Three simple tests that can potentially save thousands of lives from strokes, aneurysms or other arterial problems are getting a big endorsement today.
This story reports on a recent recommendation about vascular screening by the Society for Vascular Surgery. These are tests to screen completely asymptomatic people with some cardiovascular risk factors in order to detect vascular disease. While the surgeons offer interventions for these conditions, the jury is out on the various cut-offs for where and in whom surgical intervention is of proven benefit, but the story is not clear on this issue. The story failed to adequately explain the risks and benefits of such screening, or the risks associated with the surgical intervention that might follow.
The story also never mentioned that the vascular surgeons' screening recommendations are not in agreement with those published by the United States Preventive Services Task Force at http://www.ahrq.gov/clinic/cps3dix.htm.
The story failed to provide background about the evidence supporting the screening recommendations being made. It failed to provide comment from an independent source. And the information provided on the single scientific study mentioned misrepresented the published results of that study. (The story said the study involved only individuals 75 and older but only 21% of the patients were 75 or older and whether the difference in strokes was different between the treatment groups in this age group was described as "still uncertain".)
The story provided a price range (free to $1000) for the trio of tests mentioned.
The story confuses the potential benefit of treatment for advanced vascular disease with the potential benefit of screening for these conditions. The story says "Three simple tests that can potentially save thousands of lives from strokes, aneurysms or other arterial problems….", but failed to explain the basis of this claim.
There was no mention of potential harms of screening or of possible subsequent treatment.
It is important to consider the rate of false-positive results, which are times when the test indicates there is a problem but there actually isn't any. For patients without symptoms, with good medical care, the annual risk of stroke is 2%. However with surgery, there is a 3% risk of stroke when very experienced surgeons perform the procedure; operative complications have been estimated to be 1 or 2% higher in the hands of less skilled surgeons (Lancet (2004)363:1486). What this means to a patient is that there is a temporary increased risk of stroke for those that opt for the procedure.
Further, many of the screening tests are frequently inconclusive and a second, more invasive test, such as angiography, will be required as follow-up.
The presentation of evidence in this story was problematic. The Society for Vascular Surgery has endorsed the use of three tests to screen for vascular disease, in individuals who are at risk for these conditions. But the story doesn't tell us the precise data on which the recommendations are based. Were there multiple studies contributing to the body of knowledge about the value of these three tests? (While the story goes into laudable detail about the evidence supporting one of the recommendations of the surgeon's group, the specifics about the study were incorrectly reported. The story said the study involved only individuals 75 and older but only 21% of the patients were 75 or older and whether the difference in strokes was different between the treatment groups in this age group was described as "still uncertain".)
The story could also have mentioned how this group's recommendations differ from those of the United States Preventive Services Task Force (USPSTF). This group recommends aortic aneurymsm screening only for men between the ages of 65-75 who have smoked. They also recommend against routine screening for peripheral artery disease screening, which would be the "ankle-brachial" test mentioned in the story. USPSTF is currently revising its recommendations about the carotid artery screen.
The story included information provided by the chief of vascular surgery at the University of Maryland where the carotid artery screening program found 13% of apparently healthy people over the age of 65 were found to have significant blockages of these vessels. Presentation of this information in this context does not appear to be disease mongering.
The only two sources quoted are both vascular surgeons, represented by the professional group that published the new screening recommendations. It would have been easy and important for the story to include the perspectives of some who do not share this enthusiasm for screening.
The story did not do an adequate job of explaining the risks and benefits of screening and so it was not possible to discern from this piece the risk and benefits associated with not being screened – which is the obvious alternative.
The story stated that getting "accurate tests at a reasonable price can be a complex endeavor," provided a website where an individual could find information about screening programs, and provided the name of a commercial organization that does screening.
While the story did mention that there was variations in results among various laboratories, it did not provide insight on how to assess the quality of the screening examinations available through various organizations.
The story didn't explain how new these tests were, but one can infer from the story that they have been in use for some time. The story also didn't establish the real novelty of the story line: that this group of vascular surgeons has published recommendations that run counter to those of the U.S. Preventive Services Task Force.
There is no evidence that the story relied solely or largely on a news release.