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Few Aortic Aneurysm Screening Benefits Seen

September 28, 2012
Written by: , Filed in: Abdominal Imaging, Cardiac Imaging, Chest Radiology
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Since 2007, Medicare has covered a one-time abdominal aortic aneurysm ultrasound screening for most men age 65 or older. A new study published in Archives of Internal Medicine shows that few men have taken advantage of the opportunity. An accompanying commentary argues that they shouldn’t.

Full disclosure before we go any further: an unsuspected (and initially misdiagnosed) abdominal aortic aneurysm (AAA) killed my father. So I have a personal interest in the efficacy of screening.

New male Medicare enrollees 65 or older with a history of smoking are eligible for the one-time screening, thanks to the 2006 Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act. About 60 percent of men in that age group would thus qualify. But, according to the study, published online last week, the rate of screening among 65-year-old men increased only from 7.6 percent in 2004 to 9.6 percent in 2008.

And, the study says, that increase in screening was not associated with any changes in rates of AAA repair, AAA rupture, or all-cause mortality.

Two commentaries, published in Archives at the same time, question the benefits of AAA screening. One details the case of “Mr. R,” who underwent screening that detected an aneurysm. An endovascular aneurysm repair stent graft left him in significantly worse physical shape than before the procedure.

The other commentary contends that “there is new evidence that the burden of AAA is rapidly decreasing.” It notes that in the United States and other Western countries, mortality from ruptured AAA has decreased by as much as 50 percent in the past 10 to 15 years, paralleling the reduction of smoking prevalence among the affected population. (My father, a physically fit retired farmer who smoked cigars, died in 2001 at age 73.)

The commentary suggests not only that screening may have little benefit, but also that small aneurysms that are detected are overtreated.

One of the study authors thinks screening needs to be given more of a chance. Greater utilization of the screening and a longer follow-up period would give a truer picture of the benefits of screening, according to Jacqueline Baras Shreibati, MD, of Stanford University Medical Center:

Our primary objective was just to evaluate before and after the SAAAVE Act. It would have been nice to see some type of clinical effect, but that would certainly deserve an additional study with longer follow-up.

Dr. Shreibati is the study’s lead author. She was interviewed by Medscape’s heartwire.

In 2005, the U.S. Preventive Services Task Force recommended a one-time ultrasound AAA screening for men age 65 to 75 who had ever smoked, but not for anyone else. I’m 59. I’ve never smoked. I’m fine with forgoing a screening.

But I’m going to keep an eye on the research.

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Related seminar: Cardiovascular & Pulmonary Imaging

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