AAA Screening for Women

Routine screening for abdominal aortic aneurysm (AAA) is not recommended for women who have never smoked, as the harms outweigh the benefits. 1

Screening Recommendations by Risk Category

Do not screen these women for AAA (Grade D recommendation). 1, 2
AAA is extremely rare in women who have never smoked, with prevalence rates as low as 0.43% at age 65 and 1.15% at age 75. 3
The U.S. Preventive Services Task Force determined these women are unlikely to benefit from routine screening. 1
The harms of screening (increased surgeries, higher surgical mortality in women, psychological distress) outweigh any potential benefits. 1

The evidence is insufficient to make a recommendation for or against screening in this population (I Statement). 1, 2
AAA remains uncommon in older women who smoke or have ever smoked. 1
The quality of evidence showing that screening reduces AAA rupture and death is substantially weaker in women than in men. 1
In clinical practice, consider selective screening only for women with multiple high-risk features: age ≥70 years, current smoking, and cardiovascular disease, where prevalence may reach 6.4%. 4

The evidence is insufficient to assess benefits and harms of screening in women with a first-degree family history of AAA. 2
The European Society of Cardiology recommends screening for first-degree relatives of AAA patients aged ≥50 years, though this is based on limited evidence in women. 5

Opportunistic screening may be considered in women aged ≥75 years who are current smokers, hypertensive, or both during transthoracic echocardiography. 5
The majority of AAA rupture deaths in women occur after age 80, but competing health risks at this age minimize any screening benefit. 1

AAA prevalence is 6 times lower in women (1.3%) compared to men (7.6%). 6
Women have a higher surgical mortality risk for AAA repair than men. 1
Screening leads to approximately twice as many surgeries within 3-5 years, exposing women to disproportionate harm. 1
A randomized controlled trial of 9,342 women found no difference in rupture incidence between screened and control groups over 5-10 years. 6

A targeted screening study (FAST) of high-risk women aged 65-74 found only 0.29% prevalence of AAA. 7
Current smokers had the highest prevalence (0.83%) but lowest attendance (75.2%). 7
Cost-effectiveness analysis showed an incremental cost-effectiveness ratio of £31,000 per QALY gained, above the £20,000 threshold. 3

Do not extrapolate male screening guidelines to women—the epidemiology, surgical risks, and evidence quality are fundamentally different. 1
Do not rely on abdominal palpation for AAA detection in any population; it has poor accuracy and is not an adequate screening test. 1
Recognize that women with AAAs present later and at larger diameters, but this does not justify population screening given the low prevalence. 7
Be aware that screening causes psychological harm and leads to increased surgical interventions without proven mortality benefit in women. 1

Use ultrasonography for AAA screening, which has 95% sensitivity and nearly 100% specificity when performed with adequate quality assurance. 1, 5
One-time screening is sufficient; there is negligible benefit in rescreening those with normal aortic diameter. 1
For detected AAAs <5.5 cm, monitor with periodic ultrasound; surgical intervention is generally recommended for aneurysms ≥5.5 cm or those growing rapidly. 5