Bmj Usa Editorial

Screening for abdominal aortic aneurysm

BMJ 2004; 329 doi: (Published 22 July 2004) Cite this as: BMJ 2004;329:E311
  1. Paul S Frame (, clinical professor of family medicine
  1. University of Rochester School of Medicine and Dentistry Rochester, NY, Tri-County Family Medicine Cohocton, NY

    Its time has come

    Abdominal aortic aneurysm (AAA) has intuitively seemed an ideal candidate for detection by screening for many years. It is a common condition, especially in older men, has a long asymptomatic period of development, and is accurately detected by ultrasound. Treatment prior to rupture is certainly better than waiting till symptoms, often a fatal rupture, occur. However, routine population screening for AAA has not been recommended by major groups in the United States. In 1996 the United States Preventive Services Task Force (USPSTF) stated, “There is insufficient evidence to recommend for or against routine screening of asymptomatic adults for abdominal aortic aneurysm with abdominal palpation or ultrasound.”1

    Concerns about screening for AAA expressed by the USPSTF in 1996 included the lack of randomized controlled trials with mortality outcomes, uncertainty about the natural history and management of small aneurysms, and concerns about the high surgical mortality associated with elective repair. Many of these questions have recently been answered.

    The Multicentre Aneurysm Screening Study (MASS),2 published in 2002, was a large randomized controlled trial of ultrasound screening for AAA in men aged 65 to 74, conducted in the United Kingdom. In this trial, death due …

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