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Estimating overdiagnosis in screening for abdominal aortic aneurysm: could a change in smoking habits and lowered aortic diameter tip the balance of screening towards harm?
Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research Unit and Section for General Practice, FoUU-centrum Fyrbodal, Vänersborg, Sweden.
Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research Unit and Section for General Practice, FoUU-centrum Fyrbodal, Vänersborg, Sweden.ORCID iD: 0000-0002-5313-2598
Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
2015 (English)In: BMJ-BRITISH MEDICAL JOURNAL, E-ISSN 1756-1833, Vol. 350, article id h825Article in journal, Editorial material (Refereed) Published
Abstract [en]

Clinical context—Abdominal aortic aneurysms (AAAs) are often asymptomatic until they rupture, when the death rate is greater than 80%. If diagnosed before rupture, AAA can be treated with surgery, which has a mortality of 4-5% Diagnostic change— Sweden, the UK, and the US have initiated screening programmes for AAA. There are also proposals to change the aortic diameter for diagnosis from ≥30 mm to 25 mm Rationale for change—Early diagnosis by screening allows the opportunity of surgery to prevent ruptures Leap of faith—Detecting asymptomatic aneurysms will reduce AAA mortality and morbidity Impact on prevalence—Our estimates indicate that screening almost doubles AAA prevalence, but most AAAs are small and at low risk of rupture. Changing the definition of an AAA from 30 mm to 25 mm would double prevalence again Evidence of overdiagnosis—We estimate that if 10 000 men are invited to screening, 46 AAA deaths can be prevented over 13-15 years but 176 would have an AAA ≥30 mm detected that remained asymptomatic after 13 years. A recent drop in AAA prevalence reduces the benefits of screening and worsens the benefit:harm ratio Harms of overdiagnosis—Asymptomatic men are labelled at risk of a life threatening condition for which they will be under lifelong surveillance. Of 10 000 men invited to AAA screening, 37 (95% confidence interval 15 to 60) overdiagnosed men had unnecessary preventive surgery, of whom 1.6 (1.4 to 1.7) died Limitations—Figures for exact calculations of overdiagnosis are not available and unlikely to emerge. The psychosocial consequences of living with a screen detected AAA are inadequately investigated. Cost effectiveness data on screening are inconclusive Conclusion— Screening programmes have changed the meaning of an AAA diagnosis from a life threatening condition to a risk factor. AAA screening programmes should be revisited because of reduced benefits in modern populations and because data suggest considerable harm

Place, publisher, year, edition, pages
B M J Group , 2015. Vol. 350, article id h825
Keywords [en]
Screening, abdominal aortic aneurysm, health economy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-71804DOI: 10.1136/bmj.h825ISI: 000350301600003PubMedID: 25736421Scopus ID: 2-s2.0-84925778555OAI: oai:DiVA.org:oru-71804DiVA, id: diva2:1282184
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-04-17Bibliographically approved

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