e

One-time ultrasound can protect older male smokers

The U.S. Preventive Services Task Force changes its 1996 recommendation and backs a widespread screening of the abdominal artery for older men who have been smokers.

By PATRICK WALTERS
The Associated Press

PHILADELPHIA , Feb. 1 -- Men ages 65 to 75 who have been smokers should get a one-time ultrasound to reduce their chances of dying from a ruptured artery, an influential federal health task force recommends.

The findings by the U.S. Preventive Services Task Force represent a shift from its last recommendation, in 1996, on screening for abdominal aortic aneurysms, a ballooning of the body's main artery in the abdomen. At that time, the group didn't find enough evidence to take a stand on widespread screening.

Studies published between 1998 and 2003, however, have shown convincing evidence that the screenings could significantly help reduce the risk of death in the millions of men between 65 and 75 who have smoked.

The recommendations, published Tuesday in the Annals of Internal Medicine, are based on a study of four randomized, controlled trials involving more than 120,000 men ages 65 and older in Australia, Denmark and the United Kingdom. The findings showed a 43 percent reduction in the number of fatal ruptured aortas in those who were screened.

"This body of evidence is a very convincing body of evidence," said Dr. Diana Petitti, vice chair of the task force, an independent panel of medical experts that advises the federal Agency for Healthcare Research and Quality. "This was not a difficult call for the task force."

The major risk factors for abdominal aortic aneurysms are age, history of smoking and gender.

Abdominal aortic aneurysms, found in 4 percent to 8 percent of older men and 0.5 percent to 1.5 percent of women, occur when the aorta expands to 3 centimeters or greater. Once an aneurysm ruptures, there is very little doctors can do.

The aorta, the body's main artery connects the heart's left ventricle with all the main arteries in the body. Aortic aneurysms account for about 15,000 deaths annually in the United States; of those, 9,000 are related to aortic aneurysms in the abdomen and the rest occur in the chest.

Since about 70 percent of men aged 65 to 75 have smoked at least 100 cigarettes in their lifetime, Petitti said, the recommendation likely affects between 6 million and 7 million people.

While treatment of some aneurysms can be risky, Petitti suggested patients who need surgery carefully select a doctor and hospital. "People should shop around for the right surgeon," she said.

Investigators in the study found no risk in the ultrasound screening, other than normal psychological stress.

Aneurysms over 5.5 centimeters have the greatest risk of rupture, while concern is typically raised at 4 centimeters, said Dr. Craig Fleming, a clinical investigator at the Kaiser Center for Health Research, in Portland, Ore., who was the lead investigator in the study.

"It is a very significant indication that this is a benefit," Fleming said. "There is a pretty definite benefit for screening for men in this age group."

Story produced by
Jimmy Kunkel