Should I have a Life Line Stroke Screen?
In the post last week at home was an invitation from Life Line Screening to have a ‘Stroke/Carotid Artery’ screen to prevent a stroke from happening. There is a session at Wrenthorpe Methodist Church Hall in June and for the princely sum of £45 they will scan my carotid arteries.
Trying to be an evidence based doctor I looked at the UK National Screening Committees website. They have recently mailed GPs about private screening like this and Steven Laitner, a GP and Consultant in Public Health Medicine, comments on the website "There has been a notable increase in the number of patients being offered private screening tests. All screening involves a careful balancing of risks and benefits and where screening falls outside of established criteria it can pose a significant risk to health. GPs provide valuable advice and support to patients in this area and I hope that this new guidance will help them in supporting their patients to make fully informed screening decisions." But I could not find any guidance on their website apart from consult your GP ...Humph!
Another source of advice I found was the NHS Economic Evaluation Database (NHS EED) where there was a review a review of a stroke prevention screening protocol. This was a review of a study carried out in the USA and reported in 2004. They reported on screening people for three of immediate causes of stroke; carotid artery disease, atrial fibrillation and hypertension. They used ultrasound to screen for carotid artery disease – just like the Life Line Stroke Screening I was invited to. They screened what they called seniors (!!) aged over 50 (yeep – just like me) and found that screening ‘6,073 seniors could prevent 30 strokes’. The number of people needed to prevent 1 stroke was 200 and they estimated that there was a cost-saving was $64,807 per stroke prevented. Sounds good to me.
On the other hand, I found some newer guidance from the U.S. Preventive Services Task Force (USPSTF December 2007). They state ‘that although stroke is a leading cause of death and disability in the United States, a relatively small proportion of all disabling, unheralded strokes is due to carotid artery stenosis’. They looked at the benefits of screening and compared them to the risk. The risks of screening are from both testing strategies and also carotid operations. Carotid angiography which has a small risk of causing some strokes and if patients don’t have angiography a few will have a stroke from a carotid operation when in fact they do not have severe carotid narrowing. They conclude that the benefits of screening DO NOT outweigh the harms.
So what should I do?
Well I think I will follow the latest expert guidance I could find and send the invitation quickly to the bin!
As an end note though I was surprised that I could not find any UK guidance and how difficult it was to find some relevant guidelines and advice.
Trying to be an evidence based doctor I looked at the UK National Screening Committees website. They have recently mailed GPs about private screening like this and Steven Laitner, a GP and Consultant in Public Health Medicine, comments on the website "There has been a notable increase in the number of patients being offered private screening tests. All screening involves a careful balancing of risks and benefits and where screening falls outside of established criteria it can pose a significant risk to health. GPs provide valuable advice and support to patients in this area and I hope that this new guidance will help them in supporting their patients to make fully informed screening decisions." But I could not find any guidance on their website apart from consult your GP ...Humph!
Another source of advice I found was the NHS Economic Evaluation Database (NHS EED) where there was a review a review of a stroke prevention screening protocol. This was a review of a study carried out in the USA and reported in 2004. They reported on screening people for three of immediate causes of stroke; carotid artery disease, atrial fibrillation and hypertension. They used ultrasound to screen for carotid artery disease – just like the Life Line Stroke Screening I was invited to. They screened what they called seniors (!!) aged over 50 (yeep – just like me) and found that screening ‘6,073 seniors could prevent 30 strokes’. The number of people needed to prevent 1 stroke was 200 and they estimated that there was a cost-saving was $64,807 per stroke prevented. Sounds good to me.
On the other hand, I found some newer guidance from the U.S. Preventive Services Task Force (USPSTF December 2007). They state ‘that although stroke is a leading cause of death and disability in the United States, a relatively small proportion of all disabling, unheralded strokes is due to carotid artery stenosis’. They looked at the benefits of screening and compared them to the risk. The risks of screening are from both testing strategies and also carotid operations. Carotid angiography which has a small risk of causing some strokes and if patients don’t have angiography a few will have a stroke from a carotid operation when in fact they do not have severe carotid narrowing. They conclude that the benefits of screening DO NOT outweigh the harms.
So what should I do?
Well I think I will follow the latest expert guidance I could find and send the invitation quickly to the bin!
As an end note though I was surprised that I could not find any UK guidance and how difficult it was to find some relevant guidelines and advice.
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