The US Preventive Services Task Force (USPSTF) has released a new recommendation statement on screening for abdominal aortic aneurysms (AAA) in asymptomatic adults 50 years or older. The recommendation, published in the Journal of the American Medical Association (JAMA), incorporates new evidence and replaces the 2014 USPSTF statement. In the new recommendation, family history of AAA has been added as a risk factor for screening decisions in women, but otherwise the recommendation is consistent with the 2014 USPSTF statement.
As of 10 December 2019, the USPSTF suggests one-time screening in men aged 65–75 years who have ever smoked, selective screening for AAA in men aged 65–75 years who have never smoked, against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA, and concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women aged 65–75 years who have ever smoked or have a family history of AAA.
In a more detailed summary of the recommendation that clinicians selectively offer screening for AAA in men aged 65–75 who have never smoked, rather than routinely screening all men in this group, the USPSFT elaborate: “In determining whether this service is appropriate in individual cases, 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, or other risk factors, and personal values”.
The statement details that the prevalence of AAA has declined over the past two decades among screened men aged 65 years or older in various countries such as the United Kingdom, New Zealand, Sweden, and Denmark, with the reduction in prevalence being attributed to the decrease in the incidence of smoking over time. In the USA, however, current prevalence of AAA is unclear because of the low uptake of screening.
To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the effectiveness of one-time and repeated screening for AAA, the associated harms of screening, and the benefits and harms of available treatments for small AAAs (3–5.4cm in diameter) identified through screening.
Based on a review of the evidence, the USPSTF concludes with “moderate certainty” that screening for AAA in men aged 65–75 years who have ever smoked is of “moderate net benefit” and that screening for AAA in men aged 65–75 years who have never smoked is of “small net benefit”. They also conclude that the evidence is “insufficient” to determine the net benefit of screening for AAA in women aged 65–75 years who have ever smoked or who have a family history of AAA, and finally that they conclude with “moderate certainty” that the harms of screening for AAA in women aged 65–75 years who have never smoked and have no family history of AAA outweigh the benefits.