OBJECTIVE: Population based abdominal aortic aneurysm (AAA) screening in 65 year old men has reduced aneurysm related mortality. Men with AAA still face elevated mortality rates from cardiovascular disease and cancer compared with the population. The primary aim was to evaluate the prevalence of cancer in men with AAA and aneurysm progression rate in patients with cancer. The secondary aim was to compare survival in men diagnosed with AAA, with or without cancer.

METHODS: This was a population based longitudinal study of all men diagnosed through the Stockholm screening programme between 2010 and 2024. Patients were identified through the computerised regional database for AAA screening at diagnosis, and a subsequent per protocol chart analysis was then performed, including imaging protocols in hospital registries. Median follow up time was 7.2 years (interquartile range 3.7, 10.5).

RESULTS: Of 118 908 examined 65 year old men, 1 151 men were diagnosed and included. Any cancer was diagnosed in 283 patients during the study period (24.6%). Patients who remained cancer free during follow up had the smallest aortic diameter at baseline (34 mm: no cancer; 35 mm: cancer before index; 36 mm: cancer after index; p = .050). Lung cancer patients had the largest aneurysm diameter (40 mm). Survival was worse for patients with cancer, particularly amongst active smokers, with 5 year survival rates of 79.2% vs. 94.7% in non-smokers without cancer.

CONCLUSION: This study provides some evidence that cancer and certain cancer treatments may influence the natural history of the aneurysmal disease in patients with AAA. The excessive overall mortality in men with AAA and cancer is alarming, particularly among active smokers, which could support either more aggressive targeted cancer screening for patients diagnosed with AAA, but also considerations of delayed elective AAA treatment for this subgroup.