. The author suggested that screening patients with atherosclerotic disease, rather than the whole population is more cost effective, but risk excluding a large population at risk by this criteria. I wonder if a middle ground built upon the experience of ischaemic heart disease with a holistic assessment of all risk factors will not be more inclusive and yet cost effective. It would then be possible to include in the abdominal aortic aneurysm screening programme anyone with two or more of the following risk factors(David Spurgeon et al)even in the absence of atherosclerotic disease. Age more than 60 years
In conclusion, a well targetted abdominal aortic aneurysms screening programme akin to that used in cases of ischaemic heart disease where only those considered to have a moderate to high risk are considered for angiogram will serve a more inclusive and cost effective purpose. Competing interests: None declared |
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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The BMJ takes words seriously, even attempting a little while ago to ban the word 'accident'. I think that was ill-conceived, though it provoked interesting discussion. However, if there is a word that should be banned from serious medical journalism it is 'blunder'. This editorial comments that 'Certainly blunders in breast cancer screening have been reported in the national press...', but many of these 'blunders' are the inevitable consequence of the imperfect sensitivity and specificity of any screening test. This is, of course, why the editorial continues 'we need to understand that the advantages of screening must outweigh disadvantages'. But there is no room for blunder, while misdiagnoses are inevitable. Competing interests: None declared |
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George K Molyneaux, Media Research Director Lambourn RG17 8YZ
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There seems to be little point in having a national screening program without sufficient resources being in place to action any enlarged aneurysm. For the past eight years I have had an aneurysm monitored. In January of 2006 it had enlarged to a size of 5.7 cms. Since then I have seen three separate consultants and been referred from one hospital to another. I have had four CT scans before a suitable one was achieved and at the new hospital been put back at the bottom of the waiting list. Each consultant stated that the operation was urgent. In July I was informed that an EVAR operation would be carried out and that this would be marked as urgent and completed inside two months. I have just been told that this has now been postponed until October/November. A national screening program would put an intolerable burden on an already stretched service and should not be contemplated at this stage. Competing interests: None declared |
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Nazar R DESSOUKI, Consultant Surgeon St. BERNARDS HOSPITAL GIBRALTAR
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The death rate from rupture of the AAA in the age group 65-74 is five times greater in men than in women with more than half dying before reaching hospital. Any improvement in hospital treatment, no matter how good, would not affect the outcome of those dying from the condition before reaching hospital. Detection of AAA by clinical examination is poor, (Robicsek 1981). Screening by ultrasonography can detect the aorta in 99% of people; it is simple, safe and can detect the disease before symptoms occur Ultrasonographic screening studies have shown the prevalence of AAA in the 65 to 80 year old age group to be higher in men (7.6%) than in women (1.3%) (Scott et al 1991). Acceptance rate for screening is good at age 65 (80+ %) but is poor over the age of 75 years (Scott 1993). Screening men aged 65-74 by ultrasonography has therefore been adopted as the method of choice to combine the good acceptance rate with the population at risk from death from rupture. The use of portable ultrasonographic scanners to detect AAA has been shown to have a high sensitivity and specificity, to produce accurate and reproducible measurements and to convey no hazard to the population (Grimshaw & Docker 1992). The cost per scan is low. In conclusion, it is clear that screening for AAAs is beneficial in reducing mortality rates associated with aneurysm rupture. The main drawback of such a programme is the cost involved. It seems that more financial research must be carried out and that, if feasible, a programme of screening could be designed to target those at greatest risk of aneurysm rupture according to the known associated risk factors. Competing interests: None declared |
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