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USPSTF urges abdominal aortic aneurysm screening for older male smokers
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Men aged 65 to 75 years who have ever smoked should receive a one-time screening for abdominal aortic aneurysm with ultrasonography, according to a recommendation from the United States Preventive Services Task Force.
Men in this age group who have never smoked should be screened on a case-by-case basis, according to the USPSTF recommendation. “Patients and clinicians should consider the balance of benefits and harms on the basis of evidence relevant to the patient’s medical history, family history, other risk factors and personal values,” the recommendation stated. “… Important risk factors include older age and a first-degree relative with [abdominal aortic aneurysm]; other risk factors include a history of other vascular aneurysms, [CAD], cerebrovascular disease, atherosclerosis, hypercholesterolemia, obesity and hypertension.”
Inconclusive for women smokers
The task force concluded that current evidence is insufficient to assess the balance of benefits and harms of abdominal aortic aneurysm (AAA) screening in women aged 65 to 75 years who have ever smoked. It defined “ever smoking” as smoking at least 100 cigarettes in the past, a clarification based on responses to the draft report issued in January.
The task force recommended against AAA screening in women who have never smoked.
The recommendations apply to asymptomatic adults aged 50 years or older.
The question of AAA screening is an important one because most AAAs are asymptomatic until they rupture, and AAA ruptures are often fatal, the task force wrote.
According to population-based studies, the prevalence of AAA among adults aged 50 years or older is 3.9% to 7.2% in men and 1% to 1.3% in women, the task force wrote. However, recent research indicates the prevalence of AAA is declining in never-smokers but not among ever-smokers.
Current guidelines recommend immediate repair of AAAs 5.5 cm or larger, but the risks of elective surgery may outweigh the benefits of repair for smaller AAAs, the task force wrote. It noted that mortality rates for AAA repair procedures are higher in women than in men: 7% vs. 5% for surgery and 2% vs. 1% for endovascular repair.
Previous research indicated that screening for AAA doubled the rate of AAA-associated surgeries, although most AAAs detected were below the 5.5-cm threshold for immediate repair, according to the task force. “This finding generally results in long-term or lifelong surveillance and is probably associated with some amount of overtreatment, although the magnitude of this burden is difficult to quantify,” the authors wrote.
However, prospective cohort studies have shown that AAA-related mortality within 5 to 12 years is low (between 0% and 2.4%) among men with initially normal results after AAA ultrasonography screening, they wrote.
Further research needed
More research must be done regarding AAA screening in women who smoke and in women and men with a family history of AAA, according to the task force. Other research priorities include validation of risk-scoring tools and exploration of alternative strategies to reduce AAA growth, the authors wrote.
Disclosure: One author reports receiving support from the Agency for Healthcare Research and Quality during the conduct of the study. The other authors report no relevant financial disclosures.
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