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Randomized Controlled Trial
. 2012 Dec;99(12):1649-56.
doi: 10.1002/bjs.8897. Epub 2012 Oct 3.

Final follow-up of the Multicentre Aneurysm Screening Study (MASS) randomized trial of abdominal aortic aneurysm screening

S G Thompson  1 , H A Ashton, L Gao, M J Buxton, R A P Scott; Multicentre Aneurysm Screening Study (MASS) Group
Affiliations
Free PMC article
Randomized Controlled Trial

Final follow-up of the Multicentre Aneurysm Screening Study (MASS) randomized trial of abdominal aortic aneurysm screening

S G Thompson et al. Br J Surg. 2012 Dec.
Free PMC article

Abstract

Background: The long-term effects of abdominal aortic aneurysm (AAA) screening were investigated in extended follow-up from the UK Multicentre Aneurysm Screening Study (MASS) randomized trial.

Methods: A population-based sample of men aged 65-74 years were randomized individually to invitation to ultrasound screening (invited group) or to a control group not offered screening. Patients with an AAA (3·0 cm or larger) detected at screening underwent surveillance and were offered surgery after predefined criteria had been met. Cause-specific mortality data were analysed using Cox regression.

Results: Some 67 770 men were enrolled in the study. Over 13 years, there were 224 AAA-related deaths in the invited group and 381 in the control group, a 42 (95 per cent confidence interval 31 to 51) per cent reduction. There was no evidence of effect on other causes of death, but there was an overall reduction in all-cause mortality of 3 (1 to 5) per cent. The degree of benefit seen in earlier years of follow-up was slightly diminished by the occurrence of AAA ruptures in those with an aorta originally screened normal. About half of these ruptures had a baseline aortic diameter in the range 2·5-2·9 cm. It was estimated that 216 men need to be invited to screening to save one death over the next 13 years.

Conclusion: Screening resulted in a reduction in all-cause mortality, and the benefit in AAA-related mortality continued to accumulate throughout follow-up.

Registration number: ISRCTN37381646 (http://www.controlled-trials.com).

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Figures

Figure 1
Figure 1
Abdominal aortic aneurysm (AAA)-related mortality over 13 years in the Multicentre Aneurysm Screening Study
Figure 2
Figure 2
Rate of ruptured abdominal aortic aneurysm in men who originally screened normal and in the control group over time
Figure 3
Figure 3
Distribution of baseline aortic diameter among 32 men with ruptured abdominal aortic aneurysm who originally screened normal
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Comment in

References

    1. NHS Abdominal Aortic Aneurysm (AAA) Screening Programme: Annual Report 2010–11. http://www.aaa.screening.nhs.uk/annual_report [accessed 19 March 2012]
    1. Scottish Abdominal Aortic Aneurysm Screening Programme. http://www.scotland.gov.uk/Topics/Health/health/screening/AAAscreening [accessed 19 March 2012]
    1. Screening for Abdominal Aortic Aneurysm. 2008. http://www.sbu.se/en/Published/Alert/Screening-for-Abdominal-Aortic-Aneu... [accessed 19 March 2012]
    1. US Preventive Services Task Force. Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med. 2005;142:198–202. - PubMed
    1. Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RA, et al. Multicentre Aneurysm Screening Study Group The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002;360:1531–1539. - PubMed

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