Evidence Lacking for Recommending AAA Screening for Women

June 24, 2014

Ultrasound screening recommendations for abdominal aortic aneurysms remain mostly the same and still only definitively recommend screening for men.

The U.S. Preventative Services Task Force (USPSTF) has updated its 2005 screening guidelines for abdominal aortic aneurysms (AAA) among asymptomatic adults, according to an article published in the Annals of Internal Medicine.

In reviewing the recommendations for men, researchers looked at four large randomized controlled trials evaluating one-time screening and reduced mortality from AAA in men. Results showed that there was a benefit from three to 15 years after screening, as well as a reduction in AAA rupture and emergency surgery. Therefore, the task force continues to recommend one-time ultrasound screening for men aged 65 to 75 who have ever smoked. Recommendations also include selectively offering AAA screening in men aged 65 to 75 who have never smoked, keeping in mind the patients’ medical and family history, risk factors and personal values.

The USPSTF also continues to recommend against regular AAA screening for women who have never smoked, but they are not so sure about women who do have a history of smoking or who currently smoke. Researchers noted that there has been only one randomized control trial (RCT) that included women for screening for AAA. The results showed that there was no difference among women who had AAA rupture, AAA-specific mortality or all-cause mortality. But, the task force pointed out that “the trial was ultimately underpowered to detect differences in health outcomes by sex; as such, the results do not rule out the possibility of a small benefit of screening in this population.”

As a result, the task force felt that there was not enough evidence to conclude that AAA screening should or should not be performed among women who have ever smoked. The task force maintained its D recommendation for women who never smoked, but changed the recommendation for women who have smoked to an I statement, which “concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined,” according to the USPSTF grades.