Simple Ultrasound Could Save Many Seniors' Lives - Canadian Vascular Surgeons Call for National Screening Program



    OTTAWA, Sept. 8 /CNW Telbec/ - The Canadian Society for Vascular Surgery
today is calling for a national screening program for abdominal aortic
aneurysm screening. There is strong and growing evidence indicating that
identifying abdominal aneurysms before they rupture is effective in cutting
the death rate in half for those at risk.
    Five per cent of men and under one per cent of women over the age of 65
have an abdominal aortic aneurysm (AAA). The Society's research reveals that
ultrasound screening for AAA among men aged 65 to 75 could be as cost
effective as saving a life by mammography. The cost of a limited abdominal
ultrasound scan to screen for aortic aneurysm in Ontario, under the Ontario
Health Insurance Plan, is less that $55.
    "Canada's aging population will increase the number of individuals at
risk for AAAs and if you have one, there is a good chance that it will
rupture." says Dr. Thomas Lindsay, FRCSC, a vascular surgeon with Toronto's
University Health Network and national spokesperson for the Canadian Society
for Vascular Surgery. He stresses that, "Canada's time has come for a national
screening program."
    The Canadian Society for Vascular Surgery is calling on all national,
provincial and territorial health ministries to develop screening programs for
AAA to prevent unnecessary deaths. In the USA screening is available to all
senior citizens as part of their Welcome to Medicare examination. The UK
government decided on a screening program in January 2008 and is now planning
their implementation.
    Seniors are encouraged to talk to their doctors about booking an
ultrasound now. Early detection and treatment of an abdominal aortic aneurysm
can avoid a life-threatening risk of rupture. All men between the ages of 65
and 75 and those under 65 with a family history should be screened. Women over
65 who are at high risk because of a smoking history and a family history
should also be screened.

    The Canadian Society for Vascular Surgery is dedicated to excellence in
the promotion of vascular health for Canadians through education, research,
collaboration and advocacy. The Society provides a forum for continuing
medical education for vascular surgeons and others interested in the
investigation and treatment of patients with vascular disease.

    
                   Abdominal Aortic Aneurysm Backgrounder

    Abdominal Aortic Aneurysms

    An abdominal aortic aneurysm (AAA) is a pathological increase in size of
the main blood vessel in the abdomen. The normal aortic size is approximately
2 cm in men and a bit smaller in women. As the aorta increases in size, the
risk of rupture increases. The condition is frequently silent and rupture can
be the first symptom. Elective repair is available across Canada with
significantly better outcomes when compared to those treated for aortic
rupture.
    Abdominal aortic aneurysms (AAAs) are common and can be deadly if they are
not treated. When aortic rupture occurs the majority do not survive.

    Who is at Risk

    Five per cent of men and under one per cent of women over the age of 65
have an abdominal aortic aneurysm (AAA). All men between the ages of 65 and 75
and those under 65 with a family history should be screened. Women over 65 who
are at high risk because of a smoking history and a family history should also
be screened.

    Latest in Canada

    A detailed analysis of AAA screening sponsored by the Canadian Society for
Vascular Surgery (CSVS) was published in the Journal of Vascular Surgery in
2007. A round table discussion with staff and members of CSVS took place in
March 2008 where a multi-faceted approach for disseminating information and
garnering support for a national screening program was planned. As a result of
the increasing weight of evidence combined with a cost-effective solution, the
CSVS has undertaken an awareness campaign about the need for a national
screening program.
    The Ontario Health Technology Assessment Advisory Committee conducted a
review of the utility of vascular ultrasound screening for AAA in Ontario
patients over the age of 65. In July 2006, the advisory committee recommended
screening for AAA for all men and women aged 65-74, with a history of smoking.
The advisory committee also recommended that an implementation strategy be
developed to roll out AAA screening. In Ontario there is currently no formal
screening program for AAA, although individual ultrasound screening is at the
discretion of the physician.

    Current AAA Screening Initiatives

    In June 2005, the U.S. Preventive Services Task Force recommended one-time
ultrasound screening for AAA in men aged 65 to 75 who have ever smoked. For
men who have smoked and women and men who have a positive family history
turning age 65, a one time AAA screening is offered as part of the welcome to
Medicare physical examination. This program began January 1st 2007.
    The UK government decided on a screening program in January 2008 and is
now planning its implementation. In March 2007, the UK National Screening
Committee's reconfirmed that AAA screening could be offered to men aged 65,
provided that the men invited were given clear information about the risks of
elective surgery, and that steps were taken to create networks of vascular
surgical services to allow further specialization, bigger throughput and
therefore lower risk.

    Statement on Abdominal Aortic Aneurysm Screening

    Abdominal aortic aneurysm (AAA) is a significant cause of death in Canada.
AAAs are most common in men over the age of 65. They can be reliably detected
in a cost effective manner using a simple ultrasound scan of the abdomen
limited to visualization of the abdominal aorta. While there are risk factors
that increase an individual's risk of having an AAA, population screening of
men aged 65-75 has been proven to be effective in reducing AAA mortality.
    The Canadian Society for Vascular Surgery has reviewed and published the
results of the medical evidence for screening of AAA(1). These data
demonstrated that screening men 65 to 75 will reduce aneurysm related
mortality by half and at seven year follow-up a benefit on all cause mortality
was noted.(2) Three aneurysms discovered by screening and repaired electively,
will prevent one aneurysm death. A directed AAA screening program has been
demonstrated to be cost effective. For men, the number needed to screen to
prevent one AAA mortality is similar to mammography.
    A Canadian economic analysis has demonstrated that a national screening of
men reaching age 65 is an economically viable approach.(3)
    The incidence of AAA in women is significantly less and population based
screening in all women has not been shown to reduce mortality. Selective
screening of women over the age of 65 with multiple risk factors for aneurysms
(smoking history, family history (AAA in parent or sibling), cerebrovascular
disease) was moderately supported by the evidence.

    Therefore the Canadian Society for Vascular Surgery recommends:

        1) National and provincial health ministries develop a comprehensive
           population-based ultrasound screening program for AAA detection
           and referral.
        2) All men aged age 65-75 be screened for AAA
        3) Individual selective screening for those at high risk for AAA
            a. women over age 65 at high risk secondary to smoking,
               cerebrovascular disease and family history
            b. men less than 65 with positive family history

    -------------------------------------------------------------------------
    References:
    (1) Mastracci TM, Cina CS. Screening for abdominal aortic aneurysm in
        Canada: review and position statement of the Canadian Society for
        Vascular Surgery. J Vasc Surg 2007; 45(6):1268-1276.
    (2) Kim LG, RA PS, Ashton HA, Thompson SG. A sustained mortality benefit
        from screening for abdominal aortic aneurysm. Ann Intern Med 2007;
        146(10):699-706.
    (3) Montreuil B, Brophy J. Screening for abdominal aortic aneurysms in
        men: a Canadian perspective using Monte Carlo-based estimates. Can J
        Surg 2008; 51(1):23-34.
    




For further information:

For further information: or to request an interview: Cecily Wallace, The
Royal College of Physicians and Surgeons of Canada, (613) 260-4180, Cell (613)
286-7328, CWallace@rcpsc.edu; Cristiane Doherty, Delta Media, (613) 233-9191,
Cell (613) 799-9277, cristiane@deltamedia.ca

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