Will the U.S. Preventive Services Task Force (USPSTF) change its recommendations for abdominal aortic aneurysm (AAA) screening? It's too early to tell, but the task force published a draft research plan on August 10 to share its vision for how it will reassess the benefits and harms of ultrasound screening.
In its 2014 recommendations, the USPSTF retained its previous B-grade recommendation for one-time ultrasound screening for AAA in men ages 65 to 75 with a history of smoking. The USPSTF gave a C grade to men of this age group who have never smoked, reflecting its recommendation for selective screening. The task force also recommended against screening for women who have never smoked, noting that evidence was insufficient to assess the balance of benefits and harms of ultrasound screening for women ages 65 to 75 who have ever smoked.
With the new announcement, the USPSTF is opening the question up again. The task force is proposing an analytic framework for the draft research plan that seeks to address five questions:
- What are the effects of one-time screening for AAA on health outcomes in an asymptomatic population age 50 or older?
- Do the effects of one-time screening for AAA vary among subpopulations (i.e., by sex, smoking status, age, family history, or race/ethnicity)?
- What are the effects of rescreening for AAA on health outcomes or AAA incidence in a previously screened, asymptomatic population without AAA on initial screening?
- Do the effects of rescreening for AAA vary among subpopulations (i.e., by sex, smoking status, age, family history, or race/ethnicity)?
- Do the effects of rescreening for AAA vary by the time interval between screenings?
- What are the harms of one-time and repeated screening for AAA?
- What are the effects of treatment (pharmacotherapy or surgery) on treatment-relevant, intermediate health outcomes in an asymptomatic, screen-detected population with small AAAs (i.e., aortic diameter of 3.0 cm to 5.4 cm)?
- Do the effects of treatment vary among subpopulations (i.e., by sex, smoking status, age, family history, or race/ethnicity)?
- What are the harms of treatment in an asymptomatic, screen-detected population with small AAAs (i.e., aortic diameter of 3.0 to 5.4 cm)?
The task force also proposed three contextual questions that will not be systematically reviewed and aren't included in the analytic framework:
- Are there externally validated risk models for screening for AAA?
- Does the epidemiology or overall effectiveness of treatment of AAA differ by age, sex, smoking status, or family history?
- Does screening yield differ based on screening strategy (e.g., high-risk versus low-risk populations)?
Once finalized, the research plan will guide a systematic review by researchers at an evidence-based practice center, according to the USPSTF.
The full draft research plan can be found on the task force's website. Comments will be accepted until September 6 at 8:00 p.m. Eastern time.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
