The National Aneurysm Alliance (NAA) has welcomed the US Preventive Services Task Force Final Recommendation to recommend screening for Abdominal Aortic Aneurysms (AAA) in men between the ages of 65 and 75 who have smoked at any time in their lives. Task Force recommendations, however, fell short for other populations, including women. Although the NAA believes that existing data strongly supports screening in other sub-populations, including women with a family history of AAA, the NAA claims the Task Force's action will create an opportunity to save thousands of lives every year.
In the summer of 2004, the NAA supported the introduction of bipartisan legislation known as the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act, which would provide a Medicare benefit for a one-time ultrasound screening of individuals at high risk for AAA. The SAAAVE Act has been re-introduced in this session. Dr William Flynn, President of the American Vascular Association, said, "We now look forward to quick Congressional action on this important bipartisan initiative."
"SIR has a long commitment to AAA screening and the Task Force recommendation is an important step forward," said SIR secretary Dr Kathy Krol.
The recommendation also reflects the significance of ensuring quality standards for ultrasonography, such as the accreditation of the testing facilities and the credentialing of the technical component personnel used to perform the screening. This was welcomed by Anne Jones from the Society for Vascular Ultrasound, who claimed that in order to make the screening effective, it has to be performed in a setting with the appropriate quality standards in place. The NAA noted that the existing data also supports the screening for patients with a first-degree member family history of AAA and for other risk factors.
However, the decision to recommend testing only a narrow group of patients, men between 65 and 75 who have ever smoked, ignited a controversy similar to those surrounding other common screens. Should women, for instance, be tested for breast cancer at age 40 or 50? And what about prostate cancer exams for men: Do they catch too many growths that will never be life-threatening?
In a sense, the debate is a simple cost-benefit analysis: All tests cost money, and the medical procedures they can lead to are often expensive, dangerous and frightening. Screening for aortic aneurysms typically costs a few hundred dollars and involves an ultrasound exam similar to those used on pregnant women. When a large aneurysm is found, surgery to repair the defect can run $20,000 or more.
If this recommendation from the US Preventive Services Task Force to screen older men is widely adopted, those patients would undergo one ultrasound, and if no defect was detected they probably would not be tested again. Men with an initial test showing a slight ballooning would have annual follow-up screenings.
Dr Ned Calonge, chairman of the Preventive Services panel said, "The mission of the task force is to say we have found sufficient evidence that this is going to save lives in this group of people, so we're going to recommend it." However, there is no guarantee that the recommendation will become the policy of government or will be covered by private health plans.
The NAA is a coalition of medical professional organizations, patient advocates, individuals and medical technology manufacturers dedicated to promoting public awareness and targeted screenings for AAAs. Members of the NAA include the Society of Vascular Surgery, the American Vascular Association, the Society for Interventional Radiology, the American College of Surgeons, the Society of Vascular Ultrasound, the Society of Diagnostic Medical Sonographers, and the American Registry of Diagnostic Medical Sonographers, among others.
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