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December 10, 2019

Updated US Preventive Services Task Force Recommendations for Abdominal Aortic Aneurysm—Are We Really Up To Date?

Author Affiliations
  • 1Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
JAMA Surg. Published online December 10, 2019. doi:10.1001/jamasurg.2019.5234

The US Preventive Services Task Force (USPSTF) recently updated their recommendations1 and evidence report and systematic review2 regarding screening for abdominal aortic aneurysm (AAA), which will be published in JAMA on December 10, 2019. They are largely unchanged from the prior recommendations published in 2014. The USPSTF again recommends that men aged 65 to 75 who have ever smoked should undergo a 1-time ultrasonographic screening for AAA (B recommendation). For men aged 65 to 75 years who have never smoked, the USPSTF does not recommend routine screening. Instead, they recommend selectively screening men in this age group, taking into account the medical history, family history, other risk factors, and personal values. They assign a C recommendation to this group. They recommend against screening women who have never smoked with no family history and assign a D recommendation (not recommended). For women aged 65 to 75 years who have ever smoked or have a family history of AAA, they state that the current evidence is insufficient to assess the balance of benefits and harms (I statement; insufficient evidence to make a recommendation). The recommendation and letter grade is important, as the Patient Protection and Affordable Care Act mandates that private insurers cover services that receive a grade of A or B by the USPSTF. Thus, the US Centers for Medicare & Medicaid Services (CMS) and private insurance must cover screening for men aged 65 to 75 years who ever smoked. However, although the USPSTF does recommend selected screening for men aged 65 to 75 years without a smoking history but with other risk factors for AAA, this may not be covered by private insurance owing to the C recommendation. The Centers for Medicare & Medicaid Services cannot reimburse interventions with a D recommendation but can selectively do so for C recommendations and I statements. Although theoretically possible, very few C recommendations or I statements interventions end up reimbursed under CMS.

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    1 Comment for this article
    Why we Have the USPSTF
    Michael Plunkett, MD. MBA | Amita Health, Practice/Teaching at Resurrection Medical Center, Chicago
    This is a pretty good editorial but it is written by an “interested party.“ That is why we have the USPSTF.

    I think the vascular surgery society should sponsor a “modern study” of screening and outcomes. A five year study on a modern American population shouldn’t be too difficult to put together. There are a lot of stakeholders who would be interested. I would certainly volunteer to be in the study.