New Medical Limited

About 1 in 30 women will die from breast cancer. At least 1 in 50 men will die from ruptured abdominal aortic aneurysm and this is probably an underestimate. Comparing these two numbers shows that abdominal aortic aneurysm is almost as important a cause of death in men, as breast cancer is in women. Yet, the screening test for an AAA is far more effective at picking up the condition (and also results in many fewer false alerts) than the standard screening test for breast cancer, which is called mammography. Effective screening of a population for AAA and then operating on those found to have aneurysms, can almost completely eliminate deaths from ruptures.

So, AAA is an important condition with a good, simple test and, if the condition is found, there is an effective cure in the form of an operation to repair the aneurysm. But should you have the scan? There are three questions to consider.

The first question to ask is whether you are at risk of an aortic aneurysm, because if you’re not there’s no point having the scan! Ask yourself which of these apply to you:

Male
A man is six times more likely to have an aortic aneurysm than a woman and is more likely to develop it at an earlier age.

Over 55 years old
Abdominal aortic aneurysms are very rare at ages younger than 55.

Family history of abdominal aortic aneurysm
The closer the family member with an aortic aneurysm, the greater the risk you have. A parent with an aortic aneurysm increases your risk by approximately four times. A brother increases it by 10 times and, interestingly, a sister with an aortic aneurysm increases it by an enormous 23 times, as compared to the average.

Smoker

High blood pressure

Already have heart disease, stroke or other vascular disease
Each of these will increase your risk of an aortic aneurysm by about 10-15%.

In short:

* Healthy 45 year old man with no other risk factors? Don’t bother to consider the scan.
* Healthy 70 year old woman with no other risk factors? Don’t bother to consider the scan.
* Man over 55? Definitely consider it.
* Man over 55 who smokes and has high blood pressure? Consider it very seriously.

* And so on…

Having considered whether you are at risk, the second question to ask is whether you would have anything done about it if indeed an aneurysm was detected? As aneurysms grow, they become ever more likely to rupture. A normal aorta is under 25mm in width. By the time it gets to 55mm, it has a risk of rupturing of around 5% each year, or 1 in 20. At 75mm, the risk of a rupture each year is about 25%, or 1 in 4.

Set against this risk of a rupture, which would likely lead to death, are the risks of an operation to repair the aneurysm before it ruptures. This is a major operation and, even in skilled hands, leads to a death rate of around 5%, or 1 in 20. As you can see, this is roughly the same risk as an aneurysm of 55mm rupturing in the following year (although of course the operation risk is a one-off, as compared to the risk of a rupture which keeps recurring year after year and indeed gets higher and higher as the aneurysm inevitably enlarges) . For this reason, most surgeons recommend that patients consider operation when the aneurysm gets to around 55mm. All this gives us a pretty simple conclusion for this stage:

If you do have some risk factors for an aneurysm
(just being a man over 55 years old is enough)
and
you would consider having an operation
then you should have the scan.

This leads us onto the third question: do you want to know or not? Some people would not consider having such an operation under any circumstances, no matter how big their aneurysm. Other people may have other illnesses, such as severe lung disease, which would make an operation even riskier. Since they would not have an operation to repair it, some of these people may not wish to have a scan because they would rather not know if they have an aneurysm.

Others, on the other hand, would rather know so that they can make plans and, in particular, can make a directive that in the event of their aneurysm rupturing they do not wish to have hospital treatment or an emergency operation, but would rather be kept comfortable at home.

So there you have it. The test is available, simple, effective and relatively cheap. The decision to have it may be very easy for you or very difficult. If in doubt, go and discuss it with your own GP. Alternatively, if you are that way inclined, feel free to weigh up the pros and cons on our discussion forums with other like-minded people.

At New Medical, we consider that our job is to present you with opportunity, but the choice is, and will always remain, yours.