At what age should a man with a 40-pack year history of tobacco abuse be screened for abdominal aortic aneurysm?

Men who have a history of significant tobacco use, defined as a 100-pack year history or more, are at an increased risk for abdominal aortic aneurysm (AAA). Current guidelines recommend that men aged 65 years or older who have ever smoked should undergo screening for AAA using abdominal ultrasound. The recommendation for screening at age 65 is based on the understanding that this age group is at the highest risk for developing an aneurysm, and early detection can lead to timely intervention, reducing the risk of rupture and related mortality.

In this scenario, a man with a 40-pack year history of smoking falls into a category where screening at or after the age of 65 is generally recommended, particularly given the increased risk associated with tobacco use. Therefore, initiating screening at age 65 is justified to ensure any potential AAAs are identified early, allowing for effective management.

Guidelines prioritize this age because the prevalence of AAA significantly increases with age, and screening at an earlier age, such as 60, may not capture enough at-risk individuals, especially in those with a lesser pack year history. Hence, the decision to recommend screening starts firmly at 65, aligning with the evidence that highlights this age group as particularly vulnerable.