'I was lucky it was Boxing Day. There was less traffic and the ambulance was able to get to the hospital more quickly'
A simple ultrasound scan just like the thousands that are given to pregnant women every year could also save thousands of lives. Jim Pollard reports on the campaign to introduce national screening for AAA.
Three little letters. AAA. What do they mean to you? Amateur Athletic Association? American Automobile Association? Or just a good spot in the front of the phone book?
In fact, those three little letters kill. Albert Einstein was one victim. In the UK, AAA kills 6,000 men every year and the numbers are rising. AAA stands for abdominal aortic aneurysm.
Aneurysms are bubbles swelling inside a blood vessel, which can kill if the bubble bursts. An abdominal aortic aneurysm strikes in the aorta, the body's main artery, as it passes through the abdomen. AAA.
The weakness can be caused by an injury or a defect present since birth but usually the culprit is fatty deposits and hardening of the arteries (arteriosclerosis). It is four times as common in men as in women and all the usual factors are in the dock: smoking, high blood pressure, being overweight and stress.
The survival rate from undiagnosed AAA is low. Just 5%. Bernard Bush is one of those rare individuals. The heavy-smoking 62 year-old businessman was struck down with a ruptured AAA on Boxing Day 2003. 'I thought I was healthy but I suddenly collapsed at home,' he says. 'You just go down, bang. My family thought I was dead. I was in hospital for weeks, I have a scar from the bottom of my stomach to the top of my chest and while in hospital I caught the superbug MRSA that affected my hip and left me with a limp.'
But it doesn't have to be like that. A recent study of men over 65 in Gloucestershire found that screening men for AAA reduced the death rate from aneurysm disease by 42% after four years of follow up. If a ruptured aneurysm is treated as an emergency, more than half the patients (1 in 2) die in most hospitals; if the aneurysm can be detected earlier and treatment is planned in advance, the death rate falls to 3% (1 in 33). Other research points to the same thing. This suggests that with screening that death rate of 6,000 could be reduced a couple of hundred.
Screening is perfectly possible because in most cases, an aneurysm grows slowly, about 2-3mm a year. It can take 10 to 15 years for it to reach a size — 5-6cm — at which surgery is necessary. When the aneurysm reaches this size, the risk of rupture is high and increases about 20% a year. AAAs can be detected at an early and usually treatable stage by a simple ultrasound scan.
The so-called Multicentre Aneurysm Screening Trial (MASS) published in the British Medical Journal in 2002 showed that although it would cost in the short-term to set-up, screening would save money in the long-term because emergency treatment is so expensive and so frequently unsuccessful.
Now Dr Howard Stoate MP, chair of the All Party Parliamentary Group on Men's Health is joining Bernard Bush and the Men's Health Forum to call for a national screening campaign for British men. The MP told malehealth: 'The studies show that a screening programme could save thousands of lives and would meet the government's criteria for establishing a scheme. I have therefore asked the Secretary of State if he will launch a screening programme for those most vulnerable — men over 60.'
'I could have just made a donation but I wanted to do something practical.'
Bernard Bush knows how lucky he was. 'My blood clotted very quickly and at the same time as the aorta ruptured so did a vein next to it which set up a kind of short circuit effect which reduced the initial impact. I was also lucky it was Boxing Day. There was less traffic and the ambulance was able to get to the hospital more quickly.'
For Bernard it was a life-changing experience. 'It makes you stop and think just how stupid we men are. The wife goes to keep-fit. We go down the pub. I used to be a workaholic but this has improved my relationship with my family. I realise now which is more important.'
He was shocked by how little information and support was available for people in his position and wanted to do something about it. 'There's support and big charities for cardiac and cancer patients but nothing cardiovascular patients, especially AAA,' he says. 'I could have just made a donation to the hospital who treated me but I wanted to do something practical.' He has set-up a patient group and website to campaign for national screening and to support survivors.
Dr Ian Banks, President of the Men's Health Forum and a GP and part-time casualty doctor who has seen AAAs points out that: 'Aneurysms kill more men than colon cancer. Bowel cancer screening is now being introduced and the same action should be taken for AAAs. Early diagnosis is crucial as is wider action to tackle the underlying causes of aneurysms, especially smoking, obesity and hypertension.'
The National Screening Committee, which has previously rejected calls for national screening for AAA, will report on the issue again in the autumn. In the meantime, Dr Stoate, the MHF and Bernard Bush are asking MPs to back Dr Stoate's Early Day Motion in the Houses of Parliament calling for screening. Has your MP signed?
Jim Pollard is editor of malehealth.
Page created on August 2nd, 2004
Page updated on December 1st, 2009