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Abdominal Aortic Aneurysm in Canada: The Importance of Screening and Future Perspectives

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Ethan Sulliva
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Abdominal Aortic Aneurysm in Canada: The Importance of Screening and Future Perspectives

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Abdominal Aortic Aneurysm: A Hidden Threat in Canada

Abdominal aortic aneurysm (AAA) is a silent, potentially life-threatening condition that affects roughly 20,000 Canadians each year. The prevalence of AAA is six times higher in males aged 65-80 compared to females of the same age. Despite the high incidence rate, the exact prevalence of AAA in Canada remains unknown, primarily due to the absence of systematic and nationwide screening programs.

Recognizing the Risks

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AAA is associated with numerous risk factors including smoking, family history of AAA, coronary artery disease, atherosclerosis, hypercholesterolemia, and hypertension. A rupture of an AAA is often fatal, leading to high mortality rates. Timely detection is therefore crucial for prophylactic repair to prevent such catastrophic outcomes.

The Power of Screening

Screening with ultrasonography has proven to be a powerful tool in the fight against AAA. Studies have shown a 42% reduction in AAA-related mortality among males aged 65-74 through timely detection and intervention. However, guidelines are inconsistent regarding screening among females.

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Current Screening Guidelines in Canada

Existing Canadian guidelines recommend one-time screening with ultrasonography for males aged 65-80. The Canadian Task Force on Preventive Health Care and the Canadian Society for Vascular Surgery endorse this approach. However, the latter also recommends screening for all males aged 65-80 years and females with a history of smoking or cardiovascular disease. Despite these recommendations, no provincial or territorial screening programs currently exist in Canada.

The Need for a Comprehensive Screening Approach

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Given the high prevalence of AAA in males aged 65-80 and the potential benefits of early detection, there is a clear need for a comprehensive screening program. The discrepancy in guidelines regarding female screening further emphasizes the need for research in this area. The lack of a nationwide screening program presents a significant missed opportunity for early detection and intervention, possibly reducing AAA-related mortality.

Economic Evaluation of AAA Screening

Although screening for AAA among people aged 65 years in Ontario was found to be associated with fewer AAA related deaths and favorable cost-effectiveness, there is a dearth of contemporary evidence on the cost-effectiveness of screening on a national scale. A model-based economic evaluation could provide much-needed insights into the value of AAA screening in Canada, potentially leading to the implementation of a nationwide screening program.

Conclusion

AAA poses a significant health risk to Canadians, particularly males aged 65-80. The implementation of a comprehensive, nationwide screening program could play a pivotal role in reducing AAA-related mortality. However, such a program must be underpinned by solid contemporary evidence on the prevalence and cost-effectiveness of AAA screening in Canada. As we strive for improved health outcomes, further research is needed to fill these gaps in knowledge and provide a roadmap for robust AAA screening in Canada.

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