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Screening older men may detect more abdominal aortic aneurysms
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Based on results of a prospective, population-based study, policies should be updated to screen male smokers at age 65 years and all men at age 75 years for abdominal aortic aneurysm, according to researchers.
Some guidelines recommend that all men be screened for abdominal aortic aneurysm (AAA) at age 65 years, but researchers found that in male nonsmokers, most AAA ruptures now occur at when aged 75 years or older. In 2014, the U.S. Preventive Services Task Force recommended that men aged 65 to 75 years who have ever smoked should receive a one-time screening for AAA with ultrasonography, and that screening for men in that age group who have never smoked should be determined on a case-by-case basis.
Dominic P.J. Howard
Dominic P. J. Howard, DPhil, and colleagues conducted a prospective, population-based study of 92,728 individuals in Oxfordshire, United Kingdom, from 2002 to 2014. They analyzed incidence trends and made population projections to determine the effect of AAA screening strategies in the United Kingdom.
Howard, a vascular surgeon at the University of Oxford, and colleagues documented 103 incident acute AAA events during the study period.
Incidence rose with age
The researchers found that in men aged 65 to 74 years, the AAA incidence rate was 55 per 100,000 people per year, but it was higher in men aged 75 to 85 years (112 per 100,000 people per year) and in men aged older than 85 years (298 per 100,000 people per year). They found that 66% of events occurred in men aged 75 years or older.
Among men aged 65 to 74 years, the AAA incidence rate was highest in smokers (274 per 100,000 people per year), and 96.4% of AAA events in that age group occurred in men who had ever smoked, according to the researchers.
When Howard and colleagues extrapolated those rates to the U.K. population, they determined that the current U.K. screening program for all men at age 65 years would prevent 5.6% of deaths related to AAA and approximately 10.7% of incident acute AAA events, based on 315,200 scans per year, 1,426 scans required to prevent one death and 121 scans to save 1 year of life.
Prevention of death
They also determined that if the screening program were changed to screen male smokers at age 65 years and all men at age 75 years, 21.1% of AAA-related deaths would be prevented, based on 247,900 scans per year, 297 scans to prevent one death and 34 scans to save 1 year of life.
They projected that by 2030, 91% of all AAA-related deaths will occur in people aged 75 years or older, 61.6% in people aged 85 years or older, and 28.6% in women.
“The current screening programs in the United Kingdom, United States and Europe are a major step forward in treating [AAA], but these strategies need to be adapted to the changing population that they serve,” Howard said in a press release. “As people age and smoking rates decrease, strategies will need to be modified to remain effective.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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