Noticias

Noticias

  • Título: AAA screening re-considered: It could be the wrong thing to do…
  • Fecha: 29-05-2015
  • Frank J Criado, MD, FACS, FSVM

    Researchers argue in a recent important article (Johansson M, et al, BMJ 2015;350) whether AAA screening makes any sense as it could result in harm to some patients. It is well established that abdominal aneurysms occur mostly in men over 65 years of age and are more common among smokers. The decision to pursue aneurysm screening (over the past 15 years in Sweden, the U.K., and the U.S.) was based on four randomized controlled trials from the 1980s and 1990s.

    However, researchers based at the Universities of Gothenburg and Copenhagen argue that screening almost doubles aneurysm prevalence, but most aneurysms so uncovered are small and at low risk of rupture. They estimate that 176 of every 10,000 men invited to screening are over diagnosed. “These men are unnecessarily turned into patients and may experience appreciable anxiety throughout their remaining lives. Moreover, 37 of these men unnecessarily have preventive surgery and 1.6 of them die as a consequence,” they explained. The researchers also point to several studies showing a drop in AAA prevalence over recent decades, probably because the prevalence of smoking has fallen sharply in the recent past. “When the incidence of the condition screened for decreases, the potential benefits also decrease,” write the authors. “Furthermore, the benefit-to-harm ratio is likely to be worse in current screening programmes than in the trials on which they were based.”

    The article also warns that plans to lower the diagnostic threshold for AAA “will double aneurysm prevalence and substantially increase the rate of over diagnosis.” “Aneurysm screening programmes should be revisited because of reduced benefits in modern populations and because data suggest considerable harm,” they concluded.

    Much food for thought for sure!



  • Fuente: endovascular.es