Screening for aortic aneurysms in older men questioned

June 15, 2018

Screening programs for aortic aneurysms in the abdomen is now being questioned in a study published in The Lancet. As the condition becomes less common, general ultrasound scans for 65-year-old men may do more harm than good, the researchers assert.

"You run the risk of both over-diagnosing and over-treating a disease that does not at all represent the same problem anymore, which is a very positive development," says Minna Johansson, specialist in family medicine, PhD student at Sahlgrenska Academy, Sweden, and the lead author of the article.

Aortic aneurysms in the abdomen, or abdominal aortic aneurysms, are a localized enlargement of the aorta. The condition mainly affects older men, is strongly linked to smoking, but there usually are no symptoms. If the artery ruptures, however, the mortality rate is more than 80 percent.

The purpose of screening is to find the aneurysms before symptoms and thereby enable preventive surgery. On the downside, screening finds aortic aneurysms that never would have ruptured or caused symptoms even if they remained undetected. This means that screening leads some men to undergo a surgery that will not benefit them but that poses a risk of serious complications and even death. In addition, the diagnosis can lead to anxiety, described by patients as "living with a ticking time bomb in the stomach."

In the current study, information on 25,265 older men who were screened was compared with an age-matched control group of 106,087 men who had not been screened. It was possible to compare contemporaneous groups of screened and non-screened men because the screening program was introduced in Swedish administrative regions in stages during the 2006-2015 period.

The researchers also studied the incidence and mortality from abdominal aortic aneurysms among all Swedish men between the ages of 40 and 99 from 1987 to 2015. It was already known that the disease decreased during the period, but the role screening played was not known.

"Mortality has declined by over 70 percent, and this trend was seen in both screened and unscreened counties and in both screened and unscreened age groups," Minna Johansson says. "If the screening program had any impact at all on the decline, it was very small. This very positive reduction in mortality was probably due to a decline in smoking".

The researchers argue that time outpaced the studies that formed the basis for introduction of the screening program. In the current study, it appeared that only seven percent of the mortality reduction from abdominal aortic aneurysms that were ascertained in the largest randomized study in the field remained in today's setting. This effect was so small that it is uncertain whether it actually existed.

The decreasing mortality of the disease for reasons other than screening has led to growing problems with over-diagnosing and over-treatment. Therefore, the balance between the benefits and harms has changed for the worse, the study shows. Of 10,000 men summoned for screening, at best two will have avoided death from abdominal aortic aneurysms after six years.

At the same time, 49 men receive a diagnosis that would never have caused health problems, and of them 19 will undergo preventive surgery that they therefore cannot benefit from, but nevertheless still comes with a risk of death and serious complications.

An alternative to current screening, to which over 80 percent of all older men in Sweden attend, may be to screen only men at high risk, such as current and former heavy smokers and people in families with a history of the disease. Another option is to focus more on reducing smoking in the population in general, which would also lead to many other important health benefits. Minna Johanson and her co-authors anticipate continued discussion on the issue.

"This is a difficult ethical dilemma. It's important that the men who are summoned for screening are informed that there are serious risks arising from participation and that the chance to benefit is at best very small today. We came to the conclusion that it is doubtful that the benefits of screening outweigh the harms and that the Swedish screening program should therefore be revisited," says Minna Johansson.
-end-
Title: Benefits and harms of screening men for abdominal aortic aneurysm in Sweden: a registry-based cohort study; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31031-6/fulltext

University of Gothenburg

Related Mortality Articles from Brightsurf:

Being in treatment with statins reduces COVID-19 mortality by 22% to 25%
A research by the Universitat Rovira i Virgili (URV) and Pere Virgili Institut (IISPV) led by LluĂ­s Masana has found that people who are being treated with statins have a 22% to 25% lower risk of dying from COVID-19.

Mortality rate higher for US rural residents
A recent study by Syracuse University sociology professor Shannon Monnat shows that mortality rates are higher for U.S. working-age residents who live in rural areas instead of metro areas, and the gap is getting wider.

COVID-19, excess all-cause mortality in US, 18 comparison countries
COVID-19 deaths and excess all-cause mortality in the U.S. are compared with 18 countries with diverse COVID-19 responses in this study.

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.

Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.

What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.

COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.

Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.

Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.

Read More: Mortality News and Mortality Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.