Doubts over new screening plans

AAA can be fatal, but can be repaired if detected early

Doubts are being cast about a screening programme in England for a potentially fatal blood vessel condition.

Ministers plan to roll out ultrasound scan screening for abdominal aortic aneurysm (AAA) for all men aged 65 and over with pilots starting this year.

They believe it has the potential to save 700 lives a year.

But James Johnson, of Runcorn's Halton Hospital, said surgery to prevent a rupture could be more risky than leaving the aneurysm untreated.

Abdominal aortic aneurysms, which can cause one of the body's main blood vessels to burst, is the third most common cause of death among older men, responsible for 3,000 deaths a year.

This screening is a good example of increasing preventive healthcare in the NHS Department of Health spokeswoman

The government announced the screening programme earlier this year - the first male-only programme as men are six times more likely to have an aneurysm than women.

Aneurysms are like balloons, the larger they grow the more likely they are to burst. But if detected early enough, the condition can be corrected by surgery.

The programme has already received the backing of the Vascular Society, which represents specialists in this area.

But Mr Johnson, a vascular surgeon and former leader of the doctors' trade union, the British Medical Association, said the risk of death from undergoing surgery to repair aneurysms was one in 14.

"We know that aneurysms with a diameter of less than 5.5 cm are so unlikely to burst that the mortality from operating on them is greater than the likelihood of rupture."

Timebomb

He told the British Medical Journal that people who were screened and fell into this group would then be regularly monitored and have to live with the knowledge that they have a timebomb inside them.

And he added: "Even when the aneurysm grows to more than 5.5 cm, what happens next is not always straightforward.

"Although in an otherwise healthy patient the risk of rupture is greater than that of surgery, aneurysm patients are seldom otherwise healthy."

He said they could have a history of high blood pressure, heart attacks and strokes which could prevent them having repair surgery.

"I am not saying screening should not happen, I just think we should look into it more carefully."

But another doctor, Stephen Brearley, from Whipps Cross Hospital in London, said it had the potential to save lives and met screening guidelines.

And a Department of Health spokeswoman added the move was supported by a "substantial body of evidence".

"We estimate that the programme could save 700 lives a year within 10 years of the start of the programme.

"This screening is a good example of increasing preventive healthcare in the NHS."

Jonothan Earnshaw, honorary secretary of the Vascular Surgical Society supported screening, saying: "While the issue of patient anxiety is one which must be carefully addressed, this must not be at cost of the 2,000 men who are dying premature and painful deaths every year due to a ruptured aneurysm.

"These deaths can, and will, be avoided due to the implementation of this simple and cost effective national screening programme."