Offer AAA screening to older male smokers

Offer AAA screening to older male smokers
Offer AAA screening to older male smokers

The U.S. Preventive Services Task Force (USPSTF) is recommending routine one-time screening for abdominal aortic aneurysm (AAA) in men aged 65 to 75 years who have ever smoked in updated draft guidelines published online in Annals of Internal Medicine.

Clinicians should offer selective screening on a case-by-case basis for men in the same age group who have ever smoked, the draft guidelines state. If finalized, the recommendations will replace previous USPSTF guidance on the topic from 2005.

The older guidelines recommended against AAA screening in all women, whereas the new draft guidelines differentiate between smokers and nonsmokers. The task force has found insufficient evidence to recommend for or against screening women aged 65 to 75 years who have ever smoked, but sufficient evidence to recommend against screening nonsmoking women in the same age group.

The updated USPSTF draft guidelines are similar to recommendations from the American College of Cardiology and American Heart Association, which state one-time screening should be performed for men aged 60 years and older who have a sibling or parent with AAA and those aged 65 to 75 who have ever smoked. The ACC/AHA guidelines do not recommend screening women or nonsmoking men.

The less stringent recommendations for women are based on evidence that suggests men are at much greater risk for AAA than women. Studies put AAA prevalence at 3.9% to 7.2% in men vs. 1% to 1.3% in women aged 50 and older, with the highest rates observed in people who have ever smoked.

The new USPSTF draft recommendations are based on data from four randomized trials that showed a one-time invitation to screen significantly reduced rates of AAA rupture, emergent surgery and AAA-related deaths in men 65 years or older. A mortality benefit was observed after three years and lasted out to 15 years.

The task force also identified potential downsides to screening. These included increasing rates of elective AAA surgery; the cost of surgery, which can range from $37,000 to $43,000; the potential for surgery to replace other potential more beneficial preventive efforts; and the potential need for long-term surveillance.

The USPSTF draft recommendations are open for public comment until February 24, 2014.

References

  1. Guirguis-Blake JM et al. Ann Intern Med. 2014; doi:10.7326/M13-1844.
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