Targeted screening for abdominal aortic aneurysm in high-risk women with a smoking history

OBJECTIVE: General population-based screening of women for AAA is not recommended. A selective screening approach, targeting high-risk women with a history of smoking, may detect most AAAs and be effective. The aim of this population-based cross-sectional study was to evaluate a pragmatic screening strategy selectively targeting women with a history of smoking. METHODS: Between 2018 and 2022, all 70 year-old women in a defined catchment area, the county of Dalarna in central Sweden, were invited by letter to a one-time ultrasound examination of the aorta. The letter of invitation encouraged women with a smoking history of 20 years or more to attend. No women were excluded. The prevalence of AAA (≥30 mm), sub-AAA (25-29 mm), self-reported comorbidity, and smoking habits were recorded. The results were compared with the outcome from a previous general population-based screening program study of 70-year-old women conducted in the neighboring counties of Dalarna and Uppsala in central Sweden. RESULTS: A total of 9061 women were invited to selective screening; 42.6% (95% confidence interval CI, 41.5%-43.6%) attended after the invitation to the selective strategy vs 74.2% (95% CI, 73.2%-75.2%) in the previous general screening study (P < .001). In the selective screening cohort, 71% reported a history of smoking vs 44% in the general screening cohort (P < .001). The prevalence of screening-detected AAA was 0.8% (95% CI, 0.6%-1.1%) in the selective screening cohort vs 0.4% (95% CI, 0.2%-0.6%) in the general screening cohort (P < .001) and the corresponding prevalence of subaneurysm was 1.1% (95% CI, 0.8%-1.5%) vs 0.6% (95% CI, 0.4%-0.8%; P = .0039). Screening-detected AAAs in the total population (attenders and nonattenders) were similar between strategies: 0.3% (95% CI, 0.2%-0.5%) for targeted screening vs 0.2% (95% CI 0.2%-0.4%) for general screening (P = .23). CONCLUSIONS: Targeted AAA screening of high-risk women with a long-term smoking history doubles prevalence (0.8%) compared with general screening, halves the number of women needing screening, and maintains the detection rate. Further studies should assess the clinical impact and cost effectiveness of this approach.