Annals
Established in 1927 by the American College of Physicians

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24 June 2014 Annals of Internal Medicine Tip Sheet

Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.

1. Task Force recommends one-time screening for abdominal aortic aneurysms in older male smokers

Asymptomatic men aged 65 to 75 years who have ever smoked should have a one-time screening with ultrasonography for abdominal aortic aneurysm (AAA), according to a new recommendation statement from the United States Preventive Services Task Force that is being published in Annals of Internal Medicine. Physicians should selectively offer screening for AAA in men aged 65 to 75 who have never smoked based on assessment of the balance of benefits and harms and individual patient risk factors. Risk factors for AAA include advanced age, male sex, smoking, and a family history, with smoking being the most important modifiable risk factor. The Task Force recommends against routine screening for AAA in women who have never smoked and found insufficient evidence to recommend for or against screening women aged 65 to 75 years who have ever smoked. AAA is a weakening in the wall of the abdominal section of the aorta resulting in localized dilation, or ballooning, that is at least three centimeters – or about an inch – wide. A large proportion of AAAs are asymptomatic until a rupture develops, which is generally acute and often fatal. An evidence review showed that screening male smokers for AAA is associated with decreased AAA rupture and AAA-related mortality rates

2. Caution advised before implementing widespread lung cancer screening among Medicare beneficiaries

The case for lung cancer screening with low-dose computed tomography (LDCT) among high-risk older adults is not settled, according to the author of a new commentary being published in Annals of Internal Medicine. Recently, the United States Preventive Services Task Force recommended lung cancer screening with LDCT for high-risk older adults and private insurers are required by the Affordable Care Act to cover the procedure. As such, many were surprised when, after convening to review the evidence, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) gave the procedure a vote of low confidence. MEDCAC cited insufficient evidence to show that the benefits of screening high-risk older adults for lung cancer outweigh the harms. Renda Soylemez Wiener, MD, MPH, a pulmonologist at Boston University School of Medicine, explains the nuance of this conclusion. She cautions that the risks for complications from biopsies and post-operative mortality increase with age, as does the risk for false positive screening results. Risk for death from other causes and the development of co-morbidities also increase with age, diminishing the benefit of potential extended life from screening. Dr. Wiener points to the overzealous implementation of prostate cancer screening as a cautionary tale for those demanding immediate widespread coverage of Medicare beneficiaries. She suggests that the Centers for Medicare and Medicaid Services (CMS) look to the Veterans Health Administration’s (VHA) 8-site demonstration project as an example of LDCT screening done right because the program “includes a plan for careful data collection and evaluation to inform how benefits and harms of LDCT screening are balanced in the real world setting.” Learning from these examples, CMS may want to consider covering LDCT only in facilities like the VHA where programs are certified as comprehensive, patient-centered, and are designed to maximize benefits and minimize harms.