Abdominal Aortic Aneurysm Prevalence in Smoking-Related Cancers and Sex Differences

Abstract

INTRODUCTION: Smoking is associated with abdominal aortic aneurysms (AAA) and lung cancer, suggesting that simultaneous screening may be beneficial. Smoking is associated with many non-lung cancers, and a recent study reported higher AAA prevalence with any cancer (not site specific). The purpose of this study is to identify AAA prevalence for each site-specific smoking-related cancer. METHODS: A retrospective cohort study was conducted using electronic records from 58 U.S. healthcare organizations in 2014-2022. Patients were diagnosed with smoking-related cancers and nicotine abuse. Pearson chi-squared tests were used to compare AAA prevalence for each smoking-related cancer using propensity-matched cohorts. Sex differences were calculated. RESULTS: Compared to smokers with cancer who did not have AAA (n = 308,872), those who had an AAA diagnosis (n = 11,728) were more likely to be older (74 vs 65 years, p < 0.0001), male (82% vs 63%, p < 0.0001), and have coronary artery disease (53% vs 20%, p < 0.0001). Most cancer types were associated with higher AAA prevalence, notably bladder (OR 1.8, p < 0.0001), renal (OR 1.78, p < 0.0001), and lung (OR 1.78, p < 0.0001) cancers (Table 1). Female smokers with cancer had a lower AAA prevalence than males for every cancer type, including lung (OR 0.57, p < 0.0001), colorectal (OR 0.59, p < 0.0001), and blood (OR 0.6, p < 0.0001) cancers. Table 1. - Abdominal Aortic Aneurysm Prevalence Among Smokers With and Without Cancer Variable Smokers with cancer group Smokers without cancer group Odds ratio (95% CI) p Value Bladder N: 39,874; AAA: 4.83% N: 40,499; AAA: 2.74% 1.80 (1.67-1.94) < 0.0001 Blood N: 101,648; AAA: 2.56% N: 101,554; AAA: 1.96% 1.31 (1.24-1.39) < 0.0001 Cervical N: 13,363; AAA: 1.09% N: 13,384; AAA: 0.85% 1.27 (1.01-1.65) 0.045 Colorectal N: 12,540; AAA: 3.18% N: 12,555; AAA: 1.98% 1.62 (1.38-1.91) < 0.0001 Gastric N: 6,728; AAA: 2.72% N: 6,747; AAA: 2.00% 1.37 (1.09-1.72) 0.006 Larynx N: 15,832; AAA: 2.81% N: 15,749; AAA: 2.20% 1.29 (1.11-1.47) 0.0005 Lung N: 117,151; AAA: 3.61% N: 118,569; AAA: 2.05% 1.78 (1.70-1.88) < 0.0001 Pancreatic N: 20,452; AAA: 2.62% N: 20,419; AAA: 1.97% 1.33 (1.17-1.52) < 0.0001 Renal N: 29,818; AAA: 3.56% N: 30,171; AAA: 2.04% 1.78 (1.61-1.96) < 0.0001 CONCLUSION: Several cancer types have a high AAA prevalence. Females are nearly half as likely to have a diagnosis of AAA as males, given the same smoking-related cancer diagnosis and nicotine use. Further understanding of these associations may identify clinical benefits of combined screening for AAA and smoking-related cancers.