Table 1.
Clinical benefits and harms of AAA screening in 1 million women from screening age until age 95 years
|
Reference case* |
Best alternative strategy† |
||||||
|---|---|---|---|---|---|---|---|
| Not invited to screening | Invited to screening | Difference (% of that in non-invited group) | Not invited to screening | Invited to screening | Difference (% of that in non-invited group) | ||
| Diagnosis and treatment | |||||||
| AAA detected | 9529 | 11 697 | 2168 (23%) | 13 835 | 22 924 | 9089 (66%) | |
| Screen detected | 0 | 3101 | .. | 0 | 12 309 | .. | |
| Incidentally detected | 9529 | 8596 | .. | 13 835 | 10 615 | .. | |
| Elective AAA repair | 2165 | 2618 | 452 (21%) | 2375 | 3676 | 1301 (55%) | |
| Elective AAA repair contraindicated | 1173 | 1398 | 225 (19%) | 1261 | 1956 | 695 (55%) | |
| AAA rupture | 9235 | 8839 | −396 (−4%) | 7465 | 6555 | −910 (−12%) | |
| Emergency AAA repair | 2336 | 2239 | −97 (−4%) | 1869 | 1636 | −233 (−13%) | |
| AAA-related deaths | 8388 | 8131 | −257 (−3%) | 6886 | 6321 | −566 (−8%) | |
| Elective surgery or long-term complications of elective repair | 308 | 393 | 85 (28%) | 324 | 547 | 223 (69%) | |
| Rupture or long-term complications of emergency repair | 8080 | 7738 | −342 (−4%) | 6562 | 5774 | −789 (−12%) | |
| Non AAA-related deaths | 855 079 | 855 285 | 186 (<1%) | 849 789 | 850 220 | 431 (<1%) | |
| Re-intervention after elective repair | 505 | 619 | 114 (23%) | 543 | 913 | 370 (68%) | |
| Re-intervention after emergency repair | 322 | 302 | −20 (−6%) | 234 | 193 | −41 (−18%) | |
| Surveillance measurements | 13 773 | 16 367 | 2594 (19%) | 17 995 | 26 648 | 8653 (48%) | |
| Overdiagnosis and overtreatment | |||||||
| Overdiagnosis of AAA‡ | .. | 1036/3101 (33%) | .. | .. | 6732/12 308 (55%) | .. | |
| Overtreatment of AAA§ | .. | 94/752 (13%) | .. | .. | 494/2077 (24%) | .. | |
AAA=abdominal aortic aneurysm.
*
Invitation to screening at age 65 years, diagnosis threshold 3·0 cm, intervention threshold 5·5 cm.
†
Invitation to screening at age 70 years, diagnosis threshold 2·5 cm, intervention threshold 5·0 cm.
‡
Screen-detected AAAs in which the disease would not have otherwise become evident (incidentally detected) or caused any problems (AAA rupture) within the woman's lifetime.
§
Elective AAA repair arising from screen-detection of AAA that in the absence of screening would not have resulted in AAA death or surgery.