A new screening test for men, which could help save lives
Publication Date:11/01/2008
The government is planning to introduce a new screening test for men, to look for a condition called abdominal aortic aneurysm. We look in more detail at this serious disorder and explain the benefits of screening.
What's an abdominal aortic aneurysm?
An aneurysm is a bulge in a blood vessel, which could tear (rupture) and cause bleeding. The abdominal aorta is the blood vessel that takes blood from your heart to your stomach and legs. A weak patch in the abdominal aorta can cause it to bulge or swell. This is called an 'abdominal aortic aneurysm' (AAA for short).
The abdominal aorta is a major blood vessel. If there's an aneurysm in it that tears, the bleeding can be bad enough to kill you. This can happen quickly. Every year, about 6,000 men in the UK die because their AAA tears. More than half of all people who have an AAA rupture die as a result.
Who is at risk?
AAAs are much more common among men than women. They are more common in older men. You are most likely to get one between the ages of 65 and 75. A big, recent study showed that 5 to 10 in 100 men aged 65 to 79 had AAAs that they didn't know about.
AAAs seem to run in the family. So if your father or grandfather had one, you may be more likely to get one too. You are also more likely to get one if you smoke.
How do I know if I have this condition?
You can't usually see or feel an AAA. It's very unusual to get any symptoms and most people with an AAA don't know they have one.
But doctors can see aneurysms using ultrasound scans. An aneurysm appears as a bulge in the wall of the blood vessel, making the blood vessel (in this case, the abdominal aorta) wider.
What happens if I have one?
If an AAA does rupture, it requires urgent surgery to repair it, but even so, it is often fatal. But the likelihood of a rupture depends on how big the aneurysm is. Bigger aneurysms are more likely to rupture than smaller ones.
If the aneurysm has made your abdominal aorta bigger than 5.5 centimetres (cm) across, most doctors say you should probably have an operation to repair it. Surgeons will open your chest and then fit a tube of nylon mesh to replace the damaged part of the blood vessel. Most people with an unruptured AAA who have this operation go on to live many years without any problems.
However, all operations have risks. Some people (about 5 in 100) die during an operation to repair an aneurysm. So doctors think that, for people with smaller aneurysms, it might be better to wait. If you have a small aneurysm (an aorta between 2.5 and 5.5 cm across) your doctor might suggest you have a regular ultrasound scan to make sure it's not getting bigger. If it does get bigger, you might need surgery. Surgery for an unruptured abdominal aortic aneurysm is far safer than emergency surgery for a ruptured one.
Who can have an ultrasound scan?
At the moment, doctors only do ultrasound scans to look for abdominal aortic aneurysms (AAAs) if you've had symptoms that they think might mean a leaking aneurysm. But most men only find out they have one if they've had a scan for another reason, for example to look at the heart or lungs.
The government is now planning to set up a screening programme for all men aged 65 to have an ultrasound scan to check for AAAs. It will start testing the system this year. By 2013, the government says that all men across the country should be offered a screening test at the age of 65. They plan to set up 60 centres around the country to run the screening programme.
The government hasn't said whether men older or younger than 65 will be able to have screening if they ask for it, or whether people will need to be screened more than once. Previous studies have shown that, for people with no sign of an AAA, one scan at 65 is enough to rule out the chance of getting one after this age. But if you have a small aneurysm, more scans are needed to check it isn't getting bigger.
What does this mean for me?
If you are a man approaching 65, you might be invited for AAA screening over the next few years. You'll need to decide whether or not to take up the offer. Here are some things to consider.
- Finding an aneurysm early by having a scan might mean you can have it repaired, and avoid having a dangerous rupture.
- Surgery is not always successful. Some people die during or soon after the operation.
- But a scan that picks up an aneurysm can also tell doctors about the chance of it rupturing. In people whose aneurysms are most likely to rupture, the risk of surgery is outweighed by the risk of a rupture.
- If you have an aneurysm that is not suitable for surgery, you'll have to live with the knowledge that you have one. This could be stressful.
Overall, studies of AAA screening for men show that it can reduce the number of deaths from ruptured AAAs. The government estimates the programme could save 700 lives a year.
From:
Department of Health. Statement by Secretary of State for Health Alan Johnson. January 2008.
Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. In: The Cochrane Library, Issue 2, 2007. Wiley, Chichester, UK.
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© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
