Jack L. Cronenwett, MD
Potential Financial Conflicts of Interest: None disclosed.
Cronenwett J.; Screening for Abdominal Aortic Aneurysms. Ann Intern Med. 2005;143:309. doi: 10.7326/0003-4819-143-4-200508160-00015
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Published: Ann Intern Med. 2005;143(4):309.
TO THE EDITOR:
The U.S. Preventive Services Task Force (USPSTF) recommended screening for abdominal aortic aneurysms (AAAs) with ultrasonography only in male smokers 65 to 75 years of age. Other subsets were excluded in part because of “good evidence that screening and early treatment result in important harms, including an increased number of surgeries with associated morbidity and mortality, and psychological harms” (1). I question the evidence regarding harms.
First, the companion review on this topic by Fleming and colleagues (2) concluded that “screening does not appear to be associated with significant physical or psychological harms.” Second, the harm related to morbidity and mortality of “unnecessary” operations requires an unstated assumption that small AAAs identified by screening would be inappropriately repaired before they reached a size of substantial rupture risk. The members of the USPSTF do not provide evidence for this assumption, nor do they indicate the magnitude of this effect on their conclusions. In fact, evidence from randomized trials of AAA screening indicates that more than 90% of subsequent elective AAA repairs were performed at recommended size criteria (3).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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