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Internal Medicine

Answer 2
  1. Schedule an abdominal ultrasound. Men who smoke or have smoked are at increased risk for developing abdominal aortic aneurysm (AAA) as compared with men who have never smoked. In a meta-analysis of 4 randomized controlled trials of population-based screening for AAA in men, screening significantly reduced AAA-related mortality in men aged 65 to 80 years (odds ratio, 0.57 [95% confidence interval, 0.45—0.74]).2 The USPSTF currently recommends screening for AAA with abdominal ultrasound in men aged 65 to 75 years with a current or past smoking history. The USPSTF makes no recommendation for or against screening for AAA in men aged 65 to 75 years who have never smoked.2 Conversely, in women, the USPSTF recommends against (“D” rating) screening for AAA.2 A randomized study of women aged 65 to 80 years showed no differences in either AAA-related mortality or all-cause mortality between patients who received screening for AAA as compared with those who did not.3

    2. US Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. Primary care screening for abdominal aortic aneurysm. In: HSTAT: guide to clinical preventive services: recommendations and systematic evidence reviews, guide to community preventive services. 3rd ed. Available at www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat3.section.30111. Accessed 11 Apr 2008.

    3.  Scott RA, Wilson NM, Ashton HA, Kay DN. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study. Br J Surg 1995;82:1066-70.

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