Benefits and harms of screening men for abdominal aortic aneurysm in Sweden: a registry-based cohort study.

BACKGROUND: Large reductions in the incidence of abdominal aortic aneurysm (AAA) and AAA-related mortality mean that results from randomised trials of screening for the disorder might be out-dated. The aim of this study was to estimate the effect of AAA screening in Sweden on disease-specific mortality, incidence, and surgery. METHODS: Individual data on the incidence of AAA, AAA mortality, and surgery for AAA in a cohort of men aged 65 years who were invited to screening between 2006 and 2009, were compared with data from an age-matched contemporaneous cohort of men who were not invited for AAA screening. We also analysed national data for all men aged 40-99 years between Jan 1, 1987, and Dec 31, 2015, to explore background trends. Adjustment for confounding was done by weighting the analyses with a propensity score obtained from a logistic regression model on cohort year, marital status, educational level, income, and whether the patient already had an AAA diagnosis at baseline. Adjustment for differential attrition was also done by weighting the analyses with the inverse probability of still being in the cohort 6 years after screening. Generalised estimating equations were used to adjust the variance for repeated measurement and in response to the weighting. FINDINGS: AAA mortality in Swedish men has decreased from 36 to ten deaths per 100 000 men aged 65-74 years between the early 2000s and 2015. Mortality decreased at similar rates in all Swedish counties, irrespective of whether AAA screening was offered. After 6 years with screening, we found a non-significant reduction in AAA mortality associated with screening (adjusted odds ratio [aOR] 0·76, 95% CI 0·38-1·51), which means that two men (95% CI -3 to 7) avoid death from AAA for every 10 000 men offered screening. Screening was associated with increased odds of AAA diagnosis (aOR 1·52, 95% CI 1·16-1·99; p=0·002) and an increased risk of elective surgery (aOR 1·59, 95% CI 1·20-2·10; p=0·001), such that for every 10 000 men offered screening, 49 men (95% CI 25-73) were likely to be overdiagnosed, 19 of whom (95% CI 1-37) had avoidable surgery that increased their risk of mortality and morbidity. INTERPRETATION: AAA screening in Sweden did not contribute substantially to the large observed reductions in AAA mortality. The reductions were mostly caused by other factors, probably reduced smoking. The small benefit and substantially less favourable benefit-to-harm balance call the continued justification of the intervention into question. FUNDING: Research Unit and Section for General Practice, FoUU-centrum Fyrbodal, Sweden, and the region of Västra Götaland, Sweden.

Costs in primary care of investigating symptoms suspicious of cancer in a defined population.

OBJECTIVES: To calculate total cost of investigating symptoms related to one of the four most common cancers: prostate, breast, colorectal, and pulmonary. Special attention was given to two non-specific and common symptoms: vertigo/dizziness and tiredness/fatigue. DESIGN: Retrospective examination of patient records in a defined population. SETTING: Primary health care (PHC) and hospital care. MAIN OUTCOME MEASURES: Investigation costs of selected ICD codes. RESULTS: In total 6812 patients with 14,541 ICD codes were investigated to a total cost per registered ICD code, with one of the selected diagnostic measures, of SEK 800. Some 50% of the costs were due to X-ray examinations of which colonic X-ray was the most expensive single procedure. Symptoms related to colorectal cancer were the most expensive to investigate with vertigo/dizziness and tiredness/fatigue examined separately. Tiredness/fatigue symptoms cost SEK 395 and vertigo/dizziness SEK 197 per registered code to investigate and none of them yielded a detected malignancy. The incidence of cancer was 0.7%. The average cost of diagnosing one malignancy was SEK 236,700, if all diagnostic activities could be justified only for detection of malignancies. CONCLUSION: A high cost of diagnosing malignancy can be expected and justified, but many symptoms presented in PHC, such as tiredness/fatigue and vertigo/dizziness, have a relatively high investigation cost but detected no case of cancer in this study.

Symptom panorama in upper secondary school students and symptoms related to iron deficiency. Screening with laboratory tests, questionnaire and interventional treatment with iron.

OBJECTIVE: To study symptom panorama in students, to identify undiagnosed iron deficiency, and to evaluate any changes in symptoms and laboratory test results after treatment with iron supplementation. DESIGN: Descriptive and prospective, interventional study. SETTING: Healthcare in upper secondary school. INTERVENTION: Treatment with iron supplementation for a period of 3 months. SUBJECTS: Students in the first grade of one upper secondary school. MAIN OUTCOME MEASURES: Frequency of iron deficiency related to symptoms measured by a questionnaire (30 questions) on symptoms related to quality of life and 9 questions about diet and exercise. RESULTS: Iron deficiency was diagnosed in 12% of the students (two or more abnormal laboratory tests) and in 61% of the students one or more laboratory tests were abnormal. Symptoms of vertigo/ dizziness were significantly more common in students with iron deficiency. After iron supplementation there was a significant increase in s-ferritin levels and a decrease in s-transferrin levels, with an accompanying significant reduction of the symptom scores of vertigo/dizziness, irritability, depressive symptoms, and indisposition. CONCLUSIONS: Symptoms of vertigo/dizziness were significantly more common in students with iron deficiency. Iron supplementation reduced the symptoms of vertigo/dizziness, irritability, depressive symptoms, and indisposition.