Intended for healthcare professionals

Education And Debate

Screening for abdominal aortic aneurysms in men

BMJ 2004; 328 doi: (Published 06 May 2004) Cite this as: BMJ 2004;328:1122

Screening induces harm

In the discussion about screening I miss a debate about the harm that
may be done. It is well known that doing harm is the down-side of
screening. This is insufficiently realized by many, including surgeons and
policy makers. Aneurysm surgery is not without mortality and has a major
morbidity rate of approximately 10%. This is the price persons have to pay
for a ‘therapy’ with a very limited reduction in all cause mortality.
Ironically, the large majority of these complications happen to patients
who otherwise wouldn’t have died from a ruptured aneurysm and even
wouldn’t have known that they lived with an aneurysm. How are we going to
explain this to patients?
Earnshaw et all try to convince people with ‘the impressive’ relative risk
reduction of 42% for the mortality from aneurysm disease instead of
absolute risk reduction and the fact that screening is cost-effective. A
more balanced view in which we carefully analyse the risks in relation to
the limited benefit is mandatory before we embark upon a screening
programme for aneurysms.

Competing interests:
None declared

Competing interests: No competing interests

07 June 2004
Dink A. Legemate
Professor of Vascular Surgery & Clinical Epidemiologist
Academic Medical Center, PO Box 22700, 1100 DE Amsterdam