The new USPSTF recommendations concerning screening for AAA appear in this week’s Annals of Internal Medicine, and are being quoted in the press.
Bottom-line: screen men who have ever smoked, once between the ages of 65 and 75.
- Under 65: too low morbidity/mortality to make screening worthwhile
- Over 75: too high co-morbidities to make a big difference.
- Smoking status: 90% of AAA mortality found in the 70% of men who have ever smoked.
- Women: incidence of AAA in 65-75 year old group too low to make screening sufficiently beneficial.
This is all fine, but the way the conclusions are presented, it is as if, in the non-recommended groups, the harms of screening outweigh the benefits. I don’t think the data support this. The data just suggest that in these groups, screening simply isn’t cost-effective or sufficiently beneficial. The task force concludes:
“Because of the low prevalence of large AAAs in women, the number of AAA-related deaths that can be prevented by screening this population is small. There is good evidence that screening and early treatment result in important harms, including an increased number of surgeries with associated morbidity and mortality, and psychological harms. The USPSTF concluded that the harms of screening women for AAA outweigh the benefits.”
As I see it, the real point is not that the harms of screening women outweigh the benefits. The same harms that apply to women apply to male smokers. It’s rather that the number of deaths that can be prevented by screening this population is too small to recommend it. But that doesn’t quite sound good enough. When telling someone they will not be screened, it sounds much better if you say “the risks outweigh the the benefits”. Even if that’s not clearly supported by the data.
Is spin doctoring now a medical specialty?