Controversies in vascular screening - Art versus science

Whether or not to screen asymptomatic members of the general public for various forms of vascular disease is a controversial issue with huge medical, social, and financial ramifications. This article reviews several criteria for determining the appropriateness cf vascular screening, including: (1) is it possible to detect occult vascular disease 'early'?; (2) what should we screen for, and how should me do it?; (3) who should be screened?; and (4) what standards for vascular screening should be set? While some of these controversies may ultimately be resolvable using an evidence-based approach, it is apparent that there are issues which will not be amenable to strict scientific analysis. Individualized approaches to screening will therefore remain the rule for the foreseeable future.