Can You Have AAA Screening After 65?
If you are a man in the UK, you will normally be invited for abdominal aortic aneurysm (AAA) screening at around age 65.
But what if you don't want to have the scan then?
Could you wait until you are 70 or 75?
The first question has a straightforward answer.
Yes. Across the UK, men over 65 who have not previously been screened can contact their local AAA screening programme and request screening.
So an invitation at 65 does not necessarily mean that this is your only opportunity to have the scan.
Arrangements can change, so check with your local screening programme if you are considering doing this.
The more difficult question is whether there is any advantage or disadvantage in waiting.
How much benefit does AAA screening provide?
The main evidence that AAA screening can prevent deaths comes from randomised trials conducted many years ago.
The largest UK trial, MASS, studied 67,770 men aged 65–74.
Over about 13 years, roughly 11 in every 1,000 men in the group not invited for screening died from AAA, compared with about 7 in every 1,000 men in the group invited for screening.
So the difference was around 4–5 fewer AAA deaths per 1,000 men invited for screening.
But AAA deaths were only a small proportion of all deaths. In MASS, about 417 in every 1,000 men in the control group died from any cause over the 13 years, compared with about 409 in every 1,000 in the group invited for screening.
MASS therefore found a small reduction in deaths from all causes. However, across the screening trials as a whole, a reduction in all-cause mortality has not been demonstrated.
Screening also changed what happened before those deaths. There were more planned AAA operations in the screening group and fewer emergency operations.
Screening can have other downsides. It can identify an aneurysm that would never have caused you a problem during your lifetime. Once an aneurysm is found, you may have years of repeat scans and the worry that can come with knowing it is there. Some men will eventually have planned surgery — with its own risks — for an aneurysm that might never have ruptured if it had remained undiscovered.
There is also an important qualification when applying the MASS figures today.
AAA was found in around 50 in every 1,000 men screened in MASS, although MASS included men aged 65–74. In England in 2025–26, where routine screening is centred on men turning 65, it was found in only about 6 in every 1,000 men screened.
AAA is therefore far less common in men being screened today than it was in MASS. The absolute benefit from screening today is consequently expected to be substantially smaller than the benefit seen in the original trial, although its present size has not been established in a new randomised trial.
Would a scan be more likely to find an AAA if you waited?
Yes.
AAA becomes more common as men get older.
A particularly useful Swedish study invited men for screening at age 65 and again at age 70.
AAA was found in about:
15 in every 1,000 men at 65
24 in every 1,000 men at 70
Other studies have found the same general pattern: AAA becomes progressively more common with age.
So if you wait until 70 or 75, the chance that a scan will find an aneurysm is higher than it was at 65.
But that does not mean waiting is necessarily better.
What could be the disadvantage of waiting?
An aneurysm that could have been detected at 65 might grow or rupture before you have the later scan.
That is the potential cost of waiting.
On the other hand, many men will never develop an AAA, and the likelihood varies considerably between individuals.
Smoking is particularly important.
In one contemporary UK population study, 27 of the 28 acute AAA events occurring in men under 75 were in current or former smokers.
That does not tell us that a man who has never smoked should wait. It does show that the risk of AAA before 75 is not evenly distributed between men.
There is another side to earlier detection as well. Finding an aneurysm at 65 rather than 70 could mean additional years of surveillance and of knowing that the aneurysm is there. For some men, earlier detection could prevent a rupture. For others, the aneurysm might never have caused a problem during their lifetime.
Has screening at 65 actually been compared with screening at 70 or 75?
This is the crucial point.
We have not found a randomised trial that compared having your first AAA scan at 65 with waiting until 70 or 75.
The original screening trials compared inviting men for screening with not inviting them. They did not establish which age produces the best balance of benefits and harms.
Researchers have explored alternatives. One UK research group, for example, modelled a strategy of screening male smokers at 65 and all men at 75.
But that was a model, not a randomised trial showing that this strategy produces better outcomes.
So there is a genuine trade-off:
Waiting means having the scan at an age when AAA is more common.
But:
Waiting also leaves more time in which an AAA could develop or cause problems before it is detected.
We do not have a randomised comparison telling us which of those effects produces the better overall outcome.
So can you wait?
Yes, in the sense that NHS screening remains available to previously unscreened men over 65 across the UK.
Whether waiting until 70 or 75 gives you a better or worse balance of benefits and harms is much harder to answer.
We have not found evidence establishing that 65 is better than 70 or 75 for every man.
But nor have we found evidence establishing that waiting is better.
That brings the question back to something more fundamental:
How much are you personally likely to gain from AAA screening at all?
Your age and smoking history are relevant to that question, as are the potential benefits and downsides of finding an aneurysm.