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The programme
was established in Gloucestershire, UK, in 1990 with the aim of carrying out large scale population
screening by abdominal ultrasound scans to detect asymptomatic aortic
aneurysms. All male patients of participating GPs in Gloucestershire now
receive an invitation to attend for an ultrasound examination as they reach
the age of about 65 years. The screening examinations are carried out by a
mobile team which makes an annual visit to each participating GP practice
in the County, examining the current batch of 65 year old men.
Approximately 2200 new examinations are performed each year of which 95% are normal (aortic
diameter less than 2.6 cm) with no further follow up needed. Some 4% of newly examined
65 year olds have a slight enlargement of the aorta and are invited to
attend for a further scan when the team revisits their GP practice in a
year's time. 1% of those examined
are found to have a more significant aneurysm (4.0 cms
or greater aortic diameter), for which they are referred to a Vascular
Surgeon for more detailed examination and follow up, with a view to possible
elective surgical repair of the aneurysm.
By the end of 2004, all males between the
ages of 65 and 79 years old living in Gloucestershire will have been
offered the opportunity of an ultrasound scan. Over 36,000 scans will have
been performed, representing 86% attendance of those men invited. Over 400 aneurysm repair
operations have been performed so far on aneurysms detected by screening
As this cohort of screened men slowly
increases, the incidence of ruptured aneurysm in the screened age group is
reducing significantly and overall aneurysm-related deaths in the Gloucestershire
community have been reduced by 66% in men in the screened age group (see papers in GVG
recent publications). The great majority of aneurysm ruptures now seen in
men in Gloucestershire occur in those who, for one reason or another, did
not attend for their original screening invitation or in those born before
1925.
In 2002, the results of an independent randomized
trial of screening for aortic aneurysm, based in the South of England, were published (MASS trial). This trial, based on nearly
70,000 men, showed a 42% reduction, during 4 year follow up, in deaths
related to aortic aneurysms in men offered screening. The benefits of
screening almost certainly extend and increase well beyond 4 years and are
likely to be comparable to the 66% reduction in aneurysm related deaths
found in Gloucestershire with longer follow up periods.
The experience in Gloucestershire, the
MASS trial and other results from centres in the UK and USA all clearly indicate that ultrasound screening for
aortic aneurysms is feasible and that it significantly reduces deaths from
aneurysm rupture. Calculations indicate that the benefit from the
introduction of such a screening programme across
the UK could be obtained at a cost that compares favourably with other expenditure on health care.
The great majority of UK vascular
surgeons now believe that the scientific case for a national screening programme for aortic aneurysms is established. The
introduction of such a programme now simply awaits
political and financial approval by the Government.
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