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We thank Dr Takagi and colleagues for their updated pooled analysis. Some of the references that they used were not available when we drafted our manuscript. Their results, however, provide further evidence to support our call for a National Aneurysm Screening Programme in Canada. We believe that “aneurysm-related mortality” is a more sensitive outcome for interventions (eg, screening) aiming at reducing mortality from aneurysm rupture. The fact that Dr Takagi and colleagues were also able to demonstrate a reduction in all-cause mortality supports the benefit of screening programs for this condition. In three of the references1Lindholt J.S. Juul S. Fasting H. Henneberg E.W. Preliminary ten year results from a randomised single centre mass screening trial for abdominal aortic aneurysm.Eur J Vasc Endovasc Surg. 2006; 32: 608-614Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar, 2Ashton H.A. Gao L. Kim L.G. Druce P.S. Thompson S.G. Scott R.A.P. Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms.Br J Surg. 2007; 94: 696-701Crossref PubMed Scopus (159) Google Scholar, 3Kim L.G. Ra P.S. Ashton H.A. Thompson S.G. A sustained mortality benefit from screening for abdominal aortic aneurysm.Ann Intern Med. 2007; 146: 699-706Crossref PubMed Scopus (132) Google Scholar used by the authors, the difference between groups in all-cause mortality was largely attributable to the difference in aneurysm-related death (Table). This confirms that the randomization process distributes the nonaneurysm-related deaths equally between the intervention (screening) and the control groups. The trend in the decrease of all-cause mortality in the screened population above and beyond the reduction in death related to abdominal aortic aneurysm may be the effect of a reduction in lifestyle-related cardiovascular risk factors that are addressed when the patients access medical care for screening. This may be an additional benefit of the screening program. However, because the original studies were not meant or powered to prove this hypothesis, the issue requires further study.TableLong-term aneurysm-related, and all-cause mortality in three randomized controlled trials of screening for abdominal aortic aneurysmFirst authorFollow-up, yearsNo.ScreenedControlsAll deathAAA-related deathAll deathAAA-related deathLindholt 1Lindholt J.S. Juul S. Fasting H. Henneberg E.W. Preliminary ten year results from a randomised single centre mass screening trial for abdominal aortic aneurysm.Eur J Vasc Endovasc Surg. 2006; 32: 608-614Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar1012,639218414223451Ashton 2Ashton H.A. Gao L. Kim L.G. Druce P.S. Thompson S.G. Scott R.A.P. Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms.Br J Surg. 2007; 94: 696-701Crossref PubMed Scopus (159) Google Scholar156040203647206754Kim 3Kim L.G. Ra P.S. Ashton H.A. Thompson S.G. A sustained mortality benefit from screening for abdominal aortic aneurysm.Ann Intern Med. 2007; 146: 699-706Crossref PubMed Scopus (132) Google Scholar767,77068821057119196AAA, Abdominal aortic aneurysm. Open table in a new tab AAA, Abdominal aortic aneurysm. Regarding “Screening for abdominal aortic aneurysm reduces both aneurysm-related and all-cause mortality”Journal of Vascular SurgeryVol. 46Issue 6PreviewIn a review article by Mastracci and Cinà,1 they stated that the pooled estimate of the effect of screening on abdominal aortic aneurysm (AAA)-related mortality showed a relative risk of 0.60 (95% confidence interval [CI], 0.45 to 0.80) in favor of screening men >65 years of age. The review included four reports of randomized controlled trials (RCTs): the Viborg Country study (mean 4.3-year follow-up),2 the Western Australia study (median 3.6-year follow-up),3 the Chichester study (men) (mean 10-year follow-up),4 and the Multicentre Aneurysm Screening Study (MASS) (mean 4.1-year follow-up). Full-Text PDF Open Archive