Head To Head

Should we screen for aortic aneurysm? No

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39514.494167.AD (Published 17 April 2008) Cite this as: BMJ 2008;336:863
  1. James N Johnson, consultant surgeon
  1. 1Halton General Hospital, Runcorn WA7 2DA
  1. jnjohnson33{at}hotmail.com

    In January, the government announced pilot screening programmes for men aged 65 in England, with national screening to follow. Stephen Brearley (doi: 10.1136/bmj.39517.443796.AD) describes the rationale for this proposal while James Johnson argues that it is not without pitfalls

    The case for screening for abdominal aortic aneurysms looks open and shut. Mortality for patients with a ruptured aneurysm is around 90% if you include those who do not survive until the ambulance arrives.1 2 But if the aneurysm is discovered before it ruptures and is repaired electively, the mortality in the hand of an experienced vascular surgeon is around 7.4% in England.3 Unfortunately abdominal aortic aneurysms rarely give rise to symptoms and so are not diagnosed before they rupture. Screening would ensure that most aneurysms in the appropriate age group will be picked up and could be repaired electively.

    The UK government seems convinced, and pilot screening programmes for men aged 65 are due to be launched this year. But I believe this move is overhasty. The average …

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