Aneurysm Screening Saves Lives

Ultrasound detects potential time bomb in men over 65

THURSDAY, Nov. 14, 2002 (HealthDayNews) -- A program to screen older men for the weakness in the body's main artery called an aortic aneurysm saves lives, a British study finds.

In just four years, one life was saved for every 710 apparently healthy men over 65 who had an ultrasound examination to detect the problem, says a report in this week's issue of The Lancet.

On the surface, the report of a study including more than 67,000 men would appear to settle a long-running debate about the value of screening for aortic aneurysms and doing corrective surgery when one is found. In 1996, the U.S. Preventive Services Task Force said there was "insufficient evidence to recommend for or against routine screening of asymptomatic adults."

However, cost complicates the picture. Medicare does not pay for the screening test, which can cost several hundred dollars in the United States. "The question is, what is the cost-benefit ratio and how does it fit in with the other things we do,'" says Dr. Richard A. Stein, a professor of medicine at Weill Cornell Medical Center in New York City and a spokesman for the American Heart Association.

At the moment, Stein says, he would recommend the test only for persons with known risk factors for heart disease, such as high blood pressure or atherosclerosis. "I am not yet ready to advise an asymptomatic 65-year-old man," he says.

However, a second study on the screening procedure, appearing in this week's issue of the British Medical Journal, finds it is cost-effective as well as lifesaving. Researchers looked at the same group of men and found it would cost about $45,000 for each year saved on a person's life and that figure would fall substantially after only a few years.

An aortic aneurysm is a weak spot in the major artery running to the heart. If it bursts, it usually is fatal. The British Multicentre Aneurysm Screening Study enlisted 67,000 men aged 65 to 74, an age group at highest risk. Half were invited to have an ultrasound examination -- 27,147 accepted the invitation -- and the other half were told to do nothing.

Over four years, 1,333 aneurysms were detected in the screened group. Surgery was done to replace the weak spot in the aorta with plastic tubing when it reached a certain size. There were 65 aneurysm-related deaths in the screened group and 113 in the unscreened group, says Alan Scott, leader of the study. "Screening reduced mortality by 50 percent over four years, and it was more effective the longer you followed it," he says.

Every man should have an ultrasound test to detect an aortic aneurysm at the age of 65, Scott says. "If it is normal, it indicates you are protected against rupture for 10 years," he says.

"In view of the much higher frequency of the condition among men, and the absence of effect of screening on the incidence of ruptured aneurysms in it would be logical to screen only men," he says.

The cost of the program is low in the British nationalized health-care system -- 23 pounds (about $37) per screening, 53 pounds ($85) per person including treatment, Scott says. "But the cost depends on the system," he adds.

"This kind of screening for life-threatening conditions is the future of medicine," Stein says, but cost must be considered in setting up such programs because there is a large number of screening tests for different conditions.

"We have to begin to push the level of yield higher," he says. "Can we begin to characterize patients over a certain age by the presence of risk factors? We have to see if we can stage people in terms of risk and determine when it is fiscally appropriate [for] Medicare to pay for a test."

"But when I am 65, I will go in and have the test," he says.

What To Do

You can learn more about aortic aneurysms from the American Heart Association or the National Library of Medicine.

SOURCES: Alan Scott, Ph.D., director, Multicentre Aneurysm Screening Program, Chichester, England; Richard A. Stein, M.D., professor, medicine, Weill Cornell Medical Center, New York City; Nov. 16, 2002, The Lancet
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