Abdominal aortic aneurysm (AAA) is a significant cause of death in Canada. AAA is most common in men over the age of 65. The aneurysm can be reliably detected in a cost effective manner using a simple ultrasound scan of the abdomen limited to visualization of the abdominal aorta. While there are risk factors that increase an individual’s risk of having an AAA, population screening of men aged 65-75 has been proven to be effective in reducing AAA mortality.”1 The incidence of AAA in women is significantly less and population-based screening in all women has not been shown to reduce mortality.
The Canadian Society for Vascular Surgery recommends:
- “National and provincial health ministries develop a comprehensive population-based ultrasound screening program for AAAdetection and referral
- All men aged age 65-75 be screened for AAA
- Individual selective screening for those at high risk for AAA (e.g., women over age 65 at high risk secondary to smoking, cerebrovascular disease and family history & men less than 65 with positive family history)”1
The Canadian Society for Vascular Surgery has reviewed and published the results of the medical evidence for screening of AAA.2 These data demonstrated that screening men 65 to 75 will reduce aneurysm related mortality by half and at seven year follow-up a benefit on all-cause mortality was noted.2 Three aneurysms discovered by screening and repaired electively, will prevent one aneurysm death.2 For men, the number needed to screen to prevent one AAA mortality is similar to colorectal cancer screening via fecal occult blood testing and breast cancer screening via mammography.23
A directed AAA screening program has been demonstrated to be cost effective.247 A Canadian economic analysis has demonstrated that a national screening of men reaching age 65 is an economically viable approach.35 One Canadian study demonstrated that AAAscreening is feasible in a busy family physician practice using ultrasound technology at point of care.6
- Canadian Society of Vascular Surgery. (2007). Position statement of the Canadian Society for Vascular Surgery for screening of abdominal aortic aneurysm. Retrieved from http://canadianvascular.ca/Resources/Documents/AAA_statement08.pdf
- Mastracci, T.M.,& Cinà, C.S., on behalf of the Canadian Society for Vascular Surgery. (2007). Screening for abdominal aortic aneurysm in Canada: Review and position statement of the Canadian Society for Vascular Surgery. Journal of Vascular Surgery, 45 (6),1268-1276
- Rembold, C.M. (1998). Number needed to screen: Development of a statistic for disease screening. British Medical Journal, 317, 307-312.
- Kim, L.G., Scott, R. A., Ashton, H.A., Thompson, S.G., on behalf of the Multicentre Aneurysm Screening Study Group. A sustained mortality benefit from screening for abdominal aortic aneurysm. Annals of Internal Medicine, 146(10), 699-706.
- Montreuil B., & Brophy J. (2008). Screening for abdominal aortic aneurysms in men: a Canadian perspective using Monte Carlo-based estimates. Canadian Journal of Surgery, 51(1), 23-34.
- Blois, B. (2012). Office-based ultrasound screening for abdominal aortic aneurysm. Canadian Family Physician, 58 (3).
- Thompson, S.G., Ashton, H.A., Gao, L., Scott, R.A., on behalf of the Multicentre Aneurysm Screening Study Group. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. British Medical Journal. Retrieved from http://www.bmj.com/content/bmj/338/bmj.b2307.full.pdf.