January has seen us reach a significant milestone by screening our one millionth 65-year old man as part of the NHS Abdominal Aortic Aneurysm (AAA) Screening Programme.
AAA screening detects any dangerous swelling (aneurysm) of the aorta – the main blood vessel that runs from the heart, down through the abdomen to the rest of the body.
The national implementation of AAA screening, which began in 2009, has been a major public health success story that has prevented many premature deaths.
The NHS invites all men for free screening during the year they turn 65. Women aren’t invited because they are six times less likely than men to have an AAA and current evidence suggests that the risks of inviting them for screening outweigh the benefits.
AAAs usually cause no symptoms, but if they burst they are extremely dangerous and usually fatal. Around 8 out of 10 people with a ruptured AAA either die before they reach hospital or don’t survive surgery.
Early detection is important because once identified AAAs can be monitored or treated, greatly reducing the chances of the aneurysm causing serious problems in the future.
What happens during AAA screening?
The ultrasound scan used in AAA screening is similar to that offered to pregnant women and usually lasts less than 10 minutes. At the clinic we check personal details, explain the scan and answer any questions the patient may have. The scan is very straightforward and involves the patient lying down and the scanning sensor device moved over the abdomen area. This shows a picture of the aorta on a screen and enables the aorta to be measured. Men are told their result straight away and a copy is also sent to their GP.
What are the possible results?
If the abdominal aorta is not enlarged (less than 3cm) the man doesn’t ever need to be tested again. A small to medium aneurysm (between 3cm and 5.4cm) means the man needs regularly monitoring to check its growth.
If a man is found to have a large aneurysm (5.5cm or bigger) then he is referred to a specialist within two weeks who will advise on whether they would benefit from treatment to reduce the risk of it bursting.
How reliable is the scan?
The scan used to find aneurysms is very reliable. No screening test can be completely effective but it is very rare for a man who has had a normal result to develop a large aneurysm. Sometimes the scan doesn’t show the aorta clearly enough and the patient will be asked to come back for another scan, usually on a different day.
Are there risks involved?
AAA screening does have potential risks as well as benefits. Around 54 out of every 10,000 men screened will eventually have surgery to repair an aneurysm and one of these 54 men will not survive the operation.
How do men make their mind up whether to attend or not?
We have a duty to provide information in a way that enables people to make informed choices about screening. This blog explains more about what we mean by an informed choice.
We send an information leaflet out with every AAA screening invitation to men aged 65-year-old. We have also produced an online decision aid for men who need more help before reaching a decision.
Where do we go from here?
Since 2009, we have detected more than 11,000 aneurysms that need monitoring or treatment.
It’s an amazing milestone and I’d like to thank all colleagues involved in the programme for their hard work in screening one million men in six years – it’s a great achievement we should feel proud to have contributed to, in particular the lives saved!
If you have any ideas about how we can better support the public and health professionals to understand AAA screening and the choices that are available, please do let us know.