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Ultrasound screening of men aged 65 to 79 for abdominal aortic aneurysms significantly reduces the number of men who die from the condition, a systematic review has concluded.
The review of trials that evaluated screening says that between 5% and 10% of men in this age group have abdominal aortic aneurysms of which they are unaware (Cochrane Database of Systematic Reviews 2007;(2):CD002945).
Rupture of these aneurysms carries a very high risk of death. Screening by abdominal ultrasonography can detect these aneurysms, many of which can be treated with surgery.
In its review the Cochrane peripheral vascular diseases group searched its trials register for randomised controlled trials of population screening for abdominal aortic aneurysms. They found four studies, conducted in the United Kingdom, Denmark, and Australia and involving 127891 men and 9342 women. (Only one of the studies included women.)
All four studies offered one-off abdominal ultrasonography screening for abdominal aortic aneurysm to people aged over 65 years. Participants with a strongly positive result were investigated further and offered surgery.
The results of the review showed a significant 40% decrease in mortality from abdominal aortic aneurysm among men three to five years after screening (odds ratio 0.6 (95% confidence interval 0.5 to 0.8) but not among women (odds ratio 2 (0.4 to 10.9)). Mortality included death from rupture and from emergency or elective surgery for aneurysm repair.
Screening was also associated with a lower incidence of ruptured aneurysm in men (odds ratio 0.5 (0.2 to 1) but not in women (odds ratio 1.5 (0.3 to 8.9)). Men who were screened were more likely than men who weren't screened to undergo surgery for abdominal aortic aneurysm (odds ratio 2 (1.6 to 2.6). This was not reported in women.
Mortality from all causes did not differ significantly between screened and unscreened participants, in either men or women.
Paul Cosford, director of public health at the East of England Strategic Health Authority and the review's lead author, said, “The results showed that men aged 65-79 could benefit from screening. But there were insufficient data to ascertain the effectiveness of screening in women.”
He explained that an essential question for any screening programme is whether it does more good than harm. “The review established the overall population benefit from screening men over 65, in that fewer died from their aortic aneurysm as a result of screening, even after taking into account those who died after surgery.”
Resource analysis indicates that screening men aged over 65 for abdominal aortic aneurysm may be cost effective in developed countries, but Dr Cosford said that this needs further analysis, given the lack of information on life expectancy, complications of surgery, and quality of life. Screening in women should also be studied further, he said.