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Education And Debate

Screening for abdominal aortic aneurysms in men

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7448.1122 (Published 06 May 2004) Cite this as: BMJ 2004;328:1122

Screening for abdominal aortic aneurysms

Editor-Earnshaw et al1 describe the practice of screening for AAA
over a 13 year period, and conclude that the arguments for a national
screening programme are cogent. The results of the MASS trial2 support
their conclusion. They discuss options for screening nationally. Screening
men once at age 65 is supported by the findings of MASS and the Chichester
study3 and is in my view the preferred option because it would detect the
vast majority of patients at risk from rupture and achieve a high
acceptance rate.

Although of interest, I would not include those with AA A 2-6 cm -2-
9 cm in diameter for follow-up in a national programme, because it would
increase the workload of the screening unit significantly without any
equivalent benefit. Hobbs et al4 found that no patient with an aorta less
than 3 cm diameter suffered a ruptured AAA over a 10 year period..

The same would be true of their indicators for referral to
outpatients at a diameter of 4.0 cm instead of 5.5cm (as in MASS), . I
would suggest continued follow-up by the screening team to 5.5cm, because
from our experience, this carries an acceptably low risk of rupture, would
reduce the workload in the hospital clinics, and provide referral when
the clinical decision for surgical intervention is indicated.5

Including prevention with screening is mentioned by Earnshaw et al.
The addition of an assistant/facilitator could allow for additional
observations to be recorded and advice offered (eg concerning blood
pressure, weight and smoking) without decreasing the screening rate
significantly. This extra person could also provide support for the
ultrasonographer when going out to isolated or urban areas.

The MASS trial has shown AAA screening to be clinically beneficial
and cost-effective. Earnshaw et al have shown that AAA screening of men
using a single scan at age 65 is feasible. This adds to the evidence and
impetus for UK decision makers and politicians to support the introduction
of a national screening programme for AAA.

RAP Scott

Principal Investigator

Multi-centre Aneurysm Screening Study (MASS)

Scott Research Unit, CMEC, St Richards Hospital, Chichester, West Sussex
PO19 6SE

References

1 Earnshaw JJ Shaw E, Whyman MR, Poskitt KR, Heather BB. Screening
for abdominal aortic aneurysms in men. BMJ, 2004;328:1122-1124.

2 Multicentre Aneurysm Screening Study Group. The Multi-centre
Aneurysm Screening Study (MASS) into the effects of abdominal aortic
aneurysm screening on mortality in men: a randomised controlled trial.
Lancet 2002;360:1531-9.

3 Scott RAP, Vardulaki KA, Walker NM, Day NE, Duffy SW, Ashton HA.
The long-term benefits of a single scan for abdominal aortic aneurysm
(AAA) at age 65. Eur J Vasc Endovasc Surg 2001; 21: 535-540

4 Hobbs F, Claridge M, Drage M, Quick C, Bradbury A, Wilmink A.
Strategies to improve the effectiveness of AAA screening programmes. J Med
Screening 2004; 11: 93-96

5 The UK Small Aneurysm Trial Participants. Mortality results for
randomised controlled trial of early elective surgery or ultrasonographic
surveillance for small abdominal aortic aneurysms. Lancet 1998; 352: 1649-
1655

Competing interests:
None declared

Competing interests: No competing interests

25 August 2004
RAP Scott
Principal Investigator, Multi-centre Aneurysm Screening Study (MASS)
Scott Research Unit, CMEC, St Richards Hospital, Chichester, West Sussex PO19 6SE