Despite the diagnostic and therapeutic developments of the past decades, subarachnoid hemorrhage (SAH) is fatal in approximately 50% of cases and causes significant disability in about 30% of the survivors. In Japan, the annual mortality rate from SAH is estimated to be 22.5 per 100 000 person-years. Rupture in intracranial aneurysm (IA) accounts for more than 90% of SAH cases. Genetic factors, female gender and lifestyle are associated with IA. IA is estimated to be prevalent in as many as 2% of the general Japanese population. Because IA is preventable and treatable, a strategy for its prevention has long been expected.

There are two traditional strategies used for the prevention of diseases: population strategy and high-risk strategy. For IA, it is well established that smoking and hypertension are the major risk factors. These factors have been considered as intervention tools for the population strategy. From the viewpoint of a cost–benefit balance, a focus on risks attributable to large populations and the contraindicated ratios of those risk factors can provide a practical approach. However, a more immediate preventive strategy has been anticipated. Under Japanese law, SAH is considered to be a work-related disease and workers who have SAH attack during working hours have often claimed workers’ compensation. Thus, in the workplace, both population and high-risk strategies are desirable.1 A difficult question to address is whether magnetic resonance angiography (MRA) should be used for screening for IA. MRA is expensive and is not usually recommended as a tool for screening general populations. However, if a genetic marker for IA is available, MRA screening may be used for persons identified as high risk.

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