Screen Older Men Who've Ever Smoked for Aneurysms: Experts
MONDAY, June 23, 2014 -- Older men who smoke or have smoked 100 cigarettes or more should be screened for an abdominal aortic aneurysm, a panel of U.S. health experts recommends.
The U.S. Preventive Services Task Force noted the new guideline is for men between the ages of 65 and 75 who do not have symptoms of an abdominal aortic aneurysm, but who may be at risk for having one.
An abdominal aortic aneurysm is a weak spot in the main blood vessel taking blood from the heart, which can be fatal when, without warning, it bursts.
"We know there are two big risk factors for abdominal aortic aneurysm: smoking or having ever smoked, and being a man," said task force co-chair Dr. Kirsten Bibbins-Domingo.
Screening involves an ultrasound, a noninvasive procedure that allows doctors to see if there is an aneurysm. If one is found, it can usually be surgically repaired.
For men who are smokers or who have smoked, the benefit of a one-time screening for abdominal aortic aneurysm is clear and substantial, Bibbins-Domingo said. The risk for this type of aneurysm among men who have smoked is about 7 percent, she noted.
"For men who have never smoked, they are still at increased risk for these aneurysms, and there is clear evidence of benefit from screening, but the benefit is low. The recommendation is that they talk with their doctors about screening," Bibbins-Domingo said.
The odds for an older man who has never smoked of having an abdominal aortic aneurysm is about 2 percent, she noted.
Abdominal aortic aneurysms develop as people age, which is why the task force limits its recommendation to older patients.
For women who have smoked, the odds of developing an abdominal aortic aneurysm are less than 1 percent, she said. Therefore, the task force's recommendation is not to screen these women.
For women smokers, Bibbins-Domingo said, there is not enough evidence to recommend for or against screening.
"The advice to men is to be screened. That's particularly true if you are a smoker. If you are not a smoker, it is recommended that you be screened as well," she said.
The recommendation is published June 24 in the Annals of Internal Medicine.
Dr. Gregg Fonarow, a spokesman for the American Heart Association and a professor of cardiology at the University of California, Los Angeles, said, "Abdominal aortic aneurysms when undetected can suddenly rupture resulting in premature death."
Clinical trials have established that screening people at potential risk for abdominal aortic aneurysms reduces the risk and the need for emergency surgery, rupture and death.
"These updated recommendations reflect the current evidence available for screening asymptomatic adults," Fonarow said.
Routine screening is not recommended in adults younger than 65 or in women. "However, clinicians need to make their individual assessments based on patient risk factors and the balance of potential benefits, risks and value," he added.
The American College of Cardiology and the American Heart Association jointly recommend one-time screening for the condition in men aged 65 to 75 who have ever smoked and in men aged 60 or older who have siblings or parents with an abdominal aortic aneurysm. They do not recommend screening for men who have never smoked or for women.
Most people don't know when they have an abdominal aortic aneurysm, because often there are no symptoms. Sometimes an abdominal aortic aneurysm announces itself with severe back, stomach or groin pain. When a rupture occurs, the result can be severe pain and unconsciousness, as blood pumps out of the aorta.
Visit the U.S. National Library of Medicine for more about abdominal aortic aneurysm.
Posted: June 2014
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