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Objective to describe the potential psychological consequences of screening for abdominal aortic aneurysms (AAAs). Methods the participants were prospectively and randomly sampled from a randomised screening trial for AAA and asked to complete a validated generic and global anonymous quality of life (QL) questionnaire by self-assessment (ScreenQL). Material case–control study: ScreenQL was completed once by 168 (48%) of 350 non-responders to screening, 271 (81%) of 335 attenders before screening, 286 (85%) of 335 attenders after screening, 127 (85%) of 149 with a small AAA diagnosed at screening, and 231 (66%) of 350 who were randomised not to be offered screening for AAA (controls). Prospective study (paired data): 127 men having a small AAA diagnosed. Twenty-nine (81%) of 36 men operated after initial conservative treatment. Results initially, the QL score was 5% lower among men with a small AAA compared to the controls (p<0.05), mainly because of poorer health perception. The QL score declined significantly further to 7% below control values during the period of conservative treatment. This impairment was mainly due to a 21% and 15% reduction in scores relating to health perception and psychosomatic distress, respectively. However, all scores improved to control levels in patients operated on. The QL of attending men for screening was significantly lower than that of the controls and the attenders after the screening. No differences were noticed concerning the non-attenders. Conclusion the offer of screening causes transient psychological stress in subjects found not to have AAA. However, diagnosis of an AAA seems to impair QL permanently and progressively in conservatively treated cases. This impairment seems reversible by operation. Nevertheless, the impairment seems considerable, and must be considered in the management of AAA and in the final evaluation of screening for AAA. Copyright 2000 Harcourt Publishers Ltd

BackgroundAbdominal aortic aneurysm (AAA) is known to be associated with various diseases, especially hypertension, acute myocardial infarction (AMI), chronic obstructive airway disease (COAD), and intermittent claudication. These associations have led to a debate about whether screening of older men for AAA should be restricted to those with an associated disease.MethodsTo compare mass screening of men for AAA with screening of men with AAA-associated diseases, all previous computerized hospital-recorded AAA-associated diseases were merged with the results of mass screening of 4404 men aged 65–73 years.ResultsOf hypertensives, 82.6 per cent attended screening, of whom 17.8 per cent had AAA. For previous AMI the equivalent values were 82.3 and 9.3 per cent; for COAD 74.3 and 7.7 per cent; for angina pectoris 83.8 and 7–5 per cent; for lower limb arteriosclerosis 81.1 and 6.1 per cent; and for stroke or transient cerebral ischaemia 75.0 and 6.2 per cent. Screening of these six high-risk groups alone would have required 78.5 per cent fewer scans and 51.1 per cent of the AAAs diagnosed at mass screening would have been recognized. The attendance rate would have been 80.4 per cent, of whom 9.5 per cent would have had an aneurysm. The attendance rate among non-high-risk men was 74.7 per cent and 2.7 per cent had an aneurysm.ConclusionIf screening for AAA is desirable, the authors recommend mass rather than high-risk screening.