By Susan L. Comer

What do Lucille Ball, Albert Einstein, Harvey Korman, George C. Scott and Conway Twitty have in common?

Despite their fame and resources, they all died of a highly treatable condition known as abdominal aortic aneurysm that, while far from rare, is in fact rarely discussed. Perhaps you've never even heard of it, let alone wondered if you should be screened for it. The National Aneurysm Alliance (NAA) is hoping to change that by boosting the profile of this silent killer through the SAAAVE Act Awareness program. The NAA consists of several medical societies and public organizations including VDF.

SAAAVE stands for Screening Abdominal Aortic Aneurysms Very Efficiently. The SAAAVE Act, which provides a one-time Medicare-reimbursed AAA screening for at-risk Medicare beneficiaries, was signed into law by President George W. Bush in 2006. What exactly is an abdominal aortic aneurysm (AAA)?

Defining the problem
An AAA is an irregular weakness and expansion or bulging of the abdominal area of the aorta, the largest blood vessel in the body. When a bulge grows to five centimeters in diameter— roughly the size of a small or medium orange—it can rupture, resulting in severe internal bleeding. Such a rupture is fatal in 75 percent of cases. The Society for Vascular Surgery (SVS) estimates that 15,000 people per year die from AAA. Indeed, the condition is present in some 200,000 individuals, many of whom are unaware of it due to the lack of symptoms. Those most at risk are men aged 60 and above who have ever smoked as well as men and women 60 and above with a family history of AAA.

However, in contrast to the high fatality rate following rupture, the condition is both treatable and curable if detected prior to rupture. The best line of defense? A simple, painless, and noninvasive ultrasound screening, a test which uses highfrequency sound waves to produce an image of the soft tissues and organs that are being scanned.

Unfortunately, due to a general lack of awareness of AAA, relatively few potential victims get screened despite the provision of Medicare-reimbursed screenings through the SAAAVE Act.

In fact, only 10,000 at-risk Medicare patients were screened for AAA through SAAAVE in 2007, the year the benefit went into effect; only 18,000 were screened in 2008, and 20,000 in 2009.

Unused benefit
One major barrier to widespread screening, says Anton Sidawy, MD, MPH, president of the Vascular Disease Foundation (VDF), is the fact that those Medicare-reimbursed AAA screenings are linked to the "Welcome to Medicare" physical exam, a one-time preventive physical exam that must be conducted within 12 months of Part B enrollment. That is, a Medicare beneficiary at risk for AAA must obtain a referral for his or her AAA screening during the "Welcome to Medicare" physical exam and must get screened during the first year of eligibility.

"The problem with that," says Dr. Sidawy, "is that most people don't actually take advantage of the 'Welcome to Medicare' exam." In addition, he says, many primary-care physicians who perform "Welcome to Medicare" physical exams remain unaware of the AAA screening benefit now available, so they do not refer patients for screening.

Screen for success
That's where the SAAAVE Act Awareness program comes in. Essentially, says Dr. Sidawy, the NAA is seeking, through additional legislation and regulations, to delink the AAA screening through SAAAVE from the "Welcome to Medicare" physical exam. The goal is to extend the onetime screening to many more at-risk Medicare beneficiaries than are currently eligible and being screened. At the same time, says Dr. Sidawy, the NAA is working to better publicize the Medicare-reimbursed screening, thereby increasing awareness among patients and referring physicians. Both familiarity with the condition and the value of early detection have become ever more crucial as the baby boomers are now reaching Medicare age and are, therefore, more susceptible to AAA.

If you are aged 60 or above, have ever smoked, or have a family history of AAA, an ultrasound screening could save your life.

And this brings us to the question of what two other prominent individuals, Sen. Bob Dole and baseball personality Bob Uecker, have in common—besides their first names, of course. Both Bobs had aneurysms that were detected early and, thus, both have lived to tell about it.