Search Annals: Advanced search

Rapid Responses to:

Articles: Lois G. Kim, R. Alan P. Scott, Hilary A. Ashton, Simon G. Thompson for the Multicentre Aneurysm Screening Study Group A Sustained Mortality Benefit from Screening for Abdominal Aortic Aneurysm Ann Intern Med 2007; 146: 699-706 [Abstract] [Full text] [PDF]

Send comment/rapid response letter

Electronic letters published:

Mortality and aneusysm screening

Thomas E. Finucane   (5 June 2007)

Mortality Benefit from Screening for Abdominal Aortic Aneurysm

Hisato Takagi, Norikazu Kawai, MD, Takuya Umemoto, MD, PhD   (18 May 2007)

Mortality and aneusysm screening 5 June 2007
Thomas E. Finucane, M.D. Johns Hopkins Bayview Medical Center Send rapid response to journal: Re: Mortality and aneusysm screening tfinucan{at}jhmi.edu Thomas E. Finucane	The Editors'summary of the article on abdominal aortic aneurysm screening by Kim and colleagues is dangerously misleading. It says, in part, "The 7-year follow-up report of a large randomized trial in the United Kingdom found that men age 65 to 74 years who were invited to have ultrasonography and surveillance for AAA had lower mortality rates than did those who were not invited (hazard ration, 0.053 [CI, 0.42 to 0.68])." The actual mortality rate in the two groups was not different by conventional significance testing (hazard ratio, 0.96 [CI, 0.93 to 1.00], even though the invited group had fewer deaths from other cardiovascular causes, fewer deaths from cancer, and fewer deaths from all other causes. (The Editors are referring to the AAA-related mortality.) Conflict of Interest: None declared
Mortality Benefit from Screening for Abdominal Aortic Aneurysm 18 May 2007
Hisato Takagi, MD, PhD Shizuoka Medical Center, Norikazu Kawai, MD, Takuya Umemoto, MD, PhD Send rapid response to journal: Re: Mortality Benefit from Screening for Abdominal Aortic Aneurysm kfgth973{at}ybb.ne.jp Hisato Takagi, et al.	The Multicentre Aneurysm Screening Study (MASS) (1), a randomized controlled trial (RCT) of abdominal aortic aneurysm (AAA) screening in men, provided that the hazard ratios were 0.53 (95% CI, 0.42 to 0.68) for AAA- related mortality and 0.96 (CI, 0.93 to 1.00) for all-cause death in the group invited for screening at a mean 7.1-year follow-up. Our previous meta-analysis (2) of then available 4 RCTs of AAA screening in men (the Viborg Country trial [median follow-up, 9.6 years], the Western Australia trial [median, 3.6 years], the MASS [mean, 4.1 years] (3), and the Chichester trial [men] [mean for AAA-related mortality, 10 years; mean for all-cause mortality, 2.5 years]) demonstrated that an invitation to attend AAA screening reduced not all-cause (odds ratio [OR], 0.95; CI, 0.87 to 1.03) but AAA-related mortality (OR, 0.55; CI 0.37 to 0.83). According to a Cochrane review by Cosford and Leng (4) of 3 RCTs of AAA screening in men (the Western Australia trial [3.6 years], the MASS [4.1 years] (3), and the Chichester trial [men] [2.5 years]), there was a significant decrease in mortality from AAA in the screened group (OR, 0.60; CI, 0.47 to 0.78) but no significant difference in all-cause mortality between screened and unscreened groups (OR, 0.95; CI, 0.85 to 1.07). Herein, we performed a meta-analysis of currently available RCTs of AAA screening in men including the 7.1-year follow-up MASS (1). Our comprehensive search identified 4 RCTs: the Viborg Country trial (9.6 years), the Western Australia trial (3.6 years), the MASS (7.1 years) (1), and the Chichester trial (men) (10 years for AAA-related mortality; 2.5 years for all- cause mortality). Although the pooled OR using a random-effects model showed a significant reduction in AAA-related mortality favoring screening (OR, 0.54; CI, 0.37 to 0.79), an invitation to attend screening was not associated with a significant reduction in all-cause mortality (OR, 0.94; CI, 0.88 to 1.02). There was significant between-study heterogeneity of results analyzed by means of standard ƒÔ2 tests (P = 0.047 for AAA-related mortality, P = 0.002 for all-cause mortality) but no evidence of significant publication bias assessed using an adjusted rank-correlation test. Despite the results of the 7.1-year follow-up MASS (1), the present meta- analysis of all the currently available RCTs failed to show the all-cause mortality benefit of screening for AAA in men. 1. Kim LG, P Scott RA, Ashton HA, Thompson SG; Multicentre Aneurysm Screening Study Group. A sustained mortality benefit from screening for abdominal aortic aneurysm. Ann Intern Med. 2007;146:699-706. [PMID: 17502630] 2. Takagi H, Tanabashi T, Kawai N, Kato T, Umemoto T. Abdominal aortic aneurysm screening reduces mortality: meta-analyses of randomized, controlled trials. Eur J Vasc Endovasc Surg. 2007;33:132-3. [PMID: 17067830] 3. Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RA, et al. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002;360:1531-9. [PMID: 12443589] 4. Cosford P, Leng G. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev. 2007;(2):CD002945. [PMID: 17443519] Conflict of Interest: None declared