Mass or high-risk screening for abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is known to be associated with various diseases, especially hypertension, acute myocardial infarction (AMI), chronic obstructive airway disease (COAD), and intermittent claudication. These associations have led to a debate about whether screening of older men for AAA should be restricted to those with an associated disease.

To compare mass screening of men for AAA with screening of men with AAA-associated diseases, all previous computerized hospital-recorded AAA-associated diseases were merged with the results of mass screening of 4404 men aged 65-73 years.

Of hypertensives, 82.6 per cent attended screening of whom 17.8 per cent had AAA. For previous AMI the equivalent values were 82.3 and 9.3 per cent; for COAD 74.3 and 7.7 per cent; for angina pectoris 83.8 and 7.5 per cent; for lower limb arteriosclerosis 81.1 and 6.1 per cent; and for stroke or transient cerebral ischaemia 75.0 and 6.2 per cent. Screening of these six high-risk groups alone would have required 78.5 per cent fewer scans and 51.1 per cent of the AAAs diagnosed at mass screening would have been recognized. The attendance rate would have been 80.4 per cent, of whom 9.5 per cent would have had an aneurysm. The attendance rate among non-high-risk men was 74.7 per cent and 2.7 per cent had an aneurysm.

If screening for AAA is desirable, the authors recommend mass rather than high-risk screening.