USPSTF evidence reviews suggest one-time AAA screening could benefit older men

A one-time invitation for abdominal aortic aneurysm (AAA) screening in men 65 or older is associated with decreased AAA rupture and AAA-related mortality rates, according to a review published Jan. 27 in Annals of Internal Medicine. The invitation for screening had little to no effect on all-cause mortality rates.

Ultrasonography, the standard noninvasive screening method for AAA, has a high sensitivity and specificity and can be inexpensively performed. In 2005, the U.S. Preventive Services Task Force (USPSTF) recommended one-time screening for AAA by ultrasonography in men 65 to 75 years old who had ever smoked. At the time, a general recommendation was not made for or against screening for AAA in men 65 to 75 who had never smoked.

Lead author Janelle M. Guirguis-Blake, MD, of Tacoma Family Medicine in Washington, and colleagues conducted a systematic review of evidence about the benefits and harms of ultrasonography screening for AAAs in asymptomatic primary care patients. Guirguis-Blake et al utilized MEDLINE, the Database of Abstracts of Reviews of Effects, and the Cochrane Central Registry of Controlled Trials for relevant studies and randomized, controlled trials published between January 2004 and 2013.

After reviewing 2,723 abstracts, 204 full-text articles, and other relevant studies and trials, the researchers found convincing evidence that screening men 65 and older decreased AAA-related mortality rates by about 50 percent over 13 to 15 years.

Since the 2005 guidelines for screening were released, many have been concerned that certain demographics have been overlooked for AAA screening, including women, younger nonsmoking males, and those with family history. The review’s authors wrote, “A different high-risk approach using a validated multifactorial risk calculator that considers family history, cardiovascular disease, race, body mass index, and other factors could possibly identify a group with increased prevalence of AAA and thereby could more effectively identify AAAs and be equally efficient.”