Abstract
Background:The long-term effects of abdominal aortic aneurysm (AAA) screening were investigated in extended follow-up from the UK Multicentre Aneurysm Screening Study (MASS) randomized trial.Methods:A population-based sample of men aged 65–74 years were randomized individually to invitation to ultrasound screening (invited group) or to a control group not offered screening. Patients with an AAA (3·0 cm or larger) detected at screening underwent surveillance and were offered surgery after predefined criteria had been met. Cause-specific mortality data were analysed using Cox regression.Results:Some 67 770 men were enrolled in the study. Over 13 years, there were 224 AAA-related deaths in the invited group and 381 in the control group, a 42 (95 per cent confidence interval 31 to 51) per cent reduction. There was no evidence of effect on other causes of death, but there was an overall reduction in all-cause mortality of 3 (1 to 5) per cent. The degree of benefit seen in earlier years of follow-up was slightly diminished by the occurrence of AAA ruptures in those with an aorta originally screened normal. About half of these ruptures had a baseline aortic diameter in the range 2·5–2·9 cm. It was estimated that 216 men need to be invited to screening to save one death over the next 13 years.Conclusion:Screening resulted in a reduction in all-cause mortality, and the benefit in AAA-related mortality continued to accumulate throughout follow-up. Registration number: ISRCTN37381646 (http://www.controlled-trials.com).
Highlights
National screening programmes for abdominal aortic aneurysm (AAA) have recently been initiated for men in England and Scotland[1,2], Sweden[3], and the USA as part of Medicare[4]
Results from Multicentre Aneurysm Screening Study (MASS) were last published after 10 years of follow-up[7]; some increase in ruptured AAA among those screened normal was noted, but this had not impacted on the overall proportionate reduction in AAA-related mortality
The only existing randomized trial evidence after 10 years comes from much smaller trials; the 14year follow-up of the Danish Viborg trial did not report on ruptured AAA among those screened normal[10], whereas the 15-year follow-up of the UK Chichester trial suggested a possibly substantial increase in ruptured AAA during later follow-up[11]
Summary
National screening programmes for abdominal aortic aneurysm (AAA) have recently been initiated for men in England and Scotland[1,2], Sweden[3], and the USA as part of Medicare[4]. The UK Multicentre Aneurysm Screening Study (MASS)[5,6,7] has provided the majority of the worldwide randomized evidence, in terms of both number of participants and person-years of follow-up, for the mortality benefit following ultrasound screening for AAA8,9. The long-term effects of abdominal aortic aneurysm (AAA) screening were investigated in extended follow-up from the UK Multicentre Aneurysm Screening Study (MASS) randomized trial. The degree of benefit seen in earlier years of follow-up was slightly diminished by the occurrence of AAA ruptures in those with an aorta originally screened normal. About half of these ruptures had a baseline aortic diameter in the range 2·5–2·9 cm.
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