Male, elderly & 100+ cigarette history? That’s enough for USPSTF

Updated recommendations from the U.S. Preventive Services Task Force (USPSTF) call for screening male smokers ages 65 and older for abdominal aortic aneurysm.

Published June 24 in Annals of Internal Medicine, the statement from the USPSTF recommends one-time screening for male patients who have ever smoked and are between the ages of 65 and 75. Michael L. Lefevre, MD, MSPH, stated on behalf of the USPSTF that male patients who smoked are more at risk for abdominal aortic aneurysm than other patients and would benefit more from ultrasonography. They defined “ever smoker” as a person who smoked 100 cigarettes or more in his or her lifetime.

They gave this recommendation a grade B, suggesting that they believe there is a high certainty of a moderate to substantial net benefit to the patient and that clinicians should offer this service.

Male nonsmokers, age 65 to 75, were given a grade C, recommending a selective offering based on clinician’s judgment of risks, as the likelihood of their benefiting from screening was low.

On female smokers, age 65 to 75, however the statement said current evidence is inconclusive as to the benefit of screening. The risk of abdominal aortic aneurysm in this group was between 0.8 and 2 percent. These patients were given an “I statement,” due to the lack of evidence of benefits.

In female patients in general, the risk for abdominal aortic aneurysm is low (less than 1.5 percent on average). Risks from attempts to repair minor tears were high enough that for women who are nonsmokers, the USPSTF gave a D, recommending against the service.

The prevalence of abdominal aortic aneurysm in men is between 3.9 and 7.2 percent. Smoking increases risks. While largely asymptomatic, a ruptured abdominal aortic aneurysm carries a risk of death as high as 75 to 90 percent. However, many abdominal aortic aneurysms do not rupture and do not require immediate treatment.     

The recommendations, which update a review from 2005, apply to asymptomatic patients who are 50 years old and older.