Screening for Aortic Aneurysm

Ringo-Starr_2

Hallo all,
I read a couple of articles in the Times a week or so back about aortic aneurysms and how the government has failed to set up an NHS screening program.
I am a 67y old man and have smoked in the past so I am in the "at risk" group so I was thinking of having it done privately.
Has anyone here had screening for aortic aneurysm?
What does it involve?
How often should I have it done?
My health insurance doesn't cover it-what should I expect to pay

Ms_Chocaholic

It appears that screening for this involves an ultrasound scan. There is more info on this on the BUPA website and, although it appears they do screening, no indication of price of this is shown.

beechescomposter

Ringo Starr? Don't tell me-you live in Liverpool and you need to shop around to get a good deal!
Anyway, whether this is a wind up or not- the screening is done with ultrasound-just as in pregnant ladies. The experts recommend it is done in men aged 65-75 (some up to 79) in smokers (past or current) or at age 60 if there is a family history. There is some evidence there is overall benefit in women if there is vascular disease but the evidence is not conclusive.
For non-smokers screening may not be cost effective for a national screening program but this is not the same as saying it would not benefit an individual.
It only needs to be done once if the aorta is normal at age 65-75. If there is a large aneurysm then treatment would be recommended and there is a risk of about 2% mortality from surgury but the risk of rupture with no surgury in the larger aneurysms is 10% per year.
If there is a small aneurysm the scans are repeated every year or so but the NHS pays for this.
Aortic aneurysm screening is included in the private total body scans done with MRI or CT but this would cost around £1000+ and the other bits you pay for are of unproven benefit.
The NHS radiology department in Hereford (www.aortascan.co.uk) does aortic aneurysm screening with ultrasound for £50.
They will see folk from Liverpool too!

Ringo-Starr_2

Hi and thanks,
No I am not THE Ringo Starr but I am from Liverpool and about the same age. I think the real one lives in Surry anyway and wouldn't be short of a couple of quid.
What I can't understand is why this is not available on the NHS when I heard on the radio the other day that only around 500 women benefit from Herceptin at a cost of £100m annually while the newspaper said 7000 people (almost all men) die from aortic aneurysms annually.

DrFluffy

Because it's not a very sensitive screen. There are criteria that have to be met before a screening programme can be set up - these were set out by the WHO (Wilson and Jungner), and expanded upon: http://www.gp-training.net/training/tutorials/management/audit/screen.htm

Herceptin is a treatment... Screening is not...

mr_rush

He'd been complaining of pain for some months beforehand with the NHS doing ABSOLUTELY SWEET FA!! "There's nothing wrong with you!"
Hmmm... number of people complaining about abdominal pain vs the number of people who actually have an expanding AAA.

beechescomposter

"Because it's not a very sensitive screen"
Really DrFluffy or is this a typo error?
The studies published in the late 1980s showed upto 99% sensitivity. Ultrasound has improved since then so the sensitivity is probably not measurably short of 100%. Also the earlier studies counted a failure to visualise the aorta as a failure of detection but an aneurysm makes the aorta bigger and therefore easier to detect so the odd aorta they couldn't see was almost certainly not aneurysmal and the sensitivity, even at 99% was underestimated.
The US Preventative Services Taskforce (http://www.ahrq.gov/news/press/pr2005/tfaaapr.htm), and our own DoH have already agreed that screening is cost-effective and recommended(http://www.library.nhs.uk/screening/ViewResource.aspx?resID=60457&tabID=288&catID=5529). Male members of both the House of Commons and the House of Lords were offered ultrasound screening scans in March 2005. They just haven't got around to offering it to the public because the NHS doesn't have the infrastructure to deal with all the aneurysms that would be detected in the first few years. Luckily, like our MPs, it is possible for people to make their own arrangements for a modest cost.

DrFluffy

CT might do it, but USS is fairly poor - especially as we are becoming fatter, and US doesn't penetrate fat very well.

Also, the most recent review of the evidence places US AAA screening in the "not proven" category: http://www.jr2.ox.ac.uk/bandolier/band27/b27-3.html

Also, who would you screen, how often would you screen? At what point would you intervene? A lot of people walk around with small aneurysms not knowing about them and dying with them, not of them... Creating a whole droud of "worried well" whose life is ruled by a 'condition' that will have no impact at all on their life otherwise is a high, high price to pay - in terms of their quality of life, and I guess in increased access to healthcare for no real reason...

Sarahsaver

I have had one of these - I think;)
It was because I had a stroke caused by a blood clot at the ripe old age of 31, and was in no 'risk categories'.(not fat, non smoker) I had to swallow the scanner. I thought if it was inside you it would get a closer look therefore more accuracy and less margin of error.

Cheaper options such as not smoking and eating healthily are favourable.

Mojisola

DrFluffy wrote: »

how often would you screen? At what point would you intervene?

My Dad's aneurysm was found when he was scanned for other reasons. Because it was over a certain size he was then checked every six months. It was growing faster than they were happy with and he had to be operated on. It's a very serious operation but, without it, he would have died for certain if it had burst.

As we, his children, reach 50, we will have to have scans every two years.

beechescomposter

Oh dear DrFluffy. Doesn't the GMC say your duty as a doctor include staying up-to-date?
The review you link to was 12 years ago and would have been based on studies from a decade before. The evidence from studies on thousands of scans has accumulated over the last 15 years. The links I gave were from 2005 and 2007 and show that the evidence is now that screening by ultrasound is both beneficial and cost effective.
The evidence supports scans at 65-75 in male smokers or previous smokers. The scan is done once. People with a normal aorta are reassured. If there is a small aneurysm (26-39 mm) they have an annual scan. At 50-55 mm most aneurysms would be treated.
I don't know why you persist in ignoring the evidence that has been accepted by the health services in the USA, Canada and UK.

Sarah- it sounds like you had transoesophageal echo (TOE) to look at the heart. You should also have had a carotid ultrasound. Both use ultrasound but not to look at the abdominal aorta which is a much simpler and quicker scan.

Mojisola- the evidence on people with a family history is less strong and the recommendation is that the screening should be done at 60. However, unlike CT scanning, ultrasound is easy and harmless so a scan at 50 might be reassuring though it seems excessive to repeat it every two years if normal.