Abdominal Aortic Aneurysm Screening Urged for Women

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 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., head of vascular surgery at the University of Maryland Medical Center.

Therefore, 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 this year's 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, nor does it recommend it 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. 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That data could be outdated, however, according to Dr.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.

What he is certain of, however, is that screening for women is justified. The previous studies might not have found any improvement in mortality with screening because not enough of the women who screened positive did anything about their aneurysms, he proposed. That is not atypical behavior, particularly for women.

He also noted that in his program women account for at least 60% of those who take the time to come in for screening, and that until investigators really started to look more closely, medicine underestimated the impact of coronary artery disease on women.

“I would bet all the money I have that any screening for aneurysm will have a positive impact on mortality,” he said.

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 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., head of vascular surgery at the University of Maryland Medical Center.

Therefore, 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 this year's 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, nor does it recommend it 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. 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.

What he is certain of, however, is that screening for women is justified. The previous studies might not have found any improvement in mortality with screening because not enough of the women who screened positive did anything about their aneurysms, he proposed. That is not atypical behavior, particularly for women.

He also noted that in his program women account for at least 60% of those who take the time to come in for screening, and that until investigators really started to look more closely, medicine underestimated the impact of coronary artery disease on women.

“I would bet all the money I have that any screening for aneurysm will have a positive impact on mortality,” he said.

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 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., head of vascular surgery at the University of Maryland Medical Center.

Therefore, 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 this year's 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, nor does it recommend it 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. 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.

What he is certain of, however, is that screening for women is justified. The previous studies might not have found any improvement in mortality with screening because not enough of the women who screened positive did anything about their aneurysms, he proposed. That is not atypical behavior, particularly for women.

He also noted that in his program women account for at least 60% of those who take the time to come in for screening, and that until investigators really started to look more closely, medicine underestimated the impact of coronary artery disease on women.

“I would bet all the money I have that any screening for aneurysm will have a positive impact on mortality,” he said.