The National Health Service Abdominal Aortic Aneurysm Screening Programme in England

Background

Ruptured abdominal aortic aneurysm (AAA) is responsible for the premature death of more than 4,000 men in England and Wales every year. AAAs are usually asymptomatic before they rupture, yet they are easily detected by a simple abdominal ultrasound scan.

Methods

This paper reviews the evidence for, and implementation of, a national AAA population screening programme in England.

Results

Population screening of 65-year-old men can reassure most that they will not get an AAA, but it can also detect a small number of men with a large AAA at immediate risk of rupture, and a larger number of men with a small or medium AAA at minimal immediate risk, but who may be offered ongoing ultrasound surveillance. Population screening of men aged 65–74 has a sound evidence base, and reduces subsequent AAA-related mortality for at least 13 years by up to 50?%. Some Western countries, including the UK, have adopted population screening using public funding, whereas others remain to be convinced, and continue to collate research. The epidemiology of AAA is changing quickly, with the prevalence in 65-year-old men decreasing rapidly as smoking habits change and more medical treatments are used to manage cardiovascular risk factors.

Conclusion

As evidence on the natural history of AAA continues to emerge, new and ongoing programmes will need to be responsive and adapt. The AAA screening programme of the future will evolve using emerging clinical and cost-effectiveness data.