Do I Need AAA Screening If I’ve Never Smoked?
If you've never smoked, your risk of having an abdominal aortic aneurysm (AAA) is substantially lower than that of someone who smokes or has smoked.
AAA is now found in about 6–7 of every 1,000 men screened in England. Finding an AAA does not mean that it will rupture: most aneurysms found through screening are small and are monitored rather than treated immediately.
Smoking makes a considerable difference to who those men are. Among men with an AAA detected through NHS screening who were subsequently assessed by a specialist nurse between 2013 and 2023, about 32% were current smokers, 58% were former smokers and 10% had never smoked.
Put more simply, about nine out of every ten had smoked at some point, while about one in ten had never smoked.
If that pattern still holds, then, very roughly, of the 6–7 men in every 1,000 whose screening finds an AAA, fewer than one would be expected to be a man who had never smoked.
A large review of 23 studies found a similar pattern. People who had never smoked had about one-fifth the risk of AAA of current smokers, and about half the risk of former smokers.
The longer someone had stopped smoking, the lower their risk became. After about 25 years without smoking, the risk in former smokers approached that of people who had never smoked.
Does never smoking mean no risk?
No. People who have never smoked can still develop an AAA.
AAA becomes more common with age, and other factors including high blood pressure and having a close relative who has had an AAA are also associated with increased risk.
But smoking is particularly strongly associated with AAA. If you've never smoked, one of the most important risk factors is absent.
So why have I been invited?
Because the NHS screening programme doesn't use smoking history to decide who is invited. Across the UK, men are routinely invited for AAA screening at 65 whether they have smoked or not.
The UK's approach is unusual. Sweden also routinely invites men for AAA screening at around 65, but many European countries do not operate a comparable national invitation programme. Germany, for example, gives men from 65 an entitlement to a one-off scan but does not operate the same invitation model.
So receiving an invitation doesn't mean that your individual risk has been assessed and found to be high. It means that the UK has chosen to routinely invite men for AAA screening at 65.
So do I need AAA screening if I’ve never smoked?
The evidence can tell you that your risk of AAA is substantially lower if you've never smoked. It cannot, by itself, tell you whether screening is worthwhile for you.
That's a different question, because it depends not only on your chance of having an AAA, but also on the potential benefits and disadvantages of finding one.