Screening for abdominal aortic aneurysms in men

doi:10.1136/bmj.328.7448.1122

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J J Earnshaw, consultant surgeon (Earnshaw@rudford.demon.co.uk)1,
E Shaw, screening programme coordinator1,
M R Whyman, consultant surgeon2,
K R Poskitt, consultant surgeon2,
B P Heather, consultant surgeon1

¹Gloucestershire Royal Hospital, Gloucester GL1 3NN,
²Cheltenham General Hospital, Cheltenham, Gloucestershire

Correspondence to: J J Earnshaw

Accepted 11 March 2004

Gloucestershire's screening project shows the potential benefits of a national programme and how it could be run

Every year about 6000 men die from a ruptured abdominal aortic aneurysm in England and Wales.1 Although this represents only about 2% of all deaths in men, the condition is largely preventable. It is also a disease that seems to be increasingly prevalent, at least in Scotland, despite the fact that deaths from other atherosclerotic conditions are reducing.2 This article explores the requirements for a national aortic screening programme, using as a model the Gloucestershire aneurysm screening project, which has been running for 13 years.3

Evidence for screening

Ultrasound screening for abdominal aortic aneurysms fulfils all the criteria for a population screening programme,4 5although only in men.6 The recent multicentre aneurysm screening study found that screening reduced the mortality from aneurysm disease in men by 42% after four years of follow up; it is expected, with further study, to show a small but significant decrease in the population mortality.7 The study also showed that screening is as cost effective as other current screening programmes, at a cost of £28 000 for each added year of life.8

Ruptured abdominal aortic aneurysm is largely preventable

Credit: GCa/SPL

This information builds on data from previous smaller randomised studies,9^–11 and has encouraged debate about the value of a national screening programme for aortic aneurysms.12 13 The National Screening Committee in the United Kingdom is currently assessing the evidence before making any recommendation.14 Our experience in Gloucestershire shows how a screening programme could work.

Gloucestershire aneurysm screening project

Screening for abdominal aortic aneurysm was introduced in Gloucestershire in September 1990. All men reaching the age of 65 who are registered with general practices in the county are offered an ultrasound scan of …