The Ideal Annual Health Check-Up - Less is More

Health check-ups have become a huge business, based on the fearmongering premise that early diagnosis of disease saves lives. While this is true of a few conditions, it is not true for most cancers and diseases that are often picked up incidentally and which would have likely caused no problems, if left alone as we have seen with prostate cancer screening.

For example, gallstones are a big circus. If you decide to do an ultrasound of the abdomen as part of a yearly health check-up and it picks up gallstones, you will feel pressurized by the system to get the gallbladder removed, which despite all the advances in surgery, is not without some morbidity and mortality and often just completely unnecessary.

While health check-ups are useful, it is a good idea to follow the adage, “less is more”. One argument that many patients and doctors advance is that the more we know about our body and the more information we have about what is going on inside, the better it is. This is why whole body MRIs and sometimes even PET/CT scans are done to give you assurance that there is nothing wrong inside.

In practice however, since each individual is a unique human being with variations in anatomy and anatomic variants (conditions that look like disease but are not), more often than not these tests throw up “disease-like” features that need further tests and then even more tests, perhaps including biopsies that do nothing but take you down a rabbit-hole with all its attendant issues such as costs, anguish and perhaps even bodily harm from all those tests and examinations. This is further exacerbated by the fact that even if your doctor knows that these variants or incidental findings are irrelevant, given the current medicolegal scenario, even in India, where it is not difficult for patients to sue doctors, most doctors will practice defensive medicine and continue to test until they are 120% sure there is no disease. I wrote about this in my piece on serum PSA for prostate cancer screening, but we see this day in and day out with multiple conditions throughout the body.

An ideal health check-up would involve the following

Physical Examination

Actual physical examination for lumps and bumps

Dental, vision and hearing examination (annual or biennial)

Blood pressure measurement (this can be done quarterly by you at home)

Blood Tests

Hemoglobin and complete blood count (CBC)

Lipid levels

Fasting blood sugar and HbA1c

Serum PSA for prostate cancer for men (55-69 years) - once in 2 years - and completely optional

Other Tests

ECG after the age of 65 years

Mammogram for women (40-75 years)

HPV DNA for women (30-65 years) - once in 5 years

Low dose CT for lung cancer, if heavy smoker

Ultrasound of the abdomen for abdominal aortic aneurysm, above the age of 65, if you are a smoker or have smoked

Bone density test by DXA in women above the age of 60

Use the laboratory and other information to do your own QRISK3 assessment for cardiovascular risk.

That’s it. DO NOT do any other tests for cancer screening including blood tests or genetic tests - none of them have been validated and they all just cause more harm than good. Similarly, genetic testing for risk estimation for cardiovascular disease, dementia, etc are all pretty much useless, because there is not much you can do with this information, and yet it can cause undue stress and worry. DO NOT get carried away by those advertisements that offer 100 blood tests for a discounted price - you don’t need any of those tests as part of an annual health check-up and knowing your liver and renal and thyroid function, if you are otherwise normal is pointless and useless.

The only time you need to do more, is if you already have a particular disease or are genetically prone or have a family history of disease that warrants additional screening - a geneticist or oncologist or physician will create a plan for this.  If you are already suffering from a specific disease, then you may need additional tests on a regular basis, depending on that disease, e.g. regular fasting blood sugar or HbA1c if you are diabetic, etc.