The U.S. Preventive Services Task Force is recommending that men between the ages of 65 and 75 years who are current or former smokers undergo a one-time ultrasound screening for abdominal aortic aneurysm.
The recommendation is based on new evidence that has shown that screening and surgery to repair large abdominal aortic aneurysms (AAAs) are effective at reducing the number of deaths in men as a result of this condition. Between 59% and 83% of patients with a ruptured AAA die before reaching the hospital and undergoing surgery, according to estimates.
“This is an important recommendation, because evidence now exists that screening high-risk men for abdominal aortic aneurysms can reduce deaths from aneurysm,” task force chair Ned Calonge, M.D., said in a statement. Men 65 years and older who are currently smokers or who have been regular smokers are at the highest risk for AAA, according to the task force.
The recommendation is grade B, meaning that the task force found at least fair evidence that screening improves important health outcomes and concluded that benefits outweigh harms (Ann. Intern. Med. 2005;142:198-202).
In 1996, the task force last reviewed the topic and concluded that there was insufficient evidence to screen for such aneurysms.
The task force noted that there is evidence that surgery to repair the aorta in people with an aortic diameter of at least 5.5 cm reduces the number of deaths caused by AAA, which is the cause of approximately 9,000 deaths each year in this country. However, the number may be underestimated because most people with AAA die before reaching a hospital and their deaths may be attributed to other causes.
The condition is less likely to occur in people who have never smoked, and the U.S. Preventive Services Task Force found that screening these patients for AAA would have little net benefit. Therefore the task force made no recommendation either for or against routine screening for this condition in men between 65 and 75 years who have never smoked (grade C).
The U.S. Preventive Services Task Force is also recommending that women should not be screened for AAA (grade D).
Published research indicates that women are at low risk for such aneurysms, though few studies have been conducted in women. Death from an aneurysm is rare in women, and most of these deaths occur in women older than 80 years.
The U.S. Preventive Services Task Force found no evidence of benefit from routine screening for AAA in all women and also concluded that potential harms—mortality and complications of surgery—outweighed the potential benefits of screening and subsequent surgery.
The Agency for Healthcare Research and Quality is sponsoring an evidence review comparing endovascular repair of AAA that is expected to be published next year. The technique has been shown to have short-term benefits, compared with open surgical repair. The long-term effectiveness and complications of endovascular repair of AAA are not known.