Is Abdominal Aortic Aneurysm Screening Beneficial?

Current practice for screening for abdominal aortic aneurysms (AAA) in the U.K., the United States and Sweden is largely based on the results of randomized trials conducted in the 1980s and 1990s. The incidence rate of AAA has decreased in recent years (this is thought to be due to an overall decrease in smoking). Current practitioners are now wondering whether screening for AAA yields more benefits than downsides now that the incidence rate for AAA has decreased. A new study exploring the issue was published in a recent issue of The Lancet.

Researchers for the study collected data on AAA screenings in Swedish men and compared it to that of a population of Swedish men who were not screened. According to the results, the mortality rate decreased by more than 25%, but this drop occurred regardless of whether screening had been used. This concurs with the assumption that the drop in the incidence rate for AAA is due to the decrease in smoking. Screening showed that it was able to assist two out of every 10,000 men in avoiding the outcome of death from AAA (although this did not reach statistical significance). In addition, the screening was associated with increased odds of overdiagnosis (where 49 out of the 10,000 would be diagnosed with AAA when they did not have one; of those, 19 would undergo unnecessary surgery that increased their risk of mortality).

The researchers concluded that while there was a small beneficial effect from AAA screening, the harms of the screening decreased less significantly than the benefits did, making screening less appealing and valuable today than it once was.

Many people who are diagnosed with an abdominal aortic aneurysm receive unnecessary treatment. Without the screening, they likely would never have had any problems with it. https://t.co/qewoufJd0Q pic.twitter.com/LqaKVec04N

— Cardiology (@Cardiology_LR) June 18, 2018

Source: The Lancet