Routine AAA Screening Urged for Women

By Timothy F. KIRN

The absence of a recommendation to screen women for abdominal aortic aneurysm in the recent U.S. Preventive Services Task Force statement could mean that as many as one-quarter to one-third of individuals will be missed, according to a new study.

The study reviewed the results of a large public screening program conducted by the American Vascular Association (AVA) in 40 states between 2002 and 2004. Among the 7,841 persons screened, of whom 60% were women, 183 abdominal aortic aneurysms (AAAs) were found. An AAA was detected in 143 (5%) of the men and 40 (1%) of the women, said the study's principal investigator, William R. Flinn, M.D., vice-chair of the AVA, and head of vascular surgery at the University of Maryland Medical Center.

Thus, 22% of the AAAs detected were in women. Moreover, 40% of the women with an AAA were found to be hypertensive, a risk factor for rupture, according to Dr. Flinn, who first reported the information at the 2005 Midwestern Vascular Surgery Society annual meeting in Chicago.

The U.S. Preventive Services Task Force statement, issued this year, recommends one-time ultrasound screening for men aged 65-75 who have ever smoked. The statement does not recommend routine screening for men who have never smoked, or for women.

The rationale for not recommending screening for women is that there is fair evidence that the harms would outweigh the benefits, according to the statement.

The prevalence of large AAAs in women is low, and the majority of deaths from ruptured AAAs in women occur in those older than 80 years. At the same time, the operative mortality for surgical repair is between 2% and 6%, and about a third of surgeries have complications.

One large screening study with control subjects found no difference in mortality with screening among women followed for 10 years, the statement notes.

That data could be outdated, however, according to Dr. Flinn. In his study, the ratio of men to women with an AAA was 4:1 for those over 80 years of age, but 3:1 for those in their 70s, and about 2:1 for those in their 60s. This may reflect the fact that women have now taken on many of the risk factors of men and that the prevalence is changing, Dr. Flinn reported.

In an interview, Dr. Flinn said the evidence of a rising prevalence is rather preliminary and not based on large numbers of women. Therefore, it is less-than-definitive information.