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Invited Commentary
Oct 22, 2012

Time to Rethink Screening for Abdominal Aortic Aneurysm?Comment on “Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on Abdominal Ultrasonography Use Among Medicare Beneficiaries”

Arch Intern Med. 2012;172(19):1462-1463. doi:10.1001/archinternmed.2012.4280

The 2011 Institute of Medicine report titled “Clinical Practice Guidelines We Can Trust”1 recommends that guidelines be updated at a prespecified time and that new evidence be reviewed regularly to determine the need for earlier updating. New evidence, however, is not the only reason for updating guidelines. Another is to reconceptualize benefits and harms with the advantage of more experience and new understanding. This would seem to be the essence of critical thinking, of avoiding the cognitive “confirmation” bias whereby we simply continue to think the way we have, without serious questioning. An article in this issue of the Archives2 considers screening for abdominal aortic aneurysm (AAA). Both new evidence about benefits and new concepts of harms suggest that it may now be time to rethink AAA screening.

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