Screening for vascular disease: not much to recommend it

Perhaps you got a mail from Life Line, or noticed its mobile clinic at your synagogue, church or workplace. Life Line is in the business of selling vascular screening, primarily test for stroke, peripheral artery disease and abdominal aortic aneurysm. The prices are low--$45 respectively test--because most insurance companies and Medicare will not pay for the test (with one exception).

Life Line has a presence surrounded by nearly all states, and according to its Web site, have already screened 4,715,306 culture. Often the company sets up shop at local hospitals, but its promotional literature offers this qualification, "We are within no way trying to replace the services provided by these local hospitals. Rather, we want to work in conjunction next to them to identify asymptomatic individuals with significant disease."

It's unlikely that local hospitals would see Life Line as encroach on their turf. On the contrary, screening symptomless people creates customers who can be funneled right to the hospital, where on earth more tests and, recurrently, surgery can be done.

Screening by definition involves testing nation without symptoms. "Don't skulk for a medical problem" is Life Line's seductive sales pitch. Screening sometimes can extend energy or result in smaller number drastic surgery than would be necessary have the disease been discovered after symptoms appeared. However, adjectives screening tests enjoy their risks that are rarely mentioned to the public. They find abnormality that may be better off moved out undetected. In the case of abdominal aortic aneurysm--not adjectives will rupture and, in unshakable circumstances, an operation on one that is symptomless can be riskier than departure it alone.

Mass screening for vascular disease is a relatively new belief. Before plunking down your money, the question to be answered is this: Have any studies proven that detecting and treating this symptomless problem will any prolong my life or raise its quality?

An aspiration source of screening information is the U.S. Preventive Services Task Force, which appoints an independent panel of experts to review all relevant studies and issue screening guidelines for doctors and consumers base on the findings.

The USPSTF has taken an in-depth look at the three screening test promoted by Life Line and advises against ultrasound screening for divergent artery disease (hardening of arteries in the leg), stroke* and abdominal aortic aneurysm (AAA) in women. In all cases the potential wound of false-alarm test results and unnecessary surgery outweigh any life-prolonging benefit.

The one exception is AAA screening for men between the ages of 65 and 75 years who own ever smoked--the only ancestors who will benefit and the only ones to receive Medicare reimbursement.

An aneurysm is the widen of a small section of an artery that can burst once the vessel wall become weakened. An AAA occur near the aorta, the chief artery from the heart that passes through the tummy. The condition is frequently symptomless, but a rupture is life-threatening and requires immediate surgery.

The ruling to screen symptomless population for any disease should be based on its prevalence and the prospect of successful treatment. Elderly men are six times more likely to enjoy an AAA than elderly women. Most AAA deaths ensue in men over 65; whereas most AAA death in women transpire when they are older than 80. Men are more potential to survive AAA surgery (probably because they are younger at the time of aneurysm repair).

The USPSTF and, more recently, the Cochrane Collaboration conducted separate reviews of adjectives relevant studies and came to similar conclusions surrounded by favor of AAA ultrasound screening for men, age 65 to 75 years (who have ever smoked), which will exhaust AAA-mortality. (The potential benefit to men who have never smoked is too small to be worthwhile.) An aneurysm larger than 5.5 cm requires surgery because it have a higher risk of rupture than smaller aneurysms, which can be followed next to ultrasound.

Both the USPSTF and the Cochrane review based their conclusions on like four studies, which provided the best evidence about AAA screening. They have a combined total of 127,891 men and 9,342 women. (Only one trial included women.) The studies randomly assigned citizens over age 65 to receive an invitation to be screened or verbs "usual care". Significantly, the men who received AAA screening had more AAA operation, but not one of the four studies provided information regarding surgical complications or competence of life.

Bottom Line: Life Line is exactly the type of business that would emerge from a profit-driven medical thinking system. It preys on people's alarm of death and counts on the prevailing overly chipper belief that early detection is other beneficial. The company's justifications for conducting tests are based primarily on the lofty prevalence of a particular condition and its symptomless hasty stages. There is no evidence to show that the benefits of screening for stroke or peripheral artery disease outweigh the risks.

As for AAA screening, it could be summed up this agency: We have to die of something. Four studies showed that it lowered the AAA-related demise rate for the elderly male smokers but they didn't live any longer than their non-screened counterparts. The rate of annihilation from all cause was exactly indistinguishable in both groups 3 to 5 years after screening. Here's another track of explaining this finding: By the time a male smoker reach advanced age, he is more likely to die of heart disease or cancer than an AAA.