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Oct 22, 2012

An Unmeasured Harm of Screening

Author Affiliations

Author Affiliations: Department of Medicine, Northwestern University, Chicago, Illinois. Dr Prasad is now with the National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

Arch Intern Med. 2012;172(19):1442-1443. doi:10.1001/2013.jamainternmed.682

The US Preventive Services Task Force1 recommends a 1-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 years who have ever smoked, on the basis of trials showing a reduction in death from AAA but not improvement in overall mortality.1,2

Mr R was such a patient. A 65-year-old, obese former smoker with a history of myocardial infarction and persistent risk factors (hypertension and hyperlipidemia), Mr R had undergone a total knee arthroplasty at age 60 years because of osteoarthritis. Thereafter, he was able to walk a mile at a stretch but could go no further because of persistent joint pain. A veteran of Vietnam, Mr R underwent screening ultrasonography for AAA when the clinical reminder system of the US Department of Veterans Affairs prompted his primary care physician. He was found to have an aneurysm of 6.0 × 4.7 cm on the ultrasonogram. Mr R's primary care physician discussed the case with a vascular surgeon, who recommended a follow-up computed tomography (CT) scan with contrast and prompt follow-up in the vascular clinic.