Is screening once at age 65 an effective method for detection of abdominal aortic aneurysms?

Abstract

Objective: To evaluate whether a single screening at 65 or screening at 65 and 70 are the methods of choice to detect the majority of abdominal aortic aneurysms (AAA) suitable for treatment.

Setting: District general hospital, district general practice and community.

Methods: Data were collated from four studies (a pilot, a control trial, and two cohorts) of abdominal ultrasound screening of an invited group of 11 666 men and women aged 65-80 to derive age related prevalence, invitation acceptance rates, and operative mortality. Deaths from AAA rupture were obtained from district registrars' returns.

Results: The prevalence of AAA increased with age being greater overall in men (6.8%) than in women (1.2%). From ages 65 to 80 the prevalence in men increased from 5.4% to 10.4%, and in women from 0.6% to 2.1%. In men and women 4% of patients dying from AAA rupture were aged 65 or under and 85% of deaths occurred over the age of 70. Acceptance rates for screening decreased between 65 and 80 from 80.5% to 66.2% in men and from 72.7% to 58.3% in women. In elective or symptomatic patients operative mortality was zero up to the age of 70, increasing to 7.1% in older patients.

Conclusions: Men should be screened at age 65 to obtain a high acceptance rate and to identify those with AAA most likely to benefit from treatment. The prevalence is relatively low at this age so an additional screen at age 70 is recommended, which would pick up a further 3.7% of patients with AAA, at which age intervention is likely to be of benefit.